Microvascular decompression for idiopathic trigeminal neuralgia: ultimate solution to the management dilemma

Idiopathic Trigeminal Neuralgia is one of the most distressing craniofacial pain syndromes and micro vascular decompression is claimed to be the only best treatment option. The objectives of the study were to analyze the theory of neurovascular conflict as the basic pathology and prove the ineffectiveness of ablative procedures. A prospective observation study was carried out on 110 consecutive patients of idiopathic trigeminal neuralgia who went under micro vascular decompression. Clinical presentations and operative findings were recorded, analyzed and statistically correlated. Speical note was made of the previous interventions. All cases of secondary trigeminal neuralgia were excluded with the help of MRI brain. The result showed that in 90% cases superior cerebellar artery was the cause of compression on the root entry zone. It was concluded from this study that basic cause of the idiopathic trigeminal neuralgia is a vascular compression of the trigeminal nerve near its root entry zone and micro vascular decompression is the only best treatment option available at present. Moreover, correct interpretation of the symptoms is essenital to avoid inappropriate intervention

Idiopathic trigeminal neuralgia: clinical presentations and operative findings on microvascular decompression

To analyze the clinical presentations of idiopathic trigeminal neuralgia and its operative findings on microvascular decompression. This descriptive case series study was conducted in the Department of Neurosurgery, PGML Govt. Lady Reading Hospital, Peshawar from July, 2003 to November, 2007. A total of 110 consecutive patients of idiopathic trigeminal neuralgia undergoing microvascular decompression in the Department of Neurosurgery, Lady Reading Hospital were included in the study. Clinical presentations and operative findings were recorded and analyzed. All cases of secondary trigeminal neuralgia were excluded with the help of MRI brain. Ratio of Male: female was 2:3. Age ranged from 28-80 years, mean age being 57 years. Right side was affected in 60% cases. Maxillary and mandibular divisions in combination were involved in majority of cases. Pain-free period varied from few hours to years. The common triggering stimuli were chewing and touching. A trigger point was found in [77%] cases. Superior cerebellar artery was the cause of compression in 90% of cases. In 90% of cases compression was on the root entry zone. The nerve compression was found on superomedial aspect in 66 [60%] of cases. Almost all cases of idiopathic trigeminal neuralgia are caused by a vascular compression of the trigeminal nerve, superior cerebellar artery being the commonest cause 90%