MVD for trigeminal neuralgia; neuralgia revisited with review of literature

Abstract

INTRODUCTIONTrigeminal neuralgia (TN) is a disorder characterized by sudden sharp, shooting, lancinating pain attacks lasting several seconds to several minutes and localized to one or two branches of the trigeminal nerve. These attacks may begin spontaneously or they can be initiated by stimulation of the so-called trigger zones. The classic episodes of shooting pain are interrupted by pain-free intervals with remissions occasionally lasting for years. 1It is an uncommon craniofacial pain syndrome, representing 0.2-1.3% of facial pain syndromes, with an annual incidence of 0.7 cases per 100,000 habitants per year according to a population-based study. [2][3][4] In some cases, it is associated with excessive vagal outflow; which leads to bradycardia, hypotension, syncope or cardiac arrest. [5][6][7] Dandy elucidated the pathophysiology of trigeminal neuralgia and proposed vascular compression at the root of the trigeminal nerve as the main etiology, causing demyelinization, and ephaptic transmission. 8,9 It is shown ABSTRACT Background: Trigeminal neuralgia (TN) s an uncommon facial pain syndrome. It is commonly characterized by sudden onset of an attack of intense electric shock like facial pain localized along the sensory distribution of the ninth cranial nerve. Although many patients respond to the medical line of treatment but when PTS symptoms become intractable and could not tolerate the medications have to go for surgical decompression. Our study aims to review about micro vascular decompression for trigeminal neuralgia and its outcome along with the review of literature. Methods: It is a retrospective study conducted on 40 cases who were diagnosed with TN. between the period of July 2009 to July 2015. MVD has been performed on all the patients. Demographic data, clinical presentation, surgical findings, complications and long term follow-up were reviewed. Results:The median age of onset of TN is 50.4 years divided into five age groups ranging from 24 to 89 years with female preponderance showing 65.5% as compared to males. The distribution of location was in the ratio of right to left is 1.5:1. There was no mortality is seen in the study. 3 patients among them study population had complications 3 patients had facial hyposthesia, 1 patient had V3 paresis and 1 patient had CSF otorrhoea which got settled with drainage LP. All the patients had satisfactory improvement except one patient who had persistent pain. Conclusions: To conclude micro vascular decompression (MVD) is the surgical procedure of choice for the treatment of medically refractory TN who is fit for surgery. Of all the currently available surgical methods MVD provides the highest rate of long term satisfaction for the patients and offers the lowest rate of pain recurrence.