• Takuro Inoue, Hisao Hirai, Ayako Shima, Fumio Suzuki, Masayuki Yamaji, Takanori Fukushima, and Masayuki Matsuda.
• Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan. takuro39@gmail.com.
• Acta Neurochir (Wien). 2017 Nov 1; 159 (11): 2127-2135.

BackgroundThere is still no clear guideline for surgical treatment for patients with medically refractory trigeminal neuralgia (TN). When it comes to which surgical treatment to choose, microvascular decompression (MVD) or Gamma Knife surgery (GKS), we should know the long-term outcome of each treatment.MethodsWe analyzed 179 patients undergoing MVD and 52 patients undergoing GKS followed for 1 year or longer. We evaluated the patient's neurological status including pain relief, complications and recurrence. Results were assessed with Barrow Neurological Institute (BNI) pain intensity and facial numbness scores. Overall outcomes were compared between the two groups based on pain relief and complications.ResultsBNI pain intensity and facial numbness scores at the final visit were significantly lower in the MVD group than in the GKS group (P < 0.001, P = 0.04, respectively). Overall outcomes were superior following MVD than following GKS (P < 0.001). Following whichever treatment, there were initially high rates of pain-free status "without medication": 96.6% in the MVD group and 96.2% in the GKS group. However, 6.1% in the MVD group and 51.9% in the GKS group fell into a "with medication" state within median periods of 1.83 and 3.92 years, respectively (P < 0.001). Kaplan-Meier analysis revealed that pain recurred more often and later in the GKS group than in the MVD group (P < 0.001).ConclusionsConsidering the long-term outcomes, MVD should be chosen as the initial surgical treatment for patients with medically refractory TN.

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