Journal
CEPHALALGIA
Volume 39, Issue 2, Pages 197-208Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/0333102418783294
Keywords
Facial pain; neurosurgery; neurovascular contact; morphological changes; predictive factors
Categories
Funding
- patient organization Trigeminus Foreningen
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Introduction There is a lack of high-quality prospective, systematic studies using independent assessors of outcome of microvascular decompression as treatment for trigeminal neuralgia. Methods Clinical characteristics and outcome data were recorded prospectively from consecutive classical trigeminal neuralgia patients, using standardized interviews. Degree of neurovascular contact was evaluated by a 3.0 Tesla MRI blinded to symptomatic side. Patients were assessed before and 12 months after surgery by a neurologist. Results Twenty-six men and 33 women completed 12 months follow-up. Forty-one patients (69%) had an excellent outcome (no pain, no medication). Ten (18%) patients had a good outcome. Eight (12%) patients had no improvement or had worsening of pain. MRI showed neurovascular contact with morphological changes in 34 patients (58%). Odds ratio between neurovascular contact with morphological changes and excellent outcome was 4.4 (Cl 1.16-16.26), p=0.029. Odds ratio between male sex and excellent outcome was 11.38 (Cl 2.12-59.52), p=0.004. No significant association was found between excellent outcome and concomitant persistent pain, current age or disease duration. Conclusion Neurovascular contact with morphological changes and male sex are positive predictive factors for outcome of microvascular decompression. The findings enable clinicians to better inform patients before surgery.
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