Long-term results of microvascular decompression with video endoscopy in the treatment of patients with atypical trigeminal neuralgia
- Authors: Vinokurov A.G.1, Kalinkin A.A.1, Bocharov A.А.1, Chupalenkov S.M.1, Lesnyak V.N.1, Yusubalieva G.M.1,2, Kazmina E.S.1, Kalinkina O.N.3, Belousov V.V.4
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Affiliations:
- Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
- Engelhardt Institute of Molecular Biology of the Russian Academy of Sciences
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
- Federal center of brain research and neurotechnologies
- Issue: Vol 13, No 4 (2022)
- Pages: 5-16
- Section: Original Study Articles
- URL: https://journals.rcsi.science/clinpractice/article/view/144165
- DOI: https://doi.org/10.17816/clinpract114755
- ID: 144165
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Abstract
Background: The incidence of atypical trigeminal neuralgia (aNTN) varies from 1 to 7 per 100,000 population per year. The main cause of its development is compression of the trigeminal nerve (TN) root by a vein and/or artery in the cerebellar cistern. To date, the final tactics of treatment for patients with aNTN has not been specified. The effectiveness of conservative methods of therapy does not exceed 50%.
The aim of this study was to evaluate the results of microvascular decompression using video endoscopy in the treatment of patients with atypical trigeminal neuralgia.
Methods: In the period from 2014 to 2021, 34 patients with aNTN were operated on, of which 18 (53%) patients had neuropathic pain (more than 4 points on the DN4 scale), and 15 (44%) patients had transformation of classical trigeminal neuralgia into atypical neuralgia. The conservative therapy (carbamazepine, gabapentin, pregabalin), administered to all the patients in the preoperative period, was not accompanied by a significant relief of pain syndrome. The maximum intensity of pain upon admission to the hospital was, according to the visual analog scale (VAS), 10 points, according to the BNI (Barrow Neurological Institute) Pain Intensity Scale — V (severe, persistent pain). All the patients underwent microvascular decompression of the trigeminal nerve root with the use of Teflon; in 12 (35%) patients, in addition to microscopy, video endoscopy was used. The average follow-up period after the surgery was 3.4±1.7 years (from 1 to 5 years).
Results: In all (100%) patients, the pain was completely eliminated (BNI I) after the surgery. A total five-year excellent and good outcome of the disease on the J. Miller and BNI scale (I -II) was noted in 80% (n=27) of patients with aNTN. The risk of pain recurrence after microvascular decompression was 14% (n=3) in the first three years, and 34% (n=4) after 5 years. The use of video endoscopy made it possible to identify the blood vessels compressing the root of the trigeminal nerve with a minimal displacement of the cerebellum and cranial nerves when visualizing the neurovascular conflict.
Conclusion: The microvascular decompression method with video endoscopy is effective in the treatment of patients with aNTN.
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##article.viewOnOriginalSite##About the authors
Aleksey G. Vinokurov
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: avinok@yandex.ru
MD, PhD
Russian Federation, 28, Orekhovy boulevard, Moscow, 115682Aleksandr A. Kalinkin
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Author for correspondence.
Email: aleksandr_kalinkin27@mail.ru
ORCID iD: 0000-0002-1605-9088
MD, PhD
Russian Federation, 28, Orekhovy boulevard, Moscow, 115682Andrey А. Bocharov
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: nsi7@mail.ru
ORCID iD: 0000-0001-8970-3762
MD, PhD
Russian Federation, 28, Orekhovy boulevard, Moscow, 115682Sergey M. Chupalenkov
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: chupalenkovsm@gmail.com
ORCID iD: 0000-0001-5994-3124
Russian Federation, 28, Orekhovy boulevard, Moscow, 115682
Viktor N. Lesnyak
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: Iesnyak_kb83@mail.ru
ORCID iD: 0000-0002-2739-0649
SPIN-code: 5483-3113
MD, PhD
Russian Federation, 28, Orekhovy boulevard, Moscow, 115682Gaukhar M. Yusubalieva
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency; Engelhardt Institute of Molecular Biology of the Russian Academy of Sciences
Email: gaukhar@gaukhar.org
ORCID iD: 0000-0003-3056-4889
SPIN-code: 1559-5866
MD, PhD
Russian Federation, 28, Orekhovy boulevard, Moscow, 115682; MoscowEvgeniya S. Kazmina
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: Evg.k@bk.ru
ORCID iD: 0000-0002-3715-5140
Russian Federation, 28, Orekhovy boulevard, Moscow, 115682
Olga N. Kalinkina
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
Email: sunny1917@mail.ru
ORCID iD: 0000-0001-5538-904X
MD
Russian Federation, MoscowVsevolod V. Belousov
Federal center of brain research and neurotechnologies
Email: belousov@fccps.ru
ORCID iD: 0000-0001-6637-8098
SPIN-code: 6517-8373
Corresponding Member of the RAS, Doctor of Biological Sciences
Russian Federation, MoscowReferences
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