{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T19:22:13Z","timestamp":1792264933534,"version":"4.4.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T00:00:00Z","timestamp":1647993600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"name":"University College London Hospitals"},{"DOI":"10.13039\/100014461","name":"Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014461","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,27]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A significant proportion of patients with short-lasting unilateral neuralgiform headache attacks are refractory to medical treatments. Neuroimaging studies have suggested a role for ipsilateral trigeminal neurovascular conflict with morphological changes in the pathophysiology of this disorder. We present the outcome of an uncontrolled open-label prospective single-centre study conducted between 2012 and 2020, to evaluate the efficacy and safety of trigeminal microvascular decompression in refractory chronic short-lasting unilateral neuralgiform headache attacks with MRI evidence of trigeminal neurovascular conflict ipsilateral to the pain side. Primary endpoint was the proportion of patients who achieved an \u2018excellent response\u2019, defined as 90\u2013100% weekly reduction in attack frequency, or \u2018good response\u2019, defined as a reduction in weekly headache attack frequency between 75% and 89% at final follow-up, compared to baseline. These patients were defined as responders. The study group consisted of 47 patients, of whom 31 had short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, and 16 had short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (25 females, mean age\u2009\u00b1\u2009SD 55.2\u2009years\u2009\u00b1\u200914.8). Participants failed to respond or tolerate a mean of 8.1 (\u00b12.7) preventive treatments pre-surgery. MRI of the trigeminal nerves (n\u2009=\u200947 patients, n\u2009=\u200950 symptomatic trigeminal nerves) demonstrated ipsilateral neurovascular conflict with morphological changes in 39\/50 (78.0%) symptomatic nerves and without morphological changes in 11\/50 (22.0%) symptomatic nerves. Postoperatively, 37\/47 (78.7%) patients obtained either an excellent or a good response. Ten patients (21.3%, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing\u2009=\u20097 and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms\u2009=\u20093) reported no postoperative improvement. The mean post-surgery follow-up was 57.4\u2009\u00b1\u200924.3\u2009months (range 11\u201396\u2009months). At final follow-up, 31 patients (66.0%) were excellent\/good responders. Six patients experienced a recurrence of headache symptoms. There was no statistically significant difference between short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing and short-lasting unilateral neuralgiform headache attacks in the response to surgery (P\u2009=\u20090.463). Responders at the last follow-up were, however, more likely to not have interictal pain (77.42% versus 22.58%, P\u2009=\u20090.021) and to show morphological changes on the MRI (78.38% versus 21.62%, P\u2009=\u20090.001). The latter outcome was confirmed in the Kaplan\u2013Meyer analysis, where patients with no morphological changes were more likely to relapse overtime compared to those with morphological changes (P\u2009=\u20090.0001). All but one patient, who obtained an excellent response without relapse, discontinued their preventive medications. Twenty-two post-surgery adverse events occurred in 18 patients (46.8%) but no mortality or severe neurological deficit was seen. Trigeminal microvascular decompression may be a safe and effective long-term treatment for patients suffering short-lasting unilateral neuralgiform headache attacks with MRI evidence of neurovascular conflict with morphological changes.<\/jats:p>","DOI":"10.1093\/brain\/awac109","type":"journal-article","created":{"date-parts":[[2022,3,22]],"date-time":"2022-03-22T12:21:02Z","timestamp":1647951662000},"page":"2882-2893","source":"Crossref","is-referenced-by-count":21,"title":["Trigeminal microvascular decompression for short-lasting unilateral neuralgiform headache attacks"],"prefix":"10.1093","volume":"145","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2780-4776","authenticated-orcid":false,"given":"Giorgio","family":"Lambru","sequence":"first","affiliation":[{"name":"Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susie","family":"Lagrata","sequence":"additional","affiliation":[{"name":"Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7796-0702","authenticated-orcid":false,"given":"Andrew","family":"Levy","sequence":"additional","affiliation":[{"name":"Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5438-6549","authenticated-orcid":false,"given":"Sanjay","family":"Cheema","sequence":"additional","affiliation":[{"name":"Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indran","family":"Davagnanam","sequence":"additional","affiliation":[{"name":"Lysholm Department of Neuroradiology, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6747-7650","authenticated-orcid":false,"given":"Khadija","family":"Rantell","sequence":"additional","affiliation":[{"name":"Biostatistician, Education Unit, UCL Queen Square Institute of Neurology , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Kitchen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital for Neurology and Neurosurgery , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6013-4946","authenticated-orcid":false,"given":"Ludvic","family":"Zrinzo","sequence":"additional","affiliation":[{"name":"Functional Neurosurgery Unit, Department of Clinical & Motor Neurosciences, UCL Queen Square Institute of Neurology, University College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4960-2294","authenticated-orcid":false,"given":"Manjit","family":"Matharu","sequence":"additional","affiliation":[{"name":"Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,23]]},"reference":[{"key":"2022082719581841500_awac109-B1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/0333102417738202","article-title":"Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders, 3rd edition","volume":"38","year":"2018","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B2","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1097\/WCO.0000000000000090","article-title":"SUNCT, SUNA and trigeminal neuralgia: Different disorders or variants of the same disorder?","author":"Lambru","year":"2014","journal-title":"Curr Opin Neurol"},{"key":"2022082719581841500_awac109-B3","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1002\/1531-8249(199911)46:5<791::AID-ANA18>3.0.CO;2-8","article-title":"Functional magnetic resonance imaging in spontaneous attacks of SUNCT: Short-lasting neuralgiform headache with conjunctival injection and tearing","volume":"46","author":"May","year":"1999","journal-title":"Ann Neurol"},{"key":"2022082719581841500_awac109-B4","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1111\/j.1468-2982.2007.01352.x","article-title":"Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing","volume":"27","author":"Cohen","year":"2007","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B5","doi-asserted-by":"crossref","first-page":"3619","DOI":"10.1093\/brain\/awaa331","article-title":"Trigeminal neurovascular contact in SUNCT and SUNA: A cross-sectional magnetic resonance study","volume":"143","author":"Lambru","year":"2020","journal-title":"Brain"},{"key":"2022082719581841500_awac109-B6","doi-asserted-by":"crossref","first-page":"e1127","DOI":"10.1212\/WNL.0000000000008134","article-title":"A prospective comparative study and analysis of predictors of SUNA and SUNCT","volume":"93","author":"Lambru","year":"2019","journal-title":"Neurology"},{"key":"2022082719581841500_awac109-B7","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s10072-013-1366-0","article-title":"SUNCT and SUNA: Medical and surgical treatments","volume":"34","author":"Lambru","year":"2013","journal-title":"Neurol Sci"},{"key":"2022082719581841500_awac109-B8","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1177\/0333102417739304","article-title":"Phenotypic and treatment outcome data on SUNCT and SUNA, including a randomised placebo-controlled trial","volume":"38","author":"Weng","year":"2018","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B9","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1136\/jnnp-2020-323999","article-title":"Medical treatment of SUNCT and SUNA: A prospective open-label study including single-arm meta-analysis","volume":"92","author":"Lambru","year":"2021","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2022082719581841500_awac109-B10","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1046\/j.1468-2982.2002.00348.x","article-title":"Two cases of medically and surgically intractable SUNCT: A reason for caution and an argument for a central mechanism","volume":"22","author":"Black","year":"2002","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B11","first-page":"29","article-title":"Occipital nerve stimulation in the treatment of medically intractable SUNCT and SUNA","volume":"17","author":"Lambru","year":"2014","journal-title":"Pain Physician"},{"key":"2022082719581841500_awac109-B12","doi-asserted-by":"crossref","first-page":"2631","DOI":"10.1093\/brain\/aww204","article-title":"Ventral tegmental area deep brain stimulation in refractory short-lasting unilateral neuralgiform headache attacks","volume":"139","author":"Miller","year":"2016","journal-title":"Brain"},{"key":"2022082719581841500_awac109-B13","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1177\/0333102417721716","article-title":"Long-term follow up of intractable chronic short lasting unilateral neuralgiform headache disorders treated with occipital nerve stimulation","volume":"38","author":"Miller","year":"2018","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B14","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1136\/practneurol-2015-001298","article-title":"Neurostimulation in the treatment of primary headaches","volume":"16","author":"Miller","year":"2016","journal-title":"Pract Neurol"},{"key":"2022082719581841500_awac109-B15","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1177\/0333102414543331","article-title":"Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: Long-term results from a randomized, multicenter, double-blinded, controlled study","volume":"35","author":"Dodick","year":"2015","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B16","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1046\/j.1468-2982.2001.00252.x","article-title":"A case of a patient with SUNCT syndrome treated with Jannetta procedure","volume":"21","author":"Gardella","year":"2001","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B17","doi-asserted-by":"crossref","first-page":"E413","DOI":"10.1227\/01.NEU.0000147981.90703.8F","article-title":"Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome treated with microvascular decompression of the trigeminal nerve: Case report","volume":"56","author":"Lagares","year":"2005","journal-title":"Neurosurgery"},{"key":"2022082719581841500_awac109-B18","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.pain.2004.09.021","article-title":"SUNCT: Bilateral hypothalamic activation during headache attacks and resolving of symptoms after trigeminal decompression","volume":"113","author":"Sprenger","year":"2005","journal-title":"Pain"},{"key":"2022082719581841500_awac109-B19","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1212\/01.wnl.0000342483.46328.1a","article-title":"Video neuroimage: Symptomatic SUNCT syndrome cured after trigeminal neurovascular contact surgical decompression","volume":"72","author":"Guerreiro","year":"2009","journal-title":"Neurology"},{"key":"2022082719581841500_awac109-B20","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1111\/j.1468-2982.2009.01943.x","article-title":"Microvascular decompression may be effective for refractory SUNCT regardless of symptom duration","volume":"30","author":"Irimia","year":"2010","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B21","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1136\/jnnp.2009.182824","article-title":"Microvascular decompression of the trigeminal nerve in the treatment of SUNCT and SUNA","volume":"81","author":"Williams","year":"2010","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2022082719581841500_awac109-B22","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1177\/0333102417735847","article-title":"Microvascular decompression or neuromodulation in patients with SUNCT and trigeminal neurovascular conflict?","volume":"38","author":"Hassan","year":"2018","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B23","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1177\/0333102413485658","article-title":"The International Classification of Headache Disorders 3rd edition (beta version)","volume":"33","author":"Headache Classification Subcommittee of the International Headache Society","year":"2013","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B24","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1212\/01.wnl.0000341279.17344.c9","article-title":"Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients","volume":"72","author":"Burns","year":"2009","journal-title":"Neurology"},{"key":"2022082719581841500_awac109-B25","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1056\/NEJM199604253341701","article-title":"The long-term outcome of microvascular decompression for trigeminal neuralgia","volume":"334","author":"Barker","year":"1996","journal-title":"N Engl J Med"},{"key":"2022082719581841500_awac109-B26","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/00006123-200208000-00023","article-title":"Is the root entry\/exit zone important in microvascular compression syndromes?","volume":"51","author":"De Ridder","year":"2002","journal-title":"Neurosurgery"},{"key":"2022082719581841500_awac109-B27","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1227\/01.NEU.0000223501.27220.69","article-title":"Microanatomy of the central myelin-peripheral myelin transition zone of the trigeminal nerve","volume":"59","author":"Peker","year":"2006","journal-title":"Neurosurgery"},{"key":"2022082719581841500_awac109-B28","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1111\/ene.13950","article-title":"European Academy of Neurology guideline on trigeminal neuralgia","volume":"26","author":"Bendtsen","year":"2019","journal-title":"Eur J Neurol"},{"key":"2022082719581841500_awac109-B29","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/978-1-4419-6646-9_2","volume-title":"Survival analysis. Statistics for biology and health","author":"Kleinbaum","year":"2012"},{"key":"2022082719581841500_awac109-B30","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.2517-6161.1972.tb00899.x","article-title":"Regression models and life tables","volume":"B34","author":"Cox","year":"1972","journal-title":"J R Stat Soc"},{"key":"2022082719581841500_awac109-B31","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1177\/0333102418758283","article-title":"Guidelines of the International Headache Society for controlled trials of preventive treatment of chronic migraine in adults. International Headache Society Clinical Trials Standing Committee","volume":"38","author":"Tassorelli","year":"2018","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B32","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1093\/brain\/awu349","article-title":"Significance of neurovascular contact in classical trigeminal neuralgia","volume":"138","author":"Maarbjerg","year":"2015","journal-title":"Brain"},{"key":"2022082719581841500_awac109-B33","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1007\/s00701-017-3250-9","article-title":"Nerve atrophy in trigeminal neuralgia due to neurovascular compression and its association with surgical outcomes after microvascular decompression","volume":"159","author":"Cheng","year":"2017","journal-title":"Acta Neurochir (Wien)"},{"key":"2022082719581841500_awac109-B34","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.3171\/2014.12.JNS142086","article-title":"Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia","volume":"123","author":"Duan","year":"2015","journal-title":"J Neurosurg"},{"key":"2022082719581841500_awac109-B35","doi-asserted-by":"crossref","first-page":"210","DOI":"10.3171\/2011.4.JNS101843","article-title":"The importance of autonomic symptoms in trigeminal neuralgia. Clinical article","volume":"115","author":"Simms","year":"2011","journal-title":"J Neurosurg"},{"key":"2022082719581841500_awac109-B36","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1046\/j.1468-2982.2002.00330.x","article-title":"Objective assessment of autonomic signs during triggered first division trigeminal neuralgia","volume":"22","author":"Pareja","year":"2002","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B37","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1046\/j.1526-4610.1997.3706346.x","article-title":"Trigeminal neuralgia clinical manifestations of first division involvement","volume":"37","author":"Sjaastad","year":"1997","journal-title":"Headache"},{"key":"2022082719581841500_awac109-B38","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1007\/BF01418516","article-title":"Facial pain. IV. A prospective study of 1052 patients with a view of: Precipitating factors, associated symptoms, objective psychiatric and neurological symptoms","volume":"108","author":"Rasmussen","year":"1991","journal-title":"Acta Neurochir (Wien)"},{"key":"2022082719581841500_awac109-B39","doi-asserted-by":"crossref","first-page":"367","DOI":"10.3171\/jns.1952.9.4.0367","article-title":"Trigeminal neuralgia; A review of six hundred and eighty-nine cases with a follow-up study of sixty five per cent of the group","volume":"9","author":"Peet","year":"1952","journal-title":"J Neurosurg"},{"key":"2022082719581841500_awac109-B40","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1111\/head.12384","article-title":"Concomitant persistent pain in classical trigeminal neuralgia\u2013evidence for different subtypes","volume":"54","author":"Maarbjerg","year":"2014","journal-title":"Headache"},{"key":"2022082719581841500_awac109-B41","doi-asserted-by":"crossref","first-page":"527","DOI":"10.3171\/jns.2002.96.3.0527","article-title":"Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: Comparison of results following microvascular decompression","volume":"96","author":"Tyler-Kabara","year":"2002","journal-title":"J Neurosurg"},{"key":"2022082719581841500_awac109-B42","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1177\/0333102420949206","article-title":"Concomitant continuous pain in patients with trigeminal neuralgia is associated with trigeminal nerve root atrophy","volume":"40","author":"Di Stefano","year":"2020","journal-title":"Cephalalgia"},{"key":"2022082719581841500_awac109-B43","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1097\/00002508-200201000-00002","article-title":"Pathophysiology of trigeminal neuralgia: The ignition hypothesis","volume":"18","author":"Devor","year":"2002","journal-title":"Clin J Pain"},{"key":"2022082719581841500_awac109-B44","doi-asserted-by":"crossref","first-page":"e884","DOI":"10.1016\/j.wneu.2019.05.022","article-title":"Adverse events after microvascular decompression: a national surgical quality improvement program analysis","volume":"128","author":"Cote","year":"2019","journal-title":"World Neurosurg"}],"container-title":["Brain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/brain\/advance-article-pdf\/doi\/10.1093\/brain\/awac109\/45110513\/awac109.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/brain\/article-pdf\/145\/8\/2882\/45599764\/awac109.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/brain\/article-pdf\/145\/8\/2882\/45599764\/awac109.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T20:20:19Z","timestamp":1726863619000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/brain\/article\/145\/8\/2882\/6553134"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,23]]},"references-count":44,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,3,23]]},"published-print":{"date-parts":[[2022,8,27]]}},"URL":"https:\/\/doi.org\/10.1093\/brain\/awac109","relation":{},"ISSN":["0006-8950","1460-2156"],"issn-type":[{"value":"0006-8950","type":"print"},{"value":"1460-2156","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,8,1]]},"published":{"date-parts":[[2022,3,23]]}}}