{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:47:37Z","timestamp":1792176457173,"version":"4.4.0"},"reference-count":14,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Microvascular decompression (MVD) is an effective intervention in patients with trigeminal neuralgia (TN). How prior rhizotomy can impact long-term pain outcomes following MVD is not well understood. In this study, the authors sought to compare pain outcomes in patients who had undergone primary MVD versus those who had undergone secondary MVD after a single or multiple rhizotomies.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors retrospectively reviewed the data on all patients who had undergone MVD at their institution from 2007 to 2020. Patients were included in the study if they had undergone primary MVD or if their surgical history was notable for past rhizotomy. Barrow Neurological Institute (BNI) pain scores were assigned at preoperative and final follow-up appointments. Perioperative complications were noted for each patient, and evidence of pain recurrence was recorded as well. A history of rhizotomy as well as other variables that might influence TN pain recurrence were evaluated using a Cox proportional hazards model. The impact of prior rhizotomy on TN pain recurrence following MVD was further assessed using Kaplan-Meier survival analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of 1044 patients reviewed, 947 met the study inclusion criteria. Of these, 796 patients had undergone primary MVD, 84 had a history of a single rhizotomy before MVD, and 67 had a history of \u2265 2 rhizotomies prior to MVD. Patients in the single rhizotomy and multiple rhizotomies cohorts exhibited a greater frequency of preoperative numbness (p &lt; 0.001), higher preoperative BNI pain scores (p &lt; 0.005), and higher rates of postoperative numbness (p = 0.04). However, final follow-up BNI pain scores were not significantly different between the primary MVD and prior rhizotomy groups (p = 0.34). Cox proportional hazards analysis revealed that younger age, multiple sclerosis, and female sex independently predicted an increased risk of pain recurrence following MVD. Neither a history of a single prior rhizotomy nor a history of multiple prior rhizotomies independently increased the risk of pain recurrence. Furthermore, Kaplan-Meier analysis of pain-free survival among the 3 groups revealed no relationship between a history of prior rhizotomy and pain recurrence following MVD (p = 0.57).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Percutaneous rhizotomy does not complicate outcomes following subsequent MVD for TN pain. However, patients undergoing rhizotomy before MVD may have an increased risk of postoperative facial numbness compared to that in patients undergoing primary MVD.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.8.jns231345","type":"journal-article","created":{"date-parts":[[2023,10,21]],"date-time":"2023-10-21T01:30:53Z","timestamp":1697851853000},"page":"1155-1159","source":"Crossref","is-referenced-by-count":2,"title":["The influence of prior percutaneous rhizotomy on outcomes following microvascular decompression for trigeminal neuralgia"],"prefix":"10.3171","volume":"140","author":[{"given":"Sumil K.","family":"Nair","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Kalluri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Ran","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Collin","family":"Kilgore","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyra","family":"Halbert-Elliott","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chetan","family":"Bettegowda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risheng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"8","key":"b1","series-title":"N Engl J Med","first-page":"754","article-title":"Trigeminal neuralgia","volume":"383","author":"Cruccu G","year":"2020","unstructured":"Cruccu G, Di Stefano G, Truini A. Trigeminal neuralgia. N Engl J Med. 2020;383(8):754\u2013762."},{"issue":"1","key":"b2","series-title":"Ann Neurol","first-page":"89","article-title":"Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984","volume":"27","author":"Katusic S","year":"1990","unstructured":"Katusic S, Beard CM, Bergstralh E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol. 1990;27(1):89\u201395."},{"issue":"14","key":"b3","series-title":"Med J Aust","first-page":"494","article-title":"The treatment of trigeminal neuralgia: a clinical trial of carbamazepine (\"tegretol\")","volume":"1","author":"Burke WJ","year":"1965","unstructured":"Burke WJ, Grant JM, Selby G. The treatment of trigeminal neuralgia: a clinical trial of carbamazepine (\"tegretol\"). Med J Aust. 1965;1(14):494\u2013498."},{"issue":"1","key":"b4","series-title":"BMJ Open","first-page":"e017392","article-title":"Comparative efficacy and acceptability of antiepileptic drugs for classical trigeminal neuralgia: a Bayesian network meta-analysis protocol","volume":"8","author":"Qin Z","year":"2018","unstructured":"Qin Z, Xie S, Mao Z,  Comparative efficacy and acceptability of antiepileptic drugs for classical trigeminal neuralgia: a Bayesian network meta-analysis protocol. BMJ Open. 2018;8(1):e017392."},{"issue":"1","key":"b5","series-title":"J Neurosurg","first-page":"270","article-title":"Internal neurolysis versus intraoperative glycerin rhizotomy for trigeminal neuralgia","volume":"138","author":"Xu R","year":"2022","unstructured":"Xu R, Materi J, Raj D,  Internal neurolysis versus intraoperative glycerin rhizotomy for trigeminal neuralgia. J Neurosurg. 2022;138(1):270\u2013275."},{"key":"b6","series-title":"World Neurosurg","first-page":"e542","article-title":"Outcomes after microvascular decompression for sole arterial versus venous compression in trigeminal neuralgia","volume":"173","author":"Nair SK","year":"2023","unstructured":"Nair SK, Xie ME, Ran K,  Outcomes after microvascular decompression for sole arterial versus venous compression in trigeminal neuralgia. World Neurosurg. 2023;173:e542\u2013e547."},{"issue":"5","key":"b7","series-title":"Neurosurgery","first-page":"1029","article-title":"Multiple vessel compression of the trigeminal nerve is associated with worse outcomes in trigeminal neuralgia after microvascular decompression","volume":"92","author":"So RJ","year":"2023","unstructured":"So RJ, Kalluri AL, Zhu S,  Multiple vessel compression of the trigeminal nerve is associated with worse outcomes in trigeminal neuralgia after microvascular decompression. Neurosurgery. 2023;92(5):1029\u20131034."},{"key":"b8","series-title":"World Neurosurg","first-page":"e431","article-title":"Sex-specific pain outcomes following microvascular decompression for trigeminal neuralgia","volume":"173","author":"Kilgore CB","year":"2023","unstructured":"Kilgore CB, So RJ, Storm K,  Sex-specific pain outcomes following microvascular decompression for trigeminal neuralgia. World Neurosurg. 2023;173:e431\u2013e435."},{"issue":"3","key":"b9","series-title":"Neurol India","first-page":"688","article-title":"Microvascular decompression versus stereotactic radiosurgery as primary treatment modality for trigeminal neuralgia: a systematic review and meta-analysis of prospective comparative trials","volume":"66","author":"Sharma R","year":"2018","unstructured":"Sharma R, Phalak M, Katiyar V, Borkar S, Kale SS, Mahapatra AK. Microvascular decompression versus stereotactic radiosurgery as primary treatment modality for trigeminal neuralgia: a systematic review and meta-analysis of prospective comparative trials. Neurol India. 2018;66(3):688\u2013694."},{"issue":"17","key":"b10","series-title":"N Engl J Med","first-page":"1077","article-title":"The long-term outcome of microvascular decompression for trigeminal neuralgia","volume":"334","author":"Barker FG II","year":"1996","unstructured":"Barker FG II, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334(17):1077\u20131083."},{"issue":"5","key":"b11","series-title":"Oper Neurosurg (Hagerstown)","first-page":"262","article-title":"Case series in the utility of invasive blood pressure monitoring in microvascular decompression","volume":"22","author":"Xu R","year":"2022","unstructured":"Xu R, Nair SK, Materi J,  Case series in the utility of invasive blood pressure monitoring in microvascular decompression. Oper Neurosurg (Hagerstown). 2022;22(5):262\u2013268."},{"key":"b12","series-title":"J Pain Res","first-page":"3437","article-title":"Trigeminal neuralgia: current approaches and emerging interventions","volume":"14","author":"Xu R","year":"2021","unstructured":"Xu R, Xie ME, Jackson CM. Trigeminal neuralgia: current approaches and emerging interventions. J Pain Res. 2021;14:3437\u20133463."},{"issue":"1","key":"b13","series-title":"J Neurosurg","first-page":"104","article-title":"Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia","volume":"60","author":"Barba D","year":"1984","unstructured":"Barba D, Alksne JF. Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia. J Neurosurg. 1984;60(1):104\u2013107."},{"issue":"5","key":"b14","series-title":"J Neurosurg","first-page":"1691","article-title":"Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia","volume":"126","author":"Theodros D","year":"2017","unstructured":"Theodros D, Rory Goodwin C, Bender MT,  Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia. J Neurosurg. 2017;126(5):1691\u20131697."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/140\/4\/article-p1155.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/140\/4\/article-p1155.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/140\/4\/article-p1155.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,25]],"date-time":"2024-05-25T10:19:56Z","timestamp":1716632396000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/140\/4\/article-p1155.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,1]]},"references-count":14,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2023.8.jns231345","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,1]]}}}