Abstract
Background: Trigeminal neuralgia (TN) is characterized by idiopathic sharp, shooting, electric shock like, episodic facial pain along the sensory distribution of the fifth cranial nerve, lasting several seconds, with pain free intervals between attacks. Although many patients respond to the medical line of treatment but when 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 54 cases who were diagnosed with TN between the period of July 2013 to December 2017. Microvascular decompression (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 30 to 79 years with female preponderance showing 59.25% as compared to males. The distribution of location was in the ratio of right to left was 1.7:1. There was one mortality in our study with 4 patients reporting complications, 1 patient had facial numbness,1 patient had facial palsy,1 patient had SAH and 1 patient had CSF rhinorrhoea which resolved after re-exploration of wound and mastoid cell repair. All the patients had satisfactory improvement (post-operative Barrow score of ≤3).
Conclusions: To conclude micro vascular decompression (MVD) is the surgical procedure of choice for the treatment of TN who is fit for surgery. Among 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.
Keywords: Microvascular decompression, Trigeminal neuralgia, Facial pain.
References
- Dandy WE. Concering the cause of trigeminal neuralgia. Am J Surg. 1934; 24:447–55.
- Merskey H, Bogduk N. Classification of chronic pain, IASP Task Force on Taxonomy. Seattle: IASP Press, 1994
- Katusic S, Williams D, Beard C, et al. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945–1984. Neuroepidemiology 1991;10: 276–281
- MacDonald B, Cockerell O, Sander J, et al. The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain 2000;123:665–676
- Zakrzewska JM, Coakham HB. Microvascular decompression for trigeminal neuralgia: update. Curr Opin Neurol 2012;25(3):296-301.
- Putzki N, Pfriem A, Limmroth V, Yaldizli O, Tettenborn B, Diener HC, et al. Prevalence of migraine, tension-type headache and trigeminal neuralgia in multiple sclerosis. Eur J Neurol. 2009;16 (2):262–7.
- Nurmikko TJ, Eldridge PR. Trigeminal neuralgia—pathophysiology, diagnosis and current treatment. Br J Anaesth. 2001;87(1):117-32
- Cheng TM, Cascino TL, Onofrio BM. Comprehensive study of diagnosis and treatment of trigeminal neuralgia secondary to tumors. 1993;43 (11):2298-302.
- Dandy W. Glossopharyngeal neuralgia (tic doloreaux). Its diagnosis and treatment. Arch Surg. 1927;15:198–214.
- Pearce JM. Glossopharyngeal neuralgia. Eur Neurol. 2006;55:49–52.
- Namba S, Shimizu Y, Wani T, Fujiwara N. An experimental model of deafferented pain in the cat. Appl Neurophysiol. 1985;48(1-6):201–11.
- Devor M, Seltzer Z. Pathophysiology of damaged nerves in relation to chronic pain. In: Wall PD, Melzack R, editors. Textbook of Pain. 4th ed. London: Churchill Livingstone; 1999: 129–164.
- Clavin WH, Howe JF, Loeser JD. Ectopic Repetitive Firing in Focally Demyelinated Axon and Some Implication for Trigeminal Region. Amsterdam: Elsevier/North-Holland; 1977: 125–136.
- Burchiel KJ. Abnormal impulse generation in focally demyelinated trigeminal roots. J Neurosurg. 1980;53(5):674–83.
- Hamlyn PJ, King TT. Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg. 1992;76(6):948–954.
- Slavin KV. Glossopharyngeal neuralgia. Semin Neurosurg. 2004;15:71–9.
- Taylor JC, Brauer S, Espir MLE. Long-term treatment of trigeminal neuralgia with carbamazepine. Postgrad Med J. 1981;57 (663):16–18.
- Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg. 1967;26(1):159–62.
- Mendoza N, Illingworth R D. Trigeminal neuralgia treated by microvascular decompression: a long-term follow-up study. Br J Neurosurg. 1995;9(1):13–9.
- Gardner WJ. Concerning the mechanism of trigeminal neuralgia and hemifacial spasm. J Neurosurg1962; 19: 947– 958 [PubMed]
- Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 1967; 26: 159– 162 [PubMed]
- Barker FG, Jannetta PJ, Bissonette DJ, et al. The long term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996; 334: 1077– 1083 [PubMed]
- Sindou M, Leston JM, Decullier E, et al. Microvascular decompression for trigeminal neuralgia: the importance of a noncompressive technique—Kaplan-Meier analysis in a consecutive series of 330 patients. Neurosurgery 2008; 63: 341– 350 [PubMed
- Cowan JA, Brahma B, Sagher O. Surgical treatment of trigeminal neuralgia: comparison of microvascular decompression, percutaneous ablation, and stereotactic radiosurgery. Techn Neurosurg 2003; 8: 157– 167
- Taha JM, Tew JM., Jr Comparison of surgical treatments for trigeminal neuralgia: reevaluation of radiofrequency rhizotomy. Neurosurgery 1996; 38: 865– 871 [PubMed]
- Burchiel KJ, Steege TD, Howe JF, et al. Comparison of percutaneous radiofrequency gangliolysis and microvascular decompression for the surgical management of tic douloureux. Neurosurgery 1981; 9: 111– 119 [PubMed]
- Tronnier VM, Rasche D, Hamer J, et al. Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery2001; 48: 1261– 1267 [PubMed
- Broggi G, Ferroli P, Franzini A, et al. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J NeurolNeurosurg Psychiatry 2000;68:59–64
- Delitala A, Brunori A, Chiappetta F. Microsurgical posterior fossa exploration for trigeminal neuralgia: a study on 48 cases. Minim Invasive Neurosurg 2001; 44:152–156
- Sindou M, Howeidy T, Acevedo G. Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients. Acta Neurochir (Wien) 2002;144:1–13
- Ishikawa M, Nishi S, Aoki T, et al. Operative findings in cases of trigeminal neuralgia without vascular compression: proposal of a different mechanism. J ClinNeurosci2002;9:200–204
- Kalkanis SN, Eskandar EN, Carter BS, et al. Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery 2003;52:1251–1262
- Li S-T, Pan Q, Liu N, et al. Trigeminal neuralgia: what are the important factors for good operative outcomes with microvascular decompression. Surg Neurol 2004;62:400–404
- Pamir M, Peker S. Microvascular decompression for trigeminal neuralgia: a long-term follow-up study. Minim Invasive Neurosurg 2006;49:342–346
- Sindou M, Leston JM, Decullier E, et al. Microvascular decompression for trigeminal neuralgia: the importance of a noncompressive technique—Kaplan-Meier analysis in a consecutive series of 330 patients. Neurosurgery 2008;63:341–351
- Sandell T, Eide PK. Effect of microvascular decompression in trigeminal neuralgia patients with or without constant pain. Neurosurgery 2008;63:93–100.
- Bond AE, Zada G, Gonzalez AA, et al. Operative strategies for minimizing hearing loss and other major complications associated with microvascular decompression for trigeminal neuralgia. World Neurosurg2010;74:172–177
- Hong W, Zheng X, Wu Z, et al. Clinical features and surgical treatment of trigeminal neuralgia caused solely by venous compression. Acta Neurochir (Wien) 2011;153:1037–1042
- Zhong J, Zhu J, Li S-T, et al. Microvascular decompressions in patients with coexistent hemifacial spasm and trigeminal neuralgia. Neurosurgery 2011; 68:916–920
- Koopman JS, de Vries LM, Dieleman JP, et al. A nationwide study of three invasive treatments for trigeminal neuralgia. Pain 2011;152:507–513
- Sandel T, Eide PK. Long-term results of microvascular decompression for trigeminal neuralgia and hemifacial spasms according to preoperative symptomatology. Acta Neurochir (Wien) 2013;155: 1681–1692.
Corresponding Author
Dr Surendra Jain
S M S Medical College, Jaipur, India
DOI: https://dx.doi.org/10.18535/jmscr/v8i5.92
