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- Almqvist Téran, Nicolas, et al.
(författare)
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Posterior Fossa Volume and Dimensions : Relation to Pathophysiology and Surgical Outcomes in Classic Trigeminal Neuralgia
- 2023
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Ingår i: World Neurosurgery. - : Elsevier. - 1878-8750 .- 1878-8769. ; 179, s. e397-e403
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: A small posterior fossa (PF) has been hypothesized to explain the increased incidence of trigeminal neuralgia (TN) in females and could make microvascular decompression (MVD) more challenging. The aim of this study was to investigate the association between the PF volume and dimensions in relation to biological sex, type of neurovascular conflict (NVC), and outcome after MVD in classic TN.METHODS: In this observational study, 84 patients with TN operated on with MVD with a preoperative head computed tomography(CT) scan were included. Eighty-two adults without TN who had undergone head CT for other reasons were included as controls. PF volume and dimensions (x-axis, y-axis, and z-axis) were evaluated on the CT scans. For the patients with TN, Barrow Neurological Institute (BNI) grade was evaluated 6 months after MVD.RESULTS: There was no difference in PF volume or dimensions between the patients with TN and controls. Women showed a smaller volume and narrower (x-axis) PF than men, but these differences did not manifest when comparing patients with TN and controls within each sex. Patients with an NVC involving the superior cerebellar artery had a narrower (x-axis) and shorter (y-axis) PF than did patients with an NVC resulting from other arteries. PF volume or dimensions were not associated with BNI grade after MVD.CONCLUSIONS: PF anatomy was related to the NVC type but did not differ between patients with TN and controls and was not related to the surgical outcome after MVD.
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- Loayza, Richard, et al.
(författare)
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Outcome after microvascular decompression for trigeminal neuralgia in a single center : relation to sex and severity of neurovascular conflict
- 2023
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Ingår i: Acta Neurochirurgica. - : Springer Nature. - 0001-6268 .- 0942-0940. ; 165:7, s. 1955-1962
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Trigeminal neuralgia (TN), a severe type of facial pain, is mainly caused by a neurovascular conflict (NVC). The severity of the NVC seems associated with the outcome following microvascular decompression (MVD) surgery. This study aimed to investigate the outcome after MVD and whether it is affected by NVC severity and sex.METHODS: TN patients (n = 109) were followed for 5 to 10 years after MVD. Barrow Neurology Index (BNI), Patients Global Impression of Change (PGIC), complications, and time to relapse were evaluated. The NVC severity was retrospectively reviewed from presurgical MRI. Demographic and clinical factors and NVC severity were analyzed for potential association with outcome after MVD.RESULTS: The success rate (BNI ≤ 2) was 80% after 5 to 10 years follow-up for TN patients with severe NVC (grade 2-3) and 56% for TN patients with mild NVC (grade 0-1, P = 0.003). No sex difference was observed in outcome for patients with both mild (P = 0.924) and severe NVC (P = 0.883) respectively. Three patients (2.8%) during the hospital stay, and two patients (1.8%) at 6 weeks, experienced a complication requiring invasive treatment. At long-term 52/109 patients (47.7%) reported some type of persistent adverse event, of which the majority were mild and required no treatment.CONCLUSIONS: MVD offers an 80% probability of long-term pain relief in TN patients with severe NVC, with low frequency of serious complications. NVC severity significantly affects outcome after MVD, while no sex differences in outcome were found. In consistency with previous work, the results stress the importance of adequate neuroradiological assessment of the NVC for preoperative patient selection.
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- Svedung Wettervik, Teodor, et al.
(författare)
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Incidence of trigeminal neuralgia : A population-based study in Central Sweden
- 2023
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Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 27:5, s. 580-587
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe primary aim of this observational study was to determine the incidence of trigeminal neuralgia (TN) in a county in central Sweden. The secondary aim was to investigate TN characteristics including the affected side and nerve branches.MethodsPatients that received the ICD-10 diagnostic codes TN (G50.0), atypical facial pain (G50.1) and other/unspecified disorder of the trigeminal nerve (G50.8 and G50.9) in Uppsala County, between 2009 and 2017, were eligible for inclusion. Case ascertainment was conducted by the authors by review of the medical records.ResultsThe incidence of TN was estimated to be 5.5 (95% confidence interval 4.7–6.4) per 100,000 person-years. The incidence increased with age, from 0.1 in 0- to 19-year-olds to 23.1 per 100,000 person-years in 80+-year-olds. Females exhibited a higher incidence at 7.3 than males at 3.7 per 100,000 person-years. Most of the trigeminal neuralgia cases were diagnosed in the Neurology department (47%). Trigeminal neuralgia was most frequently right sided (59%) and limited to one cranial nerve V-branch, of which V2 was the most common.ConclusionsTrigeminal neuralgia incidence was estimated to be 5.5 per 100,000 person-years. The incidence was higher for females and increased with older age.SignificanceThere is limited knowledge about the true incidence of trigeminal neuralgia. This manuscript provides an estimate of 5.5 cases per 100,000 person-years, by using a thorough case ascertainment methodology.
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