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| |  Microvascular Decompression for Trigeminal Neuralgia After Radiosurgery: Presented at AANS By Kristina Rebelo SAN DIEGO -- May 14, 2009 -- Patients with prior stereotactic radiosurgery (SRS) for trigeminal neuralgia who experience subsequent pain within the first few years after treatment are responding well to microvascular decompression (MVD), according to a study presented here at the 77th Annual Meeting of the American Association of Neurological Surgeons (AANS). Pain tended to recur within the first few years after SRS, a popular initial treatment for trigeminal neuralgia, but MVD has been a controversial solution because of difficulty performing the procedure and efficacy issues. "The gold standard continues to be SRS, a compelling technique for the initial management of trigeminal neuralgia pain, but MVD as salvage therapy after SRS can have positive results," said Joseph C. Chen, MD, Department of Neurosurgery, Kaiser Permanente, Los Angeles, California, on May 5. The study included 15 patients with trigeminal neuralgia patients (9 men, 6 women) who were treated with MVD after SRS treatment. Researchers reviewed patient records and intraoperative video archives. After SRS, median time to painful reoccurrence was 13 months. The review showed that 13 patients achieved a pain-free outcome, with arachnoidal thickening and atherosclerotic changes involving the conflicting vessel seen in 3 cases each. Only 1 patient had significant scarring that resulted in adhesions between the trigeminal nerve and offending vessel; this factor was judged to have significantly increased the difficulty of the procedure. In 1 of the failure cases, a negative exploration was encountered, and no radiation-related changes were seen in the other failure. In most of the patients, MVD was successful after SRS procedures, and no radiation-related changes were seen. "In the failed cases, there was also a foreign body reaction, and we removed the Teflon implant with good results," said Dr. Chen. Dr. Chen suggested that the offending nerve was being hit in every SRS procedure and that failed surgeries were related to unpredictable changes in the nerve. He noted that patients often requested a second SRS procedure and that "radiosurgery can be repeated in a lot of patients, and they can be salvaged." Contrary to anecdotal reports about negative outcomes and the difficulty of the operation, Dr. Chen recommended MVD as salvage therapy for subsequent procedures. "Prior SRS does not appear to adversely affect the likelihood of [success with] subsequent MVD," Dr. Chen said. [Presentation title: Microvascular Decompression for Trigeminal Neuralgia Following Radiosurgery. Abstract 816]
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