Long-term results of microvascular decompression with video endoscopy in the treatment of patients with atypical trigeminal neuralgia

Abstract

The frequency of occurrence of atypical trigeminal neuralgia (aNTN) varies from 1 to 7 people per 100,000 population per year. The main cause of development is compression of the trigeminal nerve root (TN) by a vein and/or artery in the cerebellar cistern. To date, the final tactics of treatment of patients with aNTN have not been determined. The effectiveness of conservative methods of therapy does not exceed 50%. The aim of the study was to evaluate the results of microvascular decompression using video endoscopy in the treatment of patients with atypical trigeminal neuralgia. Methods. In the period from 2014 to 2021 34 patients with atypical HTN were operated on, of which 18 (53%) patients had neuropathic pain (more than 4 points on the DN4 scale), and 15 (44%) patients had a transformation of classical trigeminal neuralgia into atypical. Conservative therapy (carbamazepine, gabapentin, pregabalin), administered to all patients in the preoperative period, was not accompanied by a significant reduction in pain syndrome. The maximum intensity of pain upon admission to the hospital according to the visual analog scale (VAS) was 10 points, according to the severity of pain syndrome BNI (Barrow Neurological Institute) V (severe, persistent pain). All patients underwent internal affairs of the trigeminal nerve root with the use of Teflon; in 12 (35%) patients, in addition to a microscope, video endoscopy was additionally used. The average follow-up period after surgery was 3.4 1.7 years (from 1 to 5 years). Results. In all (100%) patients after surgery, the pain is completely stopped (BNI I). The total fiveyear excellent and good outcome of the disease on the J.Miller and BNI scale (I-II) was noted in 80% (n=27) of patients with atypical NTN. The risk of pain recurrence in the first three years after MVD was 14% (n=3), and after 5 years 34% (n=4). The use of video endoscopy made it possible to identify vessels compressing the root of the trigeminal nerve with minimal displacement of the cerebellum and cranial nerves when visualizing neurovascular conflict. Conclusion. The MVD method with video endoscopy is effective in the treatment of patients with aNTN