Dysesthesia
Dysesthesia is a chronic pain or uncomfortable sensation stemming from the central nervous system.
As with the other procedures, pain can return after an MVD. When the pain does come back, it tends to come back soon after surgery. Several studies have found that more than half the people whose pain recurs after an MVD have pain within the first two years. Long-term studies have found that the pain recurrence rate goes down as time passes.
On average, about six percent of MVD patients get recurrence in the first year, three percent a year get it in years two through four, fewer than two percent get pain back in years five through nine, and fewer than one percent get it in year 10. One recent review noted recurrent symptoms typically occur after a mean of 1.9 pain-free years, with a yearly recurrence risk of one to four percent.
Refractory and recurrent symptoms can occur after radiosurgery or radiofrequency ablation. After ablation, 21 to 50 percent of patients have recurrent TN and 15 percent require retreatment. After radiosurgery, approximately 13 to 22 percent of patients require repeated treatment for recurrent symptoms.
Counting the initial failures along with those who have pain recurrence, one pain specialist came up with the following prospects for MVD patients: 81 percent will be pain-free at two years, 76 percent will be pain-free at five years, and 71 percent will be pain-free at 10 years. Initial failures may happen for several reasons, such as the surgeon was unable to find the offending vessel (or vessels), the nerve wasn’t sufficiently cushioned, or the patient didn’t have TN in the first place.
When pain recurs, it is not because the effects of the MVD ‘wear off’. Rather, the most likely reason is that a divided vein sends out new branches and sets up a compression problem all over again. Or it could be that a different blood vessel elongates with age and causes an altogether new compression point. And sometimes these vessels don’t cause a new compression but instead push away the implanted cushion from between the nerve and the vessel.
Other possible causes of pain recurrence include adhesions that form to cause new damage to the trigeminal nerve or failures of the implant. (Adhesions are fibrous growths that sometimes occur along with scar tissue around the surgical site and implanted pad. Implants occasionally can be absorbed by the body – one example of failure.)
In one long-term study, patients with vein compressions were more likely to have a recurrence of pain. Also, female patients and those who did not get immediate pain relief from the MVD were slightly more likely to have pain return. Although MVDs can be done following other procedures that have failed, the success rates are reportedly lower, but several recent papers did not support that concern.
The best MVD results come when MVD is the first procedure. Repeated MVDs also can be done following a failed MVD. Those success rates also are a bit lower than the first surgery – around 80 percent compared to the 85 to 95 percent range for first- time patients.
Data from MVD Pioneer Dr. Peter Jannetta
Of 1,185 patients on whom he performed an MVD:
Of the 132 patients (11%) who required reoperation:
A study from the Netherlands likewise showed an 11% incidence of repeat MVD surgery. One year after surgery, 66% were free of pain and off medicine, and another 10% required some medicine. Their results were thus quite similar to those of Dr. Jannetta.
Dr. Jannetta noted that veins and smaller arteries were the most common findings present at a second surgery. He also mentioned that the presence of venous compression at the first surgery leads to a higher risk of recurrence. The Netherlands series noted that in 61% of repeat operations, no compression was found. They removed the Teflon pad and suspected that the pad itself had devolved into a form of granuloma and was the cause of pain.
Repeat MVD was associated with a higher incidence of facial numbness (8%) than at the first operation (1%) in Dr. Jannetta’s series. In the Netherlands series, it was 27% because of more extensive exploration.
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Dysesthesia is a chronic pain or uncomfortable sensation stemming from the central nervous system.
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The FPA does not endorse any product, doctor, procedure, medical institution, or its staff.
The FPA does not endorse any product, doctor, procedure, medical institution, or its staff.
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