Long-term Pain Relief Rates After Failed Stereotactic Radiosurgery for Idiopathic Trigeminal Neuralgia: A Prospective Comparison of First-time Microvascular Decompression and Repeat Stereotactic Radiosurgery

Winner of the William H. Sweet Young Investigator Award, Kunal P. Raygor, MD, presented his research, Long-term Pain Relief Rates After Failed Stereotactic Radiosurgery for Idiopathic Trigeminal Neuralgia: A Prospective Comparison of First-time Microvascular Decompression and Repeat Stereotactic Radiosurgery, during the 2018 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.

Microvascular decompression (MVD) and stereotactic radiosurgery (SRS) are often used to treat refractory trigeminal neuralgia (TN). Pain recurrence after SRS is common, but the ideal salvage procedure is unknown. Study authors directly compared pain outcomes after MVD and repeat SRS in a population of patients who failed SRS as an initial surgical treatment for refractory TN. Authors reviewed a prospectively-collected, single-institution database of patients undergoing surgery between 1997 and 2014. Favorable outcome is defined as Barrow Neurological Institute Pain Intensity scores of I and II. Patients were included if they had typical type 1, idiopathic TN and at least one year of follow-up.

Compared to repeat SRS, patients receiving salvage MVD had longer-lasting freedom from pain. The presence of post-SRS sensory changes was predictive of favorable outcome in the salvage SRS cohort. Study authors hope this information can help counsel patients and physicians on the ideal treatment selection after failed first-time radiosurgery.

Overall, 168 patients underwent SRS as their first TN procedure. Of 30 that failed and had a second procedure at the institution, 15 underwent first-time MVD and 15 underwent repeat SRS. Those receiving MVD were younger and more likely to receive ≥ 80 Gy radiation during the initial SRS. There were no differences in average follow-up. At last follow-up, 80 percent of MVD patients and 33.3 percent of SRS patients had a favorable outcome. The study found that 86 and 75 percent of the MVD cohort had a favorable outcome at one and five years compared to 73 and 27 percent for the SRS cohort, respectively. On multivariate regression, performing MVD was statistically significantly associated with favorable outcome. There were no statistically significant predictors of favorable outcome in the MVD cohort; however, sensory changes were associated with pain relief in the SRS cohort.

Author Block: Doris Wang, MD, PhD; Mariann Ward; Nicholas Barbaro; Edward Chang, MD

Disclosure: The author reported no conflicts of interest.

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Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 11,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.

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