Abstract
BackgroundMicrovascular decompression (MVD) is a type of neurosurgery used to treat trigeminal neuralgia (TN) caused by the vertebrobasilar contact/compression. The surgery is not risk-free, however; it may cause recurrent facial pain or other side-effects. The objective of this study was to assess the long-term pain relief and the complications of MVD surgery for the vertebrobasilar compression treatment.MethodsTwenty-three patients with TN compressed by the vertebra-basilar artery (VBA) were treated with MVD. Teflon felt was placed between the brain stem and the offending artery to mobilize the artery towards the skull base and the clivus. The Barrow Neurological Institute (BNI) Pain Intensity Scale score was used to assess pre- and post-surgical pains.ResultsOf 23 patients with pre-operative BNI IV to V, 19 patients (83%) were pain-free after surgery. Four patients experienced transient partial pain relief with BNI II–III, and 3 of them (13%) were completely pain-free within 3 months. The success rate was 96%. Three patients (13%) had pain recurrences, and one received a second MVD surgery for pain relief during the period of follow-up. Four patients suffered from TN hypesthesia, and only 2 patients (8.6%) had permanent facial hypesthesia, while one patient (4.3%) developed a gradual hearing loss after surgery.ConclusionsWhile our success rate of immediate pain relief after surgery was comparable with some reports, the percentage of patients who had pain recurrences was lower, and cases who had permanent facial hypesthesia or developed a gradual hearing loss were fewer after MVD surgery. Our rate of transient complications was higher, and the postoperative pain relief seemed unusually delayed. Our study indicates that MVD is an effective, reliable, and safe neurosurgery for treatment of TN compressed by the VBA albeit our small sample size. Failure of treatment and recurrence of the disease as well as complications could be minimized by preventing displacement of the Teflon implant and extraneous Teflon touching the trigeminal nerves.
Highlights
Microvascular decompression (MVD) is a type of neurosurgery used to treat trigeminal neuralgia (TN) caused by the vertebrobasilar contact/compression
Patients who met the following diagnosis criteria were selected for surgery and included in the study: 1) severe pain with Barrow Neurological Institute (BNI) score IV to V restricted to the trigeminal nerve distribution on one side of the face, 2) TN and vertebrobasilar ectasia (VBE) diagnosed by Magnetic resonance imaging (MRI), as described previously [1], 3) refractory to pharmacological treatment or development of serious side-effects from the medications, and 4) able to give informed consent and follow-ups
The second and/or third division of the trigeminal nerve was commonly compressed while isolated neuralgia resulting from the first division of the trigeminal nerve was not observed in these patients
Summary
Microvascular decompression (MVD) is a type of neurosurgery used to treat trigeminal neuralgia (TN) caused by the vertebrobasilar contact/compression. The surgery is not risk-free, ; it may cause recurrent facial pain or other side-effects. Though most patients with trigeminal neuralgia (TN) do not have vertebrobasilar ectasia (VBE), a small percentage of TN cases may be associated with VBE. Most of these patients with VBE are characterized by significant dilation, elongation, and tortuosity of the vertebra-basilar arteries [1]. MVD causes little or no facial numbness compared to percutaneous stereotactic rhizotomy and is highly successful as a gold standard first line treatment for TN with a minimal risk of pain recurrence [4, 5]
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