REVIEW

Efetividade da Descompressão Microvascular na Melhora Clínica da Neuralgia Trigeminal: uma revisão sistemática

Effectiveness of Microvascular Decompression in the Improvement of Trigeminal Neuralgia: a systematic review

  • Monique Benemérita Vilela Gomes (1)
  • Amanda Cipriano Torquato (2)
  • Mariana de Jesus Oliveira (3)
  • Matheus de Assis Araújo (4)
  • Silvio Pereira Ramos Junior (5)
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Resumo

Introdução: a neuralgia trigeminal (NT) é uma neuralgia craniofacial, caracterizada comumente como dor unilateral, aguda e recorrente na área de inervação do trigêmeo. A origem da dor por compressão vascular foi primeiramente descrita por Dandy (1934), conceito posteriormente aplicado por Jannetta (1966) para uso de descompressão microvascular (DMV) como tratamento. O uso de novos métodos terapêuticos, como rizotomias tradicional (RT) e percutâneas (RP) com glicerol, compressão com balão ou radiofrequência/termocoagulação ou radiocirurgia estereotáxica (RC), ratifica demanda por comparativos que guiem a abordagem cirúrgica. Entretanto, sua escassez acarreta necessidade de revisões sistemáticas na análise científica. Objetivo: analisar a eficácia no alívio da dor por DMV, comparando-a com outros métodos cirúrgicos. Métodos: revisão sistemática utilizando o fluxograma PRISMA. Utilizou-se os descritores “trigeminal neuralgia” e “microvascular decompression” na base de dados PubMed. Os critérios de inclusão basearam-se na pergunta PICOTT: pacientes com neuralgia do trigêmeo; DMV como intervenção; RT, RP e RC como métodos comparativos; melhora da dor através da escala Barrow Neurological Institute (BNI) pain scale como desfecho primário; sem restrições quanto ao tempo de seguimento, com estudos observacionais e experimentais foram selecionados. Não houve limitação quanto à data de publicação, idade, sexo e classificação da NT. A amostra final contou com 20 artigos. Resultados: melhora clínica geral com DMV foi observada em 86,6% dos pacientes (n=2108). Apenas três estudos eram randomizados, com predominância de coortes retrospectivas; o tempo de acompanhamento variou de logo após a até 10 anos pós-cirurgia. Três estudos comparando DMV com RC, mostraram melhora clínica em 84,6% (n=447) e 64,9% (n=281) dos pacientes, respectivamente. Quatro estudos compararam DMV com RP, com o segundo apresentando 86,1% (n=425) de melhora clínica. Por fim, dois trabalhos compararam DMV com RT, com o último expondo 62,6% (n=99) de eficácia. Conclusão: evidencia-se a limitação do número de estudos comparativos em relação à eficácia dos diversos tratamentos para NT. Não obstante, a descompressão microvascular segue sendo o método de maior aplicabilidade para eliminação da dor.

Palavras-chave

Descompressão microvascular; Neuralgia trigeminal; Rizotomia

Abstract

Introduction: Trigeminal Neuralgia (TN) is a craniofacial neuralgia characterized as unilateral, acute, and recurring pain in the trigeminal nerve area. The pain origin by vascular compression was originally described by Dandy (1934) and applied afterwards by Jannetta (1966) using microvascular decompression (MVD) as treatment. The introduction of new therapeutic methods, such as traditional rhizotomy and percutaneous rhizotomy, with glycerol, balloon compression, thermocoagulation/ radiofrequency, or stereotaxic radiosurgery (SRS) exposes the need of comparisons between the methods, to guide the surgical approach. Moreover, the limited amount of these comparisons indicates the need of systematic reviews in other to analyze this subject. Objective: analyze the efficacy in pain relief when MVD is used, by comparing it to other surgical treatments. Methods: systematic review using the PRISMA fluxogram. The keywords “trigeminal neuralgia” and “microvascular decompression” were used in the PubMed database. The inclusion criteria WAS based on the PICOTT question: patients with TN; MVD as intervention; traditional rhizotomy, percutaneous rhizotomy and SRS as comparison; pain improvement according to the Barrow Neurological Institute (BNI) pain scale as a primary outcome. There were no restrictions as to follow-up time, and observational and experimental studies were selected. There were no limitations considering publication date, age, sex or TN classification. The final sample was composed by 20 articles. Results: clinical improvement with MVD was observed in 86.6% of patients (n=2108). Only three studies were randomized, with a retrospective cohort prevalence; the follow up time varied from right after to until 10 years after surgery. Three studies comparing MVD with RC showed clinical improvement in respectively 84.6% (n=447) and 64.9% (n=281) of patients. Four studies compared MVD with percutaneous rhizotomy, where the second showed a clinical improvement of 86,1%. Finally, 2 studies compared MVD with traditional rhizotomy, showing the latter efficacy of 62.6% (n=99). Conclusion: the limited number of studies comparing the efficacy of TN treatments was brought to light. Furthermore, MVD is still considered the most applicable method for pain eradication.

Keywords

Microvascular decompression; Trigeminal neuralgia; Rhizotomy

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1 Medicine Student, Federal University of Piauí – UFPI, Picos, PI, Brazil.

2 Medicine Student, Vale do Rio Doce University – UNIVALE, Governador Valadares, MG, Brazil.

3 Medicine Student, Faculdade de Ensino Superior da Amazônia Reunida – FESAR, Redenção, PA, Brazil.

4 MD, MR, Medical Residency in Neurosurgery, Faculty of Medicine, Federal University of Vales do Jequitinhonha e Mucuri – UFVJM, Diamantina, MG, Brazil.

5 MD, PhD, Neurosurgeon, Faculty of Medicine, Federal University of Vales do Jequitinhonha e Mucuri – UFVJM, Diamantina, MG, Brazil.

 

Received Dec 12, 2022

Corrected Jan 18, 2023

Accepted Jan 18, 2023

JBNC  Brazilian Journal of Neurosurgery

  •   ISSN (print version): 0103-5118
  •   e-ISSN (online version): 2446-6786

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