Open Access Journal

ISSN : 2456-1304 (Online)

International Journal of Engineering Research in Electronics and Communication Engineering(IJERECE)

Monthly Journal for Electronics and Communication Engineering

Open Access Journal

International Journal of Science Engineering and Management (IJSEM)

Monthly Journal for Science Engineering and Management

ISSN : 2456-1304 (Online)

Microvascular Decompression VS Gamma Knife Surgery for the Surgical Management of Trigeminal Neuralgia

Author : Dr Ammar Rahman 1

Date of Publication :20th October 2020

Abstract: Background: Trigeminal neuralgia (TN) is a rare chronic facial pain syndrome, characterised by severe, stabbing pain felt in one or more divisions of trigeminal nerve innervation areas. TN pain is so excruciating that it heavily impacts a patient’s quality of life. Most cases can be controlled using anti-convulsive medications, however some patients do not respond to medication or have adverse effects to them at which point surgery is considered. Many different surgical procedures are available for TN, however Microvascular Decompression (MVD) and Gamma Knife Surgery (GKS) are amongst the most widely used. This appraisal seeks to determine whether MVD is more successful than GKS in treating TN. Method: Medline, Embase and The Cochrane Database of Systematic Reviews were searched, as well as executing a hand search of Google, for relevant studies comparing pain relief, pain recurrence and complications of MVD & GKS. Studies must have been published in the last 5 years, must have measured pain using the Barrow Neurological Institute (BNI) pain scale and patient follow- up must have been at least one-year post-surgery. This resulted in 2 studies meeting the inclusion criteria, which were then selected for appraisal. Results: Both studies showed a statistically significant difference between the effectiveness of MVD and GKS in the management of TN. However, both studies had several flaws, weaknesses and were subject to bias, thus impacting on their credibility. Conclusion: Whilst the evidence suggests MVD provides superior outcomes than GKS, further research is required in the form of a Randomised Controlled Trial to categorically determine which treatment is more effective..

Reference :

    1.  Brisman, R. (2017). Trigeminal Neuralgia and Dental Considerations, [Online]. Available at: http://trigeminalneuralgiaronaldbrismanmd.com/Dental-Issues.html (Accessed: 10 November 2017).
    2. Casey, K. (2017). Microvascular Decompression: Attacking the Root of the Problem. Journal of The Facial Pain Association Quarterly, Spring, pp.8-18, [Online]. Available at: http://fpa-support.org/wpcontent/uploads/2017/04/TNA-Quarterly-2017- Spring-WEB.pdf (Accessed: 11 November 2017).
    3. Cruccu, G., Gronseth, G., Alksne, J., Argoff, C., Brainin, M., Burchiel, K., Nurmikko, T. and Zakrzewska, J. (2008). AAN-EFNS guidelines on trigeminal neuralgia management. European Journal of Neurology, 15(10), pp.1013-1028, [Online]. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1468- 1331.2008.02185.x/full (Accessed: 15 October 2017)
    4. Dear Doctor – Dentistry & Oral Health. (2015). Trigeminal Neuralgia Nerve Zones, [Image]. Available at: http://www.deardoctor.com/inside-themagazine/issue-29/trigeminal-neuralgia/ (Accessed: 12 October 2017).
    5. Drake, R.L., Vogl, A.W. and Mitchell, A.W.M. (2013). Gray’s Anatomy for Students. 3 rd edn. Philadelphia: Churchill Livingstone. pp.898-899.
    6. Ghurye, S. and McMillan, R. (2017). Orofacial pain – an update on diagnosis and management. British Dental Journal, 223, pp.639-647, [Online]. Available at: https://www.nature.com/articles/sj.bdj.2017.879.pdf (Accessed: 12 October 2017).
    7. Grant, G.A., and Loeser, J.D. (2012). Trigeminal Neuralgia, Ellenbogen, R.G., Abdulrauf, S.I. and Sekhar, N. (eds.) Principles of Neurological Surgery. 3rd edn. Philadelphia: Elsevier Saunders, pp.729-736, [Online]. Available at: https://www.sciencedirect.com/science/article/pii/B97 81437707014000488 (Accessed: 20 October 2017)
    8. Grant, G.A., and Loeser, J.D. (2012). Trigeminal Neuralgia, Ellenbogen, R.G., Abdulrauf, S.I. and Sekhar, N. (eds.) Principles of Neurological Surgery. 3rd edn. Philadelphia: Elsevier Saunders, [Image]. Available at: https://www.sciencedirect.com/science/article/pii/B97 81437707014000488 (Accessed: 20 October 2017).
    9.  Hupp, J.R. (2008), Facial Neuropathology, Hupp, J.R., Ellis, E. and Tucker, M.R. (eds.) Contemporary oral and maxillofacial surgery. 5th edn. St. Louis, Missouri: Elsevier. pp621.622.
    10.  International Headache Society, (2013). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia, 33(9), pp.629 808. [Online]. Available at: http://www.ihsheadache.org/binary_data/1437_ichd-iii-betacephalalgia-issue-9-2013.pdf (Accessed: 10 October 2017).
    11. Jurge, S. (2016). Pain part 7: Trigeminal Neuralgia. Dental Update, 43(2), pp.138-149, [Online]. Available at: http://dentalupdate.co.uk/issueArticle.asp?aKey=1497 (Accessed: 15 October 2017).
    12.  Kumar, S., Rastogi, S., Kumar, S., Mahendra, P., Bansal, M., Chandra, L. (2013). Pain in trigeminal neuralgia: neurophysiology and measurement: a comprehensive review. Journal of Medicine and Life, 6(4), pp.383-388, [Online]. Available at: https://www.researchgate.net/publication/261374786_ Pain_in_trigeminal_neuralgia_neurophysiology_and_ measurement_a_comprehensive_review (Accessed: 20 October 2017).
    13. Mayfield Brain & Spine. (2016). Trigeminal Neuralgia (facial pain), [Online]. Available at: https://www.mayfieldclinic.com/PDF/PE-TRIN.pdf (Accessed: 20 October 2017).
    14. Mayfield Brain & Spine. (2016). Facial area of trigger zones. [Image]. Available at:http://https://www.mayfieldclinic.com/PE-TRIN.htm (Accessed: 20 October 2017).
    15. Mayfield Brain & Spine. (2016). MRI Scan. [Image]. Available at:http://https://www.mayfieldclinic.com/PETRIN.htm (Accessed: 20 October 2017).
    16. Mayo Clinic, (2016). Gamma Knife Stereotactic Radiosurgery. [Image]. Available at: https://www.mayoclinic.org/tests-procedures/brain- stereotactic-radiosurgery/about/pac-20384679 (Accessed: 2 November 2017).
    17. Montano, N., Conforti, G., Di Bonaventura, R., Meglio, M., Fernandez, E. and Papacci, F. (2015). Advances in diagnosis and treatment of trigeminal neuralgia. Therapeutics and Clinical Risk Management, 11, pp.289-299, [Online]. Available at: https://www.dovepress.com/advances-in-diagnosisand-treatment-of-trigeminal-neuralgia-peer-reviewedfulltext-article-TCRM (Accessed: 25 October 2017).
    18. National Institute of Health and Care Excellence – Clinical Knowledge Summaries. (2017). Trigeminal Neuralgia, [Online]. Available at: https://cks.nice.org.uk/trigeminal-neuralgia#!scenario (Accessed: 15 October 2017).
    19. Rogers, C., Shetter, A., Fiedler, J., Smith, K., Han, P. and Speiser, B. (2000). Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute. International Journal of Radiation Oncology*Biology*Physics, 47(4), pp.1013-1019, [Online]. Available at: http://www.sciencedirect.com/science/article/pii/S036 0301600005137 (Accessed: 20 October 2017).
    20.  Samandouras, G. (2010). The Neurosurgeon's Handbook. Oxford: Oxford University Press. pp.762- 766
    21. Scully, C., Almeida, O.P., Bagan, J.V., Dios, P.D. and Taylor, A.M. (2010). Oral Medicine and Pathology at a Glance. Chichester: John Wiley & Sons, pp.92-93.
    22. The National Centre for Stereotactic Radiosurgery. (2014). What is Gamma Knife?, [Online]. Available at: .
    23. Zakrzewska, J. and Linskey, M. (2014). Trigeminal neuralgia. BMJ, 348(feb17 9), pp.g474, [Online]. Available at: http://clinicalevidence.bmj.com/x/pdf/clinicalevidence/en-gb/systematic-review/1207.pdf (Accessed: 3rd November 2017).

Recent Article