Abstract
Objective To obtain objective surgical results from microvascular decompression (MVD) for trigeminal neuralgia (TN) and hemifacial spasm (HFS), a method to evaluate and analyze overall postoperative results from MVD by combining the cure rate of symptoms with the complication rate is proposed. In addition, tactics to prevent surgical complications and of the postoperative management are described.
A new standardized scoring system using consistent criteria to document treatment results of MVD is needed to allow individual surgeons to correlate and compare results with other institutes using the common criteria.
Method and Findings Surgical results were obtained from a questionnaire sent to 233 patients who had undergone surgery and had been followed up for more than 1 year after surgery (TN patients, 95; HFS patients, 138). When surgical outcome is complete cure of symptoms, the efficacy of surgery (E) is designated E-0, but when moderate symptoms are still persist postoperatively, the score is designated E-2. When no complications are reported after surgery, the complication score (C) is C-0; if troublesome complications remain, the score is designated as C-2. Total evaluation of the results (T) is judged by combining the (E) and (C) scores. For example, when E is 0, and C is C-2, the total evaluation is scored as T-2, which is diagnosed as fair. Analysis of the collected data revealed an outcome of T-0 was 70 % (59/85 patients), T-1 was 19 % (16/85), T-2 was 8 % (7/85), T-3 was 1 % (1/85), and T- was 2 % (2/85) in TN, whereas in HFS, T-0 was 61 % (62/102), T-1 was 28 % (29/102), T-2 was 7 % (7/102), and T-3 was 4 % (4/102).
Conclusion The total results of MVD should be evaluated and analyzed by combining the cure rate of symptoms together with the complication rate. Successful MVD involves not only to obtain good cure rate but also minimizing surgical complications. Therefore, to realize various methods how to avoid complications and to study postoperative management is mandatory. This new scoring system could allow much more objective analysis of the results of following MVD, and by adopting this scoring system, surgeons can compare their own overall surgical results with those of other institutes.
Disclosure
The author reports no conflict of interest concerning the material used in this paper.
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Abbreviations
- ABR:
-
Auditory brainstem response
- BNI:
-
Barrow Neurological Institute
- CSF:
-
Cerebrospinal fluid
- HFS:
-
Hemifacial spasm
- MVD:
-
Microvascular decompression
- TN:
-
Trigeminal neuralgia
- VBA:
-
Vertebrobasilar artery
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Kondo, A. (2016). Outcome Evaluation and Postoperative Management. In: Li, ST., Zhong, J., Sekula, Jr., R. (eds) Microvascular Decompression Surgery. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-7366-9_13
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