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Acta Neurochirurgica

, Volume 161, Issue 8, pp 1589–1598 | Cite as

Arachnoiditis as an outcome factor for microvascular decompression in classical trigeminal neuralgia

  • Edoardo Mazzucchi
  • Andrei BrinzeuEmail author
  • Marc Sindou
Original Article - Functional Neurosurgery - Pain
  • 142 Downloads
Part of the following topical collections:
  1. Functional Neurosurgery – Pain

Abstract

Background

Neurovascular conflict is considered a key element of classical trigeminal neuralgia (TN) and consequently, microvascular decompression (MVD) is an effective treatment. Nevertheless, failures of MVD are described by many authors. In some patients, the arachnoid membranes surrounding the trigeminal nerve and neighbouring vessels may be thickened and adhesive. Here we analyse the impact of such focal arachnoiditis on outcome after MVD for TN.

Methods

A cohort of prospectively followed patients after their MVD was reviewed for intraoperative, imaging and clinical data if findings of arachnoiditis during MVD were described. Long-term outcome assessment was the main endpoint.

Results

We reviewed data from 395 MVD procedures, performed for TN from 2001 to 2014. Intraoperative evidence of focal arachnoiditis, as described by the surgeon, has been noted in 51 patients (13%). In 35 (68.6%), neuralgia was typical and in the other 17 (31.4%) it was atypical.

As expected by definition, neurovascular conflict was found in 49 interventions (96%); it was predominantly arterial in 27 (52.9%). Accompanying arachnoiditis was encountered: mild in 20 interventions (39.2%), severe in 31 (60.8%).

A successful result (BNI I or II) was achieved in 29 patients (56.9%). The other 22 patients (43.1%) had persistence or recurrence of pain. Overall KM probability of being pain free at 15 years was 72%.

Conclusions

Intraoperative finding of arachnoiditis during MVD for classical trigeminal neuralgia is associated with poorer outcome than that of classical trigeminal neuralgia in general. This is particularly true for low grades of conflict.

Keywords

Trigeminal neuralgia Microvascular decompression Outcome Arachnoiditis Prognostic factors Neurovascular conflict 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethics committee of the “Hopital Neurologique de Lyon”.

Informed consent

All patients signed an informed consent form with the surgeon prior to the procedure.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Catholic University of Sacred HeartRomeItaly
  2. 2.University de Lyon 1LyonFrance
  3. 3.University of Medicine and Pharmacy Victor Babes TimisoaraTimisoaraRomania
  4. 4.Service de Neurochirugie FonctionelleLyonFrance

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