Cranial nerve neuralgias have increasingly been treated with microvascular decompression surgery to the detriment of percutaneous rhizotomies since 2000, according to a study published in Headache.

Patients with cranial nerve neuralgias and hemifacial spasm who cannot tolerate or do not respond to medication may benefit from interventional treatment, including percutaneous nerve destruction (eg, with glycerol injection, balloon compression, or radiofrequency ablation).

Information from the Center for Medicare and Medicaid Services Part B National Summary Data File was analyzed for the period from 2000 to 2016 and individuals diagnosed with cranial nerve compression syndromes were identified using related International Classification of Diseases and Current Procedural Terminology codes.

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An increase of 17.5 million enrollees in Medicare and Medicaid was observed between 2000 (39.6 individuals) and 2016 (57.1 million individuals). During that time period, cranial nerve decompression of cranial nerves V, VII, or IX using suboccipital craniectomy increased from 655 cases to 1096 cases, resulting in a 167% rise over 17 years, for an average increase of 33.9 cases per year (95% CI, 26.2-41.7; P <.001). The number of microvascular decompression surgeries rose from 25 cases in 2000 to 46 cases in 2016, corresponding to a 184% (1.13 cases per year) increase (95% CI, 0.37-1.88; P =.006). The number of percutaneous rhizotomies decreased from 2578 cases in 2000 to 1206 cases in 2016 — a reduction of 42.9 cases per year (95% CI, −56.0 to −29.9; P <.001).

Study limitations include a lack of specific diagnoses and outcomes for each patient and the lack of differentiation of trigeminal neuralgia from other neuralgias.

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“[The observed increased use of microvascular decompression surgery for the treatment of cranial nerve neuralgias] may be related to the improved efficacy of [microvascular decompression] compared with percutaneous methods and improved inpatient care for patients receiving craniotomies. This information may help clinicians counsel patients with [trigeminal neuralgia] and other cranial neuralgias with regard to their options,” concluded the study authors.

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Kundu B, Rolston JD. Nationwide shift from percutaneous rhizotomy to microvascular decompression for treatment of trigeminal and other cranial nerve neuralgias [published online October18, 2018]. Headache. doi:10.1111/head.13425