Article
MVD and trigeminal neuralgia. What to do when the site of the neurovascular compression is missed
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Authors
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A. Delitala
- Department of Neurosurgery, Ospedale "San Camillo”, Rome, Italy
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A. Brunori
- Department of Neurosurgery, Ospedale "San Camillo”, Rome, Italy
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A. Menniti
- Department of Neurosurgery, Ospedale "San Camillo”, Rome, Italy
| Published: | May 30, 2008 |
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Outline
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Objective: Although neuroimaging is improving, the assessment of the real entity of a conflict between the trigeminal nerve and a vascular structure is still an open question. Similarly it is difficult to propose the appropriate surgical option to patients affected by trigeminal neuralgia in which the imaging is unclear. Posterior fossa exploration with microvascular decompression (MVD) is an effective operation. In the literature it is reported to be the more effective primary surgery than others. But, what to do when a true vascular compression is missed at exploration? To try to answer to this question, the authors present their experience in the microsurgical treatment of trigeminal neuralgia (TN).
Methods: From 1990 to 2006, 198 patients suffering from trigeminal neuralgia underwent microsurgical posterior fossa exploration. In 170 (85%) a significant arterial conflict was found and released performing a microvascular decompression (MVD) with excellent or good immediate outcomes. Because of negative intraoperative findings (simple contact or no contact or venous contact), the remaining 28 patients (15%) underwent a partial section of the trigeminal nerve at the root entry zone at the pons (REZL) during the same operation.
Results: The results were excellent in the early period with no postoperative facial pain without any medications and no facial numbness. Within two years, 3 (10%) recurrences in trigeminal REZL group and 21 (12.3%) in MVD one were observed. All were treated with new posterior fossa reexploration. In one case was found a teflon-induced recompression. In the other cases a trigeminal REZ lesion was performed. In the total follow-up period (range: 7–132 months) another 12 (7%) re-explorations with TREZL were performed in MVD group. in 2 cases percutaneous baloon micrompression was performed.
Conclusions: Trigeminal REZL, performed during the same trigeminal nerve exploration, should be preferred to percutaneous treatments in cases of negative exploration (contact or no conflict) or recurrence. The section of half or less of the inferolateral (V1-V2) or superolateral (V3-V2) aspect of the "portio major" allows long-lasting pain relief and good preservation of sensory function.
