Riazur Rehman, Azmat Ullah, Farooq Azam, Mohammad Ilyas.
Microvascular decompression in patients with intractable idiopathic trigeminal neuralgia.
J Surg Pak Jan ;16(1):14-7.

Objective To evaluate etiology and implications of microvascular decompression (MVD) in patients with intractable idiopathic trigeminal neuralgia. Study design Descriptive case series. Place & Duration of study Neurosurgery department of Hayatabad Medical Complex, Peshawar from January 2007 to December 2009. Methodology Patients with idiopathic trigeminal neuralgia (ITN) irrespective of age and sex, were included in the study. Patients responding to medical treatment were excluded. MRI brain was done for all patients to exclude secondary causes. Microvascular decompression was performed in all patients under general anesthesia. Patients were examined on seventh postoperative day and the clinical findings were documented. Outcome of surgery was declared as successful when there was a commensurate relief of neuralgia paroxysms and deep background pain along with total withdrawal of medications. Results Fifty two patients were operated for trigeminal neuralgia. There were 23(44%) males and 29 (56%) females (M:F 1:1.26). Age ranged between 20-70 years (Mean 56 years). Right sided neuralgia was present in 34(65%) cases. In 50 cases(96 %) a neurovascular conflict was found. The superior cerebellar artery (SCA) was the cause of compression in 45 (86.53%) patients, anterior inferior cerebellar artery (AICA) in two patients, and one patient each, the vessel involved was posterior inferior cerebellar artery (PICA), basilar artery, and petrosal vein. In 2 patients trigeminal nerve was found encased by tight arachnid adhesions. Trigeminal nerve entry zone was the point of conflict in 38 cases (73.07%). The mandibular division (V3) was involved in 30 cases (57.70%) followed by maxillary division (V2) in 18 cases (34.61%) and ophthalmic division (V1) in 4 cases (7.69%). Distortion of the nerve was noticed in 25 cases (48.07%) followed by marked indentation in 22 cases (42.31%). Complete pain relief was noted (free of medication) in 49 cases (94.23%). Cerebrospinal fluid (CSF) leakage occurred in 3 cases (5.76%). One patient developed wound infection. One patient (1.92%) expired in the postoperative period due to mid brain stroke. Conclusions The main etiological factor of trigeminal neuralgia was vascular compression, especially by SCA, of the 5th nerve roots at brain stem. Microvascular decompression is safe and effective therapy for all ages.

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