Surgical Results of Microvascular Decompression and Partial Sensory Rhizotomy in the Treatment of 154 Patients with Trigeminal Neuralgia

ABSTRACT

OBJECTIVE: To evaluate the efficacy of microvascular decompression(MVD) for trigeminal neuralgia(TN) and to discuss current understanding of the mechanism of MVD for this disorder. PATIENTS AND METHODS:Since 1987, 154 patients treated for trigeminal neuralgia(TN) had been followed for an average 4.3 years. Among these patients, 145 had vascular compression of the nerve and underwent microvascular decompression(MVD). Remaining 9 patients had no offending vessels, so partial sensory rhizotomy(PSR) was performed in these patients. RESULTS: Immediate pain relief was achieved in 95%(147/154) of all patients, but the rate dropped to 90%(140/154) during the follow-up period. Recurrence rate in the MVD group was 2% and in the PSR group 55%. Among those patients underwent MVD, permanent sequelae occurred in only 1 patient(sensorineural hearing loss) and transient complications(impaired hearing due to hemotympanum, minor sensory deficit etc.) were more frequent. There were no differences in the outcome, considering age, sex and the duration of symptoms. There was a close relationship between operative findings of arterial compression on the nerve and long-term complete pain relief. Prognosis for patients with severe arterial compression was better than that for patients with mild or venous compression. CONCLUSION: MVD provides a high rate of success with a minor risk of complications, and this study gives support to the hypothesis that in most cases of TN is caused by neurovascular compression.