Tag: anticonvulsant

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Effects of the length of preoperative conservative management on postoperative outcomes after primary microvascular decompression for trigeminal neuralgia

J Neurosurg 143:92–99, 2025

Prolonged preoperative conservative management with anticonvulsants in trigeminal neuralgia is associated with worse pain outcomes and higher pain recurrence after microvascular decompression. Early surgical intervention may improve postoperative results and reduce pain recurrence risk in these patients.

• Longer duration of preoperative conservative management (anticonvulsant use) before microvascular decompression (MVD) for trigeminal neuralgia (TN) is linked to worse postoperative pain outcomes and higher risk of pain recurrence.

• Median duration of conservative management before surgery was 1.74 years.

• Patients with longer conservative management had higher final BNI pain scores and greater rates of pain recurrence than those with shorter management.

• Longer conservative management predicted shorter pain-free survival after MVD.

• Younger age and longer conservative management duration were independent predictors of worse postoperative pain and recurrence.

• No significant difference in preoperative pain scores between groups; both had high pain levels pre-surgery.

• Findings suggest early surgical intervention may benefit TN patients who are candidates for MVD.

• Study was retrospective and single-institution, limiting generalizability; further research is needed.

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Anticonvulsant prophylaxis for brain tumor surgery

Seizures frequency

J Neurosurg 121:1139–1147, 2014

Patients who undergo craniotomy for brain tumor resection are prone to experiencing seizures, which can have debilitating medical, neurological, and psychosocial effects.

A controversial issue in neurosurgery is the common practice of administering perioperative anticonvulsant prophylaxis to these patients despite a paucity of supporting data in the literature. The foreseeable benefits of this strategy must be balanced against potential adverse effects and interactions with critical medications such as chemotherapeutic agents and corticosteroids. Multiple disparate metaanalyses have been published on this topic but have not been applied into clinical practice, and, instead, personal preference frequently determines practice patterns in this area of management.

Therefore, to select the current best available evidence to guide clinical decision making, the literature was evaluated to identify meta-analyses that investigated the efficacy and/or safety of anticonvulsant prophylaxis in this patient population. Six meta-analyses published between 1996 and 2011 were included in the present study.

The Quality of Reporting of Meta-analyses and Oxman-Guyatt methodological quality assessment tools were used to score these meta-analyses, and the Jadad decision algorithm was applied to determine the highest-quality meta-analysis. According to this analysis, 2 metaanalyses were deemed to be the current best available evidence, both of which conclude that prophylactic treatment does not improve seizure control in these patients.

Therefore, this management strategy should not be routinely used.

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