A Case Series of Stereotactic Radiosurgery First for Trigeminal Neuralgia: A History of Stereotactic Radiosurgery Does Not Complicate Microvascular Decompression

被引:3
作者
Nair, Sumil K. [1 ]
Xie, Michael E. [1 ]
Ran, Kathleen [1 ]
Kalluri, Anita [1 ]
Kilgore, Collin [1 ]
Halbert-Elliott, Kyra [1 ]
Huang, Judy [1 ]
Lim, Michael [2 ]
Bettegowda, Chetan [1 ]
Xu, Risheng [1 ,3 ]
机构
[1] Johns Hopkins Univ, Sch Med, Dept Neurosurg, Baltimore, MD USA
[2] Stanford Univ, Sch Med, Dept Neurosurg, Stanford, CA USA
[3] Johns Hopkins Univ, Dept Neurosurg, Sch Med, 1800 Orleans St,Zayed Tower 6-6132, Baltimore, MD 21287 USA
关键词
Stereotactic radiosurgery; Trigeminal neuralgia; Microvascular decompression; Pain recurrence;
D O I
10.1227/ons.0000000000000819
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND AND OBJECTIVES: The influence of prior stereotactic radiosurgery (SRS) on outcomes of subsequent microvascular decompression (MVD) for patients with trigeminal neuralgia (TN) is not well understood. To directly compare pain outcomes in patients undergoing primary MVD vs those undergoing MVD with a history of 1 prior SRS procedure.METHODS: We retrospectively reviewed all patients undergoing MVD at our institution from 2007 to 2020. Patients were included if they underwent primary MVD or had a history of SRS alone before MVD. Barrow Neurological Institute (BNI) pain scores were assigned at preoperative and immediate postoperative time points and at every follow-up appointment. Evidence of pain recurrence was recorded and compared via Kaplan-Meier analysis. Multivariate Cox proportional hazards regression was used to identify factors associated with worse pain outcomes.RESULTS: Of patients reviewed, 833 met our inclusion criteria. Thirty-seven patients were in the SRS alone before MVD group, and 796 patients were in the primary MVD group. Both groups demonstrated similar preoperative and immediate postoperative BNI pain scores. There were no significant differences between average BNI at final follow-up between the groups. Multiple sclerosis (hazard ratio (HR) = 1.95), age (HR = 0.99), and female sex (HR = 1.43) independently predicted increased likelihood of pain recurrence on Cox proportional hazards analysis. SRS alone before MVD did not predict increased likelihood of pain recurrence. Furthermore, Kaplan-Meier survival analysis demonstrated no relationship between a history of SRS alone and pain recurrence after MVD (P = .58).CONCLUSION: SRS is an effective intervention for TN that may not worsen outcomes for subsequent MVD in patients with TN.
引用
收藏
页码:353 / 358
页数:6
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