Effectiveness of Microvascular Decompression for the Treatment of Idiopathic Trigeminal Neuralgia

Authors

  • Sohail Amir Neurosurgery Naseer Teaching Hospital, Peshawar
  • MAIMOONA QADIR Department of Gynae & Obstetric Unit,
  • MUHAMMAD USMAN 3Department of Neurosurgery, Naseer Ullah Babar Memorial Hospital, Peshawar

Keywords:

Microvascular decompression, Trigeminal neuralgia, Efficacy.

Abstract

Objective: To review the efficacy and safety of microvascular decompression for idiopathic trigeminal neuralgia.
Materials and Methods: This descriptive cross sectional study was conducted at Neurosurgery Department of Naseer teaching Hospital, Peshawar from 1st January 2016 to 31st December2017. All patients fulfilling the inclusion criteria undergo micro vascular decompression (MVD). MRI brain was done in all patient to exclude the secondary cause. Patients were examined on 5th post operative day and clinical finding documented. Outcome of surgery is determined by visual analogue scale in which Pain was graded as no pain (0 score), mild (1 – 3), moderate (4 – 7), severe (8 – 10) to see the pain relief.
Results: Forty four patients were operated for trigeminal neuralgia (TN). There were 18 (41%) males and 26 (59%) females. Mean age was 33 years. Entry zone of trigeminal nerve was point of conflict in 33 (75%) patients. The mandibular division (V2) was involved in 26 (59%) patients, followed by maxillary division (V3) in 13 (29.54%) patients and ophthalmic division (V1) in 5 (11.36%) cases. At fifth postoperative day, status of pain relief was analyzed amongst 44 patients and it was observed that 37 (84.09%) patients had no pain, 5 (11.36%) had mild pain and 1 (2.27%) had severe pain. Postoperative complications were observed as nausea and vomiting in 15 (34.09%) patients, Diplopia in 6 (13.63%), facial palsy in 6 (13.63%), CSF leak in 5 (11.36%), mild deafness in 5 (11.36%), wound infection in 4 (9.09%) and cerebellar infarction in 3 (6.81%) patients.
Conclusion: Microvascular decompression is an effective surgical option for trigeminal neuralgia refractory to medical treatment.

References

1. Chen JF, Lee ST. Comparison of percutaneous trigemi-nal ganglion compression and microvascular decom-pression for the management of trigeminal neuralgia. Clin Neurol Neurosurg. 2003; 105: 203-8.
2. Civelek E, Causever T, Imer M. Trigeminal neuralgia and treatment options. Agri. 2005; 17: 19-26.
3. De Siqueira SR, da Nobrega JC. Mastiatory problems after balloon compression for trigeminal neuralgia: A longitudinal study. J Oral Rehab. 2007; 34: 88-96.
4. Pamir MN, Peker S. Microvascular decompression for trigeminal neuralgia: A long term follow up study. Minim Invas Neurosurg. 2006; 49: 342-6.
5. Satoh T, Onoda K. Preoperative simulation for micro-vascular decompression in patients in patients with idiopathic trigeminal neuralgia: Visualisation with three dimensional magnetic resonance cisternogram and angiogram fusion imaging: Clinial studies. Neurosurg. 2007; 60: 104-14.
6. Tawk RG, Fronekowiak M, Scott BE, Alberico RA. Stereotactic gamma knife surgery for trigeminal neural-gia: Detailed analysis of treatment response. J Neuro-surg. 2005; 12: 787-9.
7. Kanpolat Y, Savas A, Bekar A, Berk C. Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25 year experience with 1600 patients. Neurosurg. 2001; 48: 524-34.
8. Kitt CA, Gruber K, Davis M.Trigeminal neuralgia: Opportunities for research and treatment. Pain, 2000; 85: 3-7.
9. Love S, Caokham HB. Trigeminal neuralgia: Pathology and pahtogenesis. Brain, 2001; 124: 2347-60.
10. Sweet WH, Wepsie JG. Controlled Thermocoagulation of trigeminal ganglion and rootlets for differential des-truction of pain fibres. Part I: Trigeminal Ganglion. J Neurosurg. 1974; 39: 143-56.
11. Taha JM, Tew JM. Comparison of surgical treatments for trigeminal neuralgia: Re evaluation of radiofreque-ncy rhizotomy. Neurosurg. 1996; 38: 865-71.
12. Jannetta PJ. Outcome after microvascular decompress-ion for typical trigeminal neuralgia, hemifacial spasm, tinnitis, disabling positional vertigo and glossopharyn-geal neuralgia. Clin Neurosurg. 1996; 26: 159-62.
13. Lee SH, Levy EI. Recurrent trigeminal neuralgia attri-butable to veins after microvascular decompression. Neurosurg. 2000; 46: 356-62.
14. Cheshire WP. Trigeminal neuralgia: for one nerve a multitude of treatments. Expert Rev Neurother. 2007; 11: 1565-79.
15. Toda K. Etiology of trigeminal neuralgia. Oral Sci International, 2007; 4: 10-8.
16. Toda K. Trigeminal neuralgia – symptoms, diagnosis, classification and related disorders. Oral Sci Internat-ional, 2007; 4: 1-9.
17. Toda K. Operative treatment of trigeminal neuralgia review of current techniques. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106: 788-805.
18. Casey KF. Role of patient history and physical exami-nation in the diagnosis of trigeminal neuralgia. Neuro-surg Focus, 2005; 18 (5): 1.
19. Olson S, Atkinson L, Weidmann M. Microvascular de-compression for trigeminal neuralgia : recurrences and complications. J Clin Neurosci. 2005; 12: 787-9.
20. Aryan HE, Nakaji P, Lu DC. Multimodality treatment of trigeminal neuralgia: impact of radiosurgery and high resolution magnetic resonance imaging. J Clin Neurosci. 2006; 13: 239-44.
21. Reveulta – Gutierrez R, Lopez – Gonzalez MA. Surgi-cal treatment of trigeminal neuralgia without vascular decompression: 20 years of experience. Surg Neurol. 2006; 66: 32-6.
22. Mcleod NM, Patton DW. Peripheral alcohol injection in teh management of trigeminal neuralgia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104: 12-7.
23. Gardner WJ. Concerning the mechanism of trigeminal neuralgia and hemifacial spasm. J Neurosurg. 1962; 19: 947-58.
24. Jannetta PJ. Arterial compression of the trigeminal nerve at teh pons in patients with trigeminal neuralgia. J Neurosurg. 1967; 26: 159-62.
25. Kabatas S, Karasu A. Microvascular decompression as a surgical management for trigeminal neuralgia: a long term follow-up and review of literature. Neurosurgery, 2009; 32: 87-94.
26. Klun B. Microvascular decompression and partial sen-sory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients. Neurosurgery, 1992; 30: 49-52.
27. Kabatas S, Albayrak SA, Cansever T, Hepgul KT. Mic-rovascular decompression as a surgical management for trigeminal neuralgia: A critical review of literature. Neurol India, 2009; 57 (2): 134-7.

Downloads

Published

2018-10-04

Issue

Vol. 21 No. 1 (2017): January-March

Section

Original Articles

License

The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).