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      Patterns and Variations in Microvascular Decompression for Trigeminal Neuralgia

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          Abstract

          Microvascular decompression (MVD) is a highly effective surgical treatment for trigeminal neuralgia (TN). Although there is little prospective clinical evidence, accumulated observational studies have demonstrated the benefits of MVD for refractory TN. In the current surgical practice of MVD for TN, there have been recognized patterns and variations in surgical anatomy and various decompression techniques. Here we provide a stepwise description of surgical procedures and relevant anatomical characteristics, as well as procedural options.

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          AAN-EFNS guidelines on trigeminal neuralgia management.

          G Cruccu, G. Gronseth, J Alksne … (2008)
          Several issues regarding diagnosis, pharmacological treatment, and surgical treatment of trigeminal neuralgia (TN) are still unsettled. The American Academy of Neurology and the European Federation of Neurological Societies launched a joint Task Force to prepare general guidelines for the management of this condition. After systematic review of the literature the Task Force came to a series of evidence-based recommendations. In patients with TN MRI may be considered to identify patients with structural causes. The presence of trigeminal sensory deficits, bilateral involvement, and abnormal trigeminal reflexes should be considered useful to disclose symptomatic TN, whereas younger age of onset, involvement of the first division, unresponsiveness to treatment and abnormal trigeminal evoked potentials are not useful in distinguishing symptomatic from classic TN. Carbamazepine (stronger evidence) or oxcarbazepine (better tolerability) should be offered as first-line treatment for pain control. For patients with TN refractory to medical therapy early surgical therapy may be considered. Gasserian ganglion percutaneous techniques, gamma knife and microvascular decompression may be considered. Microvascular decompression may be considered over other surgical techniques to provide the longest duration of pain freedom. The role of surgery versus pharmacotherapy in the management of TN in patients with multiple sclerosis remains uncertain.
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            Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia.

            S Mullan, T Lichtor (1983)
            Fifty patients were treated for trigeminal neuralgia by percutaneous microcompression of the trigeminal ganglion. A No. 4 Fogarty balloon catheter was inserted under brief general anesthesia, using biplane fluoroscopy. This procedure is essentially a percutaneous simplication of the older Taarnhøj-Sheldon-Pudenz operation. The follow-up period ranged from 0.5 to 4.5 years. Pain recurred in 12% of cases during that time, and it is anticipated that within 5 years the recurrence rate will reach 20%, which is approximately the same rate as for the alternative established procedures. The advantages of this technique are freedom from discomfort on the part of the patient, a remarkable ease of performance on the part of the operator, absence of associated mortality, and a minimal morbidity rate.
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              Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. 1. Trigeminal neuralgia.

              Raymond Sweet, J Wepsic (1974)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Neurol Med Chir (Tokyo)
                Journal ID (iso-abbrev): Neurol. Med. Chir. (Tokyo)
                Journal ID (publisher-id): NMC
                Title: Neurologia medico-chirurgica
                Publisher: The Japan Neurosurgical Society
                ISSN (Print): 0470-8105
                ISSN (Electronic): 1349-8029
                Publication date (Print): May 2015
                Publication date (Electronic): 28 April 2015
                Volume: 55
                Issue: 5
                Pages: 432-441
                Affiliations
                [1 ]Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Osaka
                Author notes

                Conflicts of Interest Disclosure

                The authors have declared no conflicts of interest.

                Address reprint requests to: Hiroki Toda, MD, Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, 2-4-20, Ohgimachi, Kita, Osaka, Osaka 530-8480, Japan. e-mail: htoda-nsu@ 123456umin.ac.jp
                Article
                Publisher ID: nmc-55-432
                DOI: 10.2176/nmc.ra.2014-0393
                PMC ID: 4628171
                PubMed ID: 25925756
                SO-VID: b71311c7-6bd2-4dca-a71a-3f732f669db9
                Copyright © © 2015 The Japan Neurosurgical Society
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                Date received : 10 November 2014
                Date accepted : 05 January 2015
                Categories
                Subject: Review Article

                Keywords: trigeminal neuralgia,microvascular decompression,surgical nuances
                Data availability:
                Keywords: trigeminal neuralgia, microvascular decompression, surgical nuances

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