The long-term outcome of microvascular decompression for trigeminal neuralgia

Abstract

Objective. Evaluation of the effectiveness of Microvascular Decompression (MVD) for Trigeminal Neuralgia (TGN), with emphasis on patient's perception of outcome, and satisfaction with the procedure.

Materials and Methods. A cohort of 372 MVD operations carried out between 1982 and 2005 were reviewed, contact could be attempted with 319 patients. Questionnaires assessing the patient's perception of outcome returned by 266 patients (71%). statistical analysis of the data was carried out using a cox proportional-hazard regression analysis. Anticipated outcome measures: Time to pain recurrence; predictive value of imaging, operative findings and complications; patients' satisfaction, and outcome of revision MVD.

Results. Complete pain relief (off medication) achieved in 71% of patients at 10 years. Overall 84% of responders to questionnaires expressed satisfaction with the operative outcome, the mean duration of TGN was 80 months and mean post-operative follow-up of 7 years. No mortality reported in this series.

Conclusion. This is a large review of MVD, which confirms the long-term effectiveness of the procedure, and uniquely reflects patient's perception of the operation. Predictors of favourable outcome were shorter preoperative duration of TGN, older age at time of MVD, typical features, and vascular compression; moreover, complications, and previous neurodestructive procedures did not show significant effect on long-term pain relief. Satisfaction with MVD was exclusively related to long-term pain relief without medications.

Key words:

• Trigeminal neuralgia
• microvascular decompression
• outcome
• satisfaction

Acknowledgement

The authors like to acknowledge Mr. J.B. Miles for his contributions in setting up the technique of microvascular decompression. We also like to thank all staff members at the clinical trials department in the Walton Centre for their contribution in management of questionnaires, patient's records, and data entry.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.