Microvascular Decompression and Partial Sensory Rhizotomy in the Treatment of Trigeminal Neuralgia

Abstract

The results of the treatment of trigeminal neuralgia by neurovascular decompression or partial sensory rhizotomy in a personal series of 220 patients are presented. Microvascular decompression was performed in 178 patients and partial sensory rhizotomy in 42. The mean follow-up was 5.2 years. Immediate pain relief was achieved in 94% of all patients, but the rate dropped to 84% during the follow-up period. The recurrence rate in the microvascular decompression group was 6% and in the PSR 49%. Permanent sequelae occurred in 4 patients (loss of hearing, 1; loss of corneal reflex, 1; lesion of the portio minor, 2), but transitory complications (impaired hearing caused by hematotympanum and diplopia) were more frequent, especially in the beginning of the series. Elderly patients tolerated the procedure very well and the percentage of complications was evenly distributed in all age groups. Three patients died. No patient developed painful dysesthesias or anesthesia dolorosa. There were no differences in the outcome, considering sex and age. The duration of symptoms did not influence the prognosis. Patients with severe compression did better than those with a mild one, and patients with an arterial compression did better than those with a venous one. Trigeminal neuralgia in multiple sclerosis is seldom relieved by microvascular decompression. The experience of the surgeon reduces the number of negative findings considerably.

Comparison of Clinical Symptoms and Magnetic Resonance Angiographic (MRA) Results in Patients with Trigeminal Neuralgia and Persistent Idiopathic Facial Pain. Medium-Term Outcome after Microvascular Decompression of Cases with Positive MRA Findings

“…However, there have been reports that NC can not always be found during surgical exploration. These negative findings varied from 4% to 89%, with an average 7.5% (3,(13)(14)(15); the rate in our initial series was 20%. Before considering a posterior cranial fossa exploration for MVD it is advisable to prove the presence of NC of the trigeminal nerve.…”

Pre-operative image-based segmentation of the cranial nerves and blood vessels in microvascular decompression: Can we prevent unnecessary explorations?

“…These patients were treated only with partial sensory rhizotomy and the authors reported a 91% success rate of pain relief 30 . Klun reported 178 patients after MVD and 42 patients after rhizotomy with a follow-up period of up to 12 years (mean 5.2 years) 31 . He excluded patients with “atypical pain.” The 5 year-rate of complete pain relief was 84% for both operations 31 .…”

Trigeminal Neuralgia Related to Megadolichobasilar Artery Compression: A Prospective Series of Twenty-Nine Patients Treated with Gamma Knife Surgery, with More Than One Year of Follow-Up

“…Since his observation, approximately 34 studies of TN caused by vertebral and/or basilar artery compression have been published, usually in the form of case reports [12,16,18,19,20,21,22,23,25,26,27,28,29,31,57,58,59]. In most of them, the incidence of this anatomical condition ranges from 0 to 2.8% [7,13,57,60,61,62], with only 1 large series from Japan reporting a higher incidence (7.7%) [31]. Park et al [30] recently reported a percentage of 2% of the global population treated with GKS.…”