Article
Trigeminal neuralgia and multiple sclerosis: Successful microvascular decompression in three cases
Trigeminus-Neuralgie und Multiple Sklerose: Erfolgreiche mikrovaskuläre Dekompression in drei Fällen
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Authors
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Dirk Rasche
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg
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B. Kress
- Neuroradiologische Abteilung, Universitätsklinikum Heidelberg, Heidelberg
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R. Wirtz
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg
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A. Unterberg
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg
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V. Tronnier
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg
| Published: | April 23, 2004 |
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Outline
Text
Objective
The incidence of trigeminal neuralgia is significantly higher in chronic inflammatory diseases like multiple sclerosis. The treatment of choice is pharmacological and carbamazepine is the standard drug. Thermocoagulation in the gasserian ganglion is the operative alternative if medication fails. Although very successful in cases without chronic inflammatory disease, microvascular decompression of the trigeminal nerve in the cerebellopontine angle is not often considered in these patients.
Methods
In three patients with multiple sclerosis and therapy-resistant trigeminal neuralgia, a microvascular decompression of the trigeminal nerve at the root-entry zone was performed. Two patients had only minor symptoms of chronic demyelinisation such as gait ataxia or sensory deficits of the lower extremities, but one patient was not able to walk because of a paraparesis. Pre-operatively magnetic resonance imaging with thin slice examination of the trigeminal nerves in the pontine angle was performed and an acute inflammatory process was excluded. All patients were operated in the park-bench position via a suboccipital craniotomy. In two cases an arterial, and in one case a venous compression of the trigeminal nerve root-entry zone was found. Neurovascular decompression was performed with interposition of a little piece of gore-tex. Peri- and postoperative complications could not be examined.
Results
All patients tolerated the operation well and no new neurological deficit or worsening of the multiple sclerosis was seen. All cases were immediately pain free and medication could be stopped. The preoperative MRI and intraoperative findings correlated positively in all patients. Postoperative high resolution T2-weighted MRI revealed the gore-tex cushion and can be used for follow-up examinations.
Conclusions
Microvascular decompression of the trigeminal nerve in the pontine angle is a safe procedure and should therefore be discussed and also offered to patients with multiple sclerosis and insufficient medical treatment. The long-term results need to be evaluated. High resolution MRI of the trigeminal nerve can visualize the relationship of nerve and surrounding vessels and is helpful in decision making in these patients.
Diese Studie wurde unterstützt vom Deutschen Forschungsverbund Neuropathischer Schmerz (DFNS), gefördert vom Bundesministerium für Bildung und Forschung (BMBF), Teilprojekt C 2.1.1, Förderkennzeichen 01 EM 01 03
