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Outcome of microvascular decompression for trigeminal neuralgia treated with the stitched sling retraction technique

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Abstract

The purpose of this retrospective study was to describe and evaluate the long-term outcome of microvascular decompression (MVD) with the stitched sling retraction technique for treating trigeminal neuralgia (TN). Between January 2007 and December 2012, 50 patients with idiopathic TN underwent MVD using the stitched sling retraction technique at our institution. The median follow-up period was 5.2 years (range, 1.8–6.8 years). Using Kaplan–Meier analysis, the rates of complete pain relief without medications were 88 % at 1 year and 83 % at 5 years. Recurrence was noted in two patients, and one patient was re-treated using a complementary procedure for pain relief. Although transient complications were observed in seven patients, no permanent neurological deficit was observed. We conclude that the stitched sling retraction technique is a safe and effective treatment for TN and maintains substantial pain relief and low recurrence rates over a long period of time.

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Conflict of interest

The authors have no financial interest in the subject presented in this paper.

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Authors and Affiliations

  1. Department of Neurosurgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan

    Jun Masuoka, Toshio Matsushima, Kouhei Inoue, Yukiko Nakahara, Yukinori Takase & Masatou Kawashima

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  1. Jun Masuoka
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  2. Toshio Matsushima
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  3. Kouhei Inoue
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  4. Yukiko Nakahara
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  5. Yukinori Takase
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  6. Masatou Kawashima
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Corresponding author

Correspondence to Jun Masuoka.

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Comments

Francesco Acerbi, Milan, Italy

Masuoka et al. very well described a large series of patients with typical trigeminal neuralgia, treated by microvascular decompression (MVD) with stitched sling retraction technique.

The authors reported a high percentage of patients with a complete pain control (BNI) at the end of follow-up, with an acceptable rate of complication.

This is an interesting and attracting technique for MVD. However, when a new technique is proposed, it should be not only attracting, but also useful and possibly better than other techniques available. In my mind, better should imply lower rates of recurrence and not higher rates of complications. The stitched sling retraction technique could theoretically assure a very high rate of success, hypothetically higher than the classic interposition technique. However, this has not been demonstrated yet in a prospective randomized trial comparing two similar groups of patients. In fact, the results in large series treated by interposition technique (1, 2) have shown very high rate of success with longer follow-up than the series by Masuoka et al. In addition, this kind of technique cannot be applied to every case, i.e. when there is a venous conflict, with vertebral artery compressing the nerve, of if many perforators come from the offending vessel. Finally, the stitched sling retraction technique requires much stimulation to be completed and this can be associated with higher rate of complications. In the present series, for example, there is a 6 % of cases with venous infarction causing transient cerebellar dysfunction. In conclusion, even if very attractive and well described by the authors, I could not consider at the moment the stitched sling retraction technique as the gold standard for MVD in patients with trigeminal neuralgia.

References

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2. Sindou M, Leston J, Decullier E, Chapuis F. Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg. 2007, 107(6):1144–53.

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Masuoka, J., Matsushima, T., Inoue, K. et al. Outcome of microvascular decompression for trigeminal neuralgia treated with the stitched sling retraction technique. Neurosurg Rev 38, 361–365 (2015). https://doi.org/10.1007/s10143-015-0607-5

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  • DOI: https://doi.org/10.1007/s10143-015-0607-5

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