Microvascular decompression as a surgical management for trigeminal neuralgia: A critical review of the literature

Abstract

Trigeminal neuralgia (TN) is a common pain syndrome and is characterized by recurrent episodes of intense lancinating pain in one or more divisions of the trigeminal nerve. Neurovascular compression (NVC) has been considered as the main cause of TN in the root entry zone (REZ) of the trigeminal nerve in the cerebellopontine angle cistern. Microvascular decompression (MVD) is the surgical procedure of choice for the treatment of medically refractory TN. MVD has also been shown to provide pain relief even in patients without visible neurovascular compression. Additionally, it has been accepted that MVD can provide the highest rate of long-term patient satisfaction with the lowest rate of pain recurrence. We did, systematic review of the subject and also our own experiences.

Microvascular Decompression: Salient Surgical Principles and Technical Nuances

“…After an internal review of the data, which demonstrated an elevated CSF leak of 25%, the protocol was changed to include buttressing with either a methylmethacrylate flap or replacement of the bone flap prior to wound closure. Since this time, our CSF leak rate has approximated 8%-consistent with other rates (2.4 -12%) reported in the literature 7,13 . The percentage of our patients reporting hearing loss (3%) also approximates figures reported in the literature (0.8-2.8%) 1,2,12,13 , .…”

“…However, the majority of patients require more definitive surgical measures6. Both microvascular decompression (MVD) and ablative procedures (e.g., radiosurgery, percutaneous radiofrequency lesioning, balloon compression, or glycerol rhizolysis) have been shown to be effective at controlling trigeminal neuralgia symptoms acutely-however, MVD has been demonstrated to be superior in preventing long-term recurrence 7 .…”

“…Additionally, recurrence of symptoms has been reported to occur in as many as 39% of patients 10,11 following this procedure. In addition to being correlated with intraoperative variables such as nerve location, blood vessel, type and duration of symptoms 6,7 , the rate of recurrence also has been correlated with experience of the surgeon and hospital in performing MVD 12 . With proper technique, patient outcome can be maximized and adverse outcomes can be reduced.…”

To be or not to be a neurovascular conflict: importance of the preoperative identification of the neurovascular conflict in the trigeminal neuralgia

“…Even though the initial treatment is the medical one, with antiepileptic drugs, the neurovascular decompression represents the election treatment in the NVCS, being the most efficient treatment to achieve initial and long-term pain control for TN (2,25,55), with a success rate of 63%-94% (3,5,11,26,35,51) and a complications rate of almost 1-5% (3,5,6). Moreover, in 91-97% of the cases, pain relief appears immediately after the surgery (19).…”

Persistent primitive trigeminal artery as a cause of trigeminal neuralgia and persistent primitive trigeminal artery associated with pituitary adenoma: Two case reports

“…Although patients are usually asymptomatic, it has been reported that it may accompany third and sixth cranial nerve palsies, aneurysms, vascular anomalies and hemifacial spasm [2][3][4]. The pituitary lesions accompanying PPTA and trigeminal neuralgia (TN) associated with a PPTA are rarely seen [5][6][7][8][9][10]. Knowledge of the typical imaging findings of PPTA prevents major surgical complications [8].…”