Skip to main content
Log in

Microvascular decompression in the surgical management of trigeminal neuralgia

  • Original Articles
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

The pathophysiological mechanisms underlying trigeminal neuralgia are not clearly understood and several therapeutic modalities have been advocated. Microvascular decompression (MVD) is a widely used surgical approach for the decompression of the affected root entry zone (REZ) of the fifth cranial nerve. In this paper, we present our experience based on 32 patients with trigeminal neuralgia who were treated with MVD, and discuss the role of this procedure in the surgical management of trigeminal neuralgia.

All patients had typical TN pain and had had previous medical management which was unsuccessful. Fourteen patients (44%) had been previously treated with other surgical procedures and had persisting pain at the time of admission. Preoperatively, computerized tomography was obtained in all patients; twelve patients (37.5%) were evaluated with magnetic resonance imaging. These neuroradiological studies revealed an asymmetrical vascular structure at the involved REZ in nine patients (28%). All patients underwent MVD, and a vascular loop causing compression on the REZ of the fifth cranial nerve was demonstrated in each case. No mortality was observed, and the only permanent morbidity was cerebellar infarction in one patient (3%). Symptorns disappeared in all patients in the early postoperative period, and only three recurrences (12%) were observed within the follow-up period (mean: 26 months).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adams CBT: Microvascular compression: an alternative view and hypothesis. J Neurosurg 57 (1989) 1–12

    Google Scholar 

  2. Apfelbaum RI: Surgery for tic douloureux. Clin Neurosurg 31 (1984) 351–368

    Google Scholar 

  3. Apfelbaum RI: Surgical management of disorders of the lower cranial nerves. In: Schmiedek HH, Sweet WH (eds.): Operative Neurosurgical Techniques, 2nd ed., New York, Grune & Stratton, 1988

    Google Scholar 

  4. Arias MJ: Percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia. A prospective study of 100 cases. J Neurosurg 65 (1986) 32–36

    Google Scholar 

  5. Barba D, JF Alksne: Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia. J Neurosurg 60 (1984) 104–107

    Google Scholar 

  6. Burchiel KJ, H Clarke, M Haglund, JD Loeser: Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 69 (1988) 35–38

    Google Scholar 

  7. Dandy WE: Concerning the cause of trigeminal neuralgia. Am J Surg 24 (1934) 447–455

    Google Scholar 

  8. Gardner WJ, MV Miklos: Response of trigeminal neuralgia to “decompression” of sensory root. Discussion of cause of trigeminal neuralgia. JAMA 170 (1959) 1773–1776

    Google Scholar 

  9. Gardner WJ: Concerning the mechanism of trigeminal neuralgia and hemifacial spasm. J Neurosurg 19 (1962) 947–958

    PubMed  Google Scholar 

  10. Gybels JM, WH Sweet: Neurosurgical Treatment of Persitent Pain. Physiological and pathological mechanisms of human pain. Gildenberg PL (ed): Karger, Basel 1989

    Google Scholar 

  11. Håkanson S: Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neurosurgery 9 (1981) 638–641

    PubMed  Google Scholar 

  12. Håkanson S: Retrogasserian glycerol injection as a treatment of tic douloureux. Adv Pain Res Ther 5 (1983) 927–933

    Google Scholar 

  13. Hardy DG, AL Rhoton: Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve. J Neurosurg 49 (1978) 669–678

    PubMed  Google Scholar 

  14. Jannetta PJ: Gross (mesoscopic) description of the human trigeminal nerve and ganglion. J Neurosurg 26 (1967) 109–111

    Google Scholar 

  15. Jannetta PJ: Neurovascular compression in cranial nerve and systemic disease. Ann Surg 192 (1980) 518–525

    PubMed  Google Scholar 

  16. Jannetta PJ: Trigeminal neuralgia: Treatment by microvascular decompression. In: Wilkins RH, Rengachary SS (eds.): Neurosurgery Vol. 3, New York, Mc Graw Hill 1985

    Google Scholar 

  17. Jannetta PJ: Microsurgical management of trigeminal neuralgia. Arch Neurol 42 (1985) 800–802

    PubMed  Google Scholar 

  18. Kanpolat Y, N Avman, HZ Gökalp, E Arasil, E Özkal, M Selçuki: Controlled radiofrequency thermocoagulation of trigeminal ganglion in the treatment of trigeminal neuralgia, hemifacial spasm, and facial neuralgia. Acta Neurochir suppl 33 (1984) 511–514

    Google Scholar 

  19. Latchaw JP, RW Hardy, SB Forsythe, AF Cook: Trigeminal neuralgia treated by radio frequency coagulation. J Neurosurg 59 (1981) 479–484

    Google Scholar 

  20. Lobato RD, JJ Rivas, R Sarabia, JL Madrid: Percutaneous compression of the gasserian ganglion for trigeminal neuralgia. Pain, suppl 4, 1987

  21. Loeser JD: The management of tic douloureux. Pain 3 (1977) 155–162

    Google Scholar 

  22. Pamir MN, F Özer, GE Kele§: Microvascular decompression in the treatment of trigeminal neuralgia. Marmara Medical Journal 3 (1990) 56–59

    Google Scholar 

  23. Pamir MN, AF Özer, E Keles, C Erzen, N Gürmen: The aid of computerized tomography in hemifacial spasm. J Neuroradiol 19 (1992) 293–300

    PubMed  Google Scholar 

  24. Saini SS: Retrogasserian anhydrous glycerol injection therapy in trigeminal neuralgia: observations in 552 patients. J Neurol Neurosurg Psychiat 50 (1987) 1536–1538

    Google Scholar 

  25. Siegfried J: 500 percutaneous thermocoagulation of the gasserian ganglion for trigeminal pain. Surg Neurol 8 (1977) 126–131

    Google Scholar 

  26. Siegried J: Percutaneous controlled thermocoagulation of gasserian ganglion in trigeminal neuralgia. Experience with 1000 cases. In: Samii M, Jannetta PJ (eds.): The Cranial Nerves, Springer Verlag, Berlin 1981

    Google Scholar 

  27. Sindou M, Y Keravel, B Abdennebi, J Szapiro: Traitement neurochirurgical de la névralgie trigéminale: abord direct ou méthode percutanée? Neurochirurgie 33 (1987) 89–111

    Google Scholar 

  28. Sweet WH: The treatment of trigeminal neuralgia (tic douloureux). New Engl J Med 315 (1986) 174–177

    Google Scholar 

  29. Sweet WH: Trigeminal neuralgia: problems as to cause and consequent conclusions regarding treatment. In: Wilkins RH, Rengachary SS (eds.): Neurosurgery Update Vol. 2, New York, Mc Graw Hill 1991

    Google Scholar 

  30. White JC, WH Sweet: Pain and the neurosurgeon. A forty-year experience. Charles C Thomas, Springfield 1969

    Google Scholar 

  31. Wong BY, GK Steinberg, L Rosen: Magnetic resonance imaging of vascular compression in trigeminal neuralgia. J Neurosurg 70 (1989) 132–134

    Google Scholar 

  32. Young RF: Glycerol rhizolysis for treatment of trigeminal neuralgia. J Neurosurg 69 (1988) 39–45

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Necmettin Pamir, M., Ali Zirh, T., Fahir Özer, A. et al. Microvascular decompression in the surgical management of trigeminal neuralgia. Neurosurg. Rev. 18, 163–167 (1995). https://doi.org/10.1007/BF00383719

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00383719

Keywords

Navigation