The authors present their experience in the microsurgical treatment of trigeminal
neuralgia (TGN). Over the last five years 48 patients were explored and 34 (71 %)
underwent microvascular decompression (MVD) for significant arterial or venous conflicts.
The remaining 14 patients (29 %) underwent partial sensory rhizotomy (PSR) because
of negative intraoperative findings (simple contact or no conflict). Excellent or
good immediate outcomes were achieved in 87.5 and 12.5 % of patients, respectively.
Of the three severe recurrences observed during the follow-up period (24.7 months;
range: 7 - 65 months), two underwent percutaneous microcompression and one posterior
fossa reexploration, which revealed teflon-induced recompression. None of the PSR
cases experienced incapacitating face numbness. MVD, an extremely effective procedure
in the immediate post-operative period, is burdened in the long term by 20 % recurrences,
the majority occurring within two years from surgery. We believe that careful intraoperative
evaluation of the conflict entity could be the key to achieve a significant reduction
of recurrences: overestimation of simple vascular contact of doubtful etiologic relevance,
may lead to ineffective decompression and unsatisfactory results. In our opinion PSR
should be preferred to percutaneous treatments in cases of negative exploration (contact
or no conflict). In accordance with others we observed that section of half or less
of the inferolateral “portio major” allows long-lasting pain relief and good preservation
of sensory function.
Key words:
Trigeminal Neuralgia - Microvascular Decompression - Partial Sensory Rhizotomy - Pain
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Corresponding Author
Andrea Brunori,M. D.
Via A. Poerio 33
00152 Roma
Italy
Telefon: + 39-06-5870-4295(-4534; -4232)
Fax: + 39-06-5870-4928
eMail: brunoria@tin.it
