1. Cephalalgia. 2018 Jan 1:333102418783294. doi: 10.1177/0333102418783294. [Epub
ahead of print]

Prognostic factors for outcome of microvascular decompression in trigeminal
neuralgia: A prospective systematic study using independent assessors.

Heinskou TB(1), Rochat P(2), Maarbjerg S(1), Wolfram F(3), Brennum J(2), Olesen
J(1), Bendtsen L(1).

Author information: 
(1)1 Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup,
University of Copenhagen, Denmark.
(2)2 Department of Neurosurgery, Rigshospitalet Blegdamsvej, University of
Copenhagen, Denmark.
(3)3 Department of Diagnostics, Rigshospitalet Glostrup, University of
Copenhagen, Denmark.

Introduction There is a lack of high-quality prospective, systematic studies
using independent assessors of outcome of microvascular decompression as
treatment for trigeminal neuralgia. Methods Clinical characteristics and outcome 
data were recorded prospectively from consecutive classical trigeminal neuralgia 
patients, using standardized interviews. Degree of neurovascular contact was
evaluated by a 3.0 Tesla MRI blinded to symptomatic side. Patients were assessed 
before and 12 months after surgery by a neurologist. Results Twenty-six men and
33 women completed 12 months follow-up. Forty-one patients (69%) had an excellent
outcome (no pain, no medication). Ten (18%) patients had a good outcome. Eight
(12%) patients had no improvement or had worsening of pain. MRI showed
neurovascular contact with morphological changes in 34 patients (58%). Odds ratio
between neurovascular contact with morphological changes and excellent outcome
was 4.4 (Cl 1.16-16.26), p = 0.029. Odds ratio between male sex and excellent
outcome was 11.38 (Cl 2.12-59.52), p = 0.004. No significant association was
found between excellent outcome and concomitant persistent pain, current age or
disease duration. Conclusion Neurovascular contact with morphological changes and
male sex are positive predictive factors for outcome of microvascular
decompression. The findings enable clinicians to better inform patients before
surgery.

DOI: 10.1177/0333102418783294 
PMID: 29896973