Trigeminal neuralgia; difficulties during surgery without proir MRI screening

ABSTRACT

A retrospective study of 40 cases of Trigeminal Neuralgia who were treated surgically [by MVD, micro-vascular decompression]. Department of Neurosurgery Quaid-l-Azam Medical College/Bahawal Victoria Hospital Bahawalpur during four [4] year period from January 2003 to December 2006 These patients were resistant to medical treatment so MVD was performed. Methods Total number of patients is [40] forty. In 10 patients CT scan brain and especially for posterior fossa was performed before surgery to rule out any suspected tumour pathology. In the remaining 30 cases no MRI or CT scanning of brain was done before surgery and diagnosis of Trigeminal Neuralgia was made on clinical grounds. Posterior fossa was opened by standard right or left retro-mastoid approach depending upon the side of pain. In 27 out of 40 cases the superior cerebellar artery [SCA] was the offending vessel. In 5 cases, only the vein was the cause of pain. In 2 cases, vein and artery, both were the offending vessels. In 2 cases, only arachnoidal adhesions were the cause of pain. And in 4 cases, after opening the posterior fossa it was found that cause of pain is a tumour of trigeminal nerve [3 cases] or meningioma [1 case] of cerebellopontine angle. From these operative findings of tumours in the posterior fossa in cases of Trigeminal Neuralgia, it is concluded that all the patients suffering from Trigeminal Neuralgia should be screened with MRI prior to surgery to rule out any tumour pathology as a cause of Trigeminal Neuralgia, so that proper preparations be made before surgical intervention