Abstract
Background: Vertebrobasilar dolichoectasia (VBD) is one of the rare causes of trigeminal neuralgia (TN). The common surgical treatments for patients with TN caused by VBD (VBD-TN) are microvascular decompression (MVD) and Gamma Knife radiosurgery (GKRS). However, the therapeutic effects of the two methods have not been clinically compared, so this study was performed to evaluate the treatment outcomes of MVD and GKRS for patients with VBD-TN.Methods: The retrospective study was performed from March 2011 to March 2019 in Wuhan Union Hospital. A total of 80 patients diagnosed with VBD-TN were included in this study, and they were divided into the MVD group (n = 46) and GKRS group (n = 34) according to the surgical methods. The imaging data, intraoperative findings, treatment outcomes, and complications of the two groups were analyzed and compared. Meanwhile, the influencing factors of the treatment effect are also explored on the two groups.Results: Patients who underwent MVD were younger than patients who underwent GKRS (median ages were 61.1 and 65.4 years old, respectively, p = 0.03). The median follow-up was 61.1 months for the MVD group and 56.8 months for the GKRS group. The favorable outcomes [Barrow Neurological Institute (BNI) pain score, BNI scores I–II] occurred in 97.8% of patients treated with MVD and in 78.9% of patients treated with GKRS (p = 0.009). The favorable outcomes in the percentage of patients after MVD 1, 3, 5, and 7 years were 95.7, 85.1, 74.2, and 74.2%, respectively, whereas the corresponding percentages after GKRS were 76.5, 66.2, 56.6, and 47.2%, respectively (p = 0.031). The postoperative complications (except facial numbness) in the MVD group were higher than those in the GKRS group (p = 0.036), but the incidence of new and worsening facial numbness was lower in the GKRS group (p < 0.001).Conclusions: MVD is superior to GKRS in obtaining and maintaining favorable outcomes for patients with VBD-TN, but it also comes with more complications other than facial numbness. Thus, the treatment program can be tailored to a patient's unique condition and wishes.
Highlights
Trigeminal neuralgia (TN) is mainly characterized by recurrent paroxysmal electric shock-like or acupuncture-like pain in the distribution area of the trigeminal nerve that is composed of the eye branch (V1), the maxillary branch (V2), and the mandibular branch (V3), which usually lasts for a few seconds [1,2,3]
We introduced the chopped Teflon felt implant into the conflicting neurovascular area between the artery and nervous structures, thereby separating the Vertebrobasilar dolichoectasia (VBD) from the trigeminal nerve (Figure 1A), while in the transposition subgroup, the proximal part of the vertebrobasilar artery was moved ventrally and cranially through the gap between the IX and VII–VIII nerves, and fixed on the nearby petrous bone wall with biomedical glue (Figure 1B)
Demographic data showed that the age of patients performed by microvascular decompression (MVD) was younger than the patients performed by Gamma Knife radiosurgery (GKRS), which based on the patient’s choice (p = 0.03), whereas there was no significant difference in gender, pain side, basal Barrow Neurological Institute pain intensity score (BNI) score, history of MVD (n = 46) GKRS (n = 34) P-value
Summary
Vertebrobasilar dolichoectasia (VBD) is one of the rare causes of trigeminal neuralgia (TN). The common surgical treatments for patients with TN caused by VBD (VBD-TN) are microvascular decompression (MVD) and Gamma Knife radiosurgery (GKRS). The therapeutic effects of the two methods have not been clinically compared, so this study was performed to evaluate the treatment outcomes of MVD and GKRS for patients with VBD-TN
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