Microvascular decompression for trigeminal neuralgia: comments ona series of 250 cases including 10 patients with multiple sclerosis

摘要

OBJECTIVE—To examine surgical findings and results of microvascular decompression (MVD) for trigeminal neuralgia (TN), including patients with multiple sclerosis, to bring new insight about the role of microvascular compression in the pathogenesis of the disorder and the role of MVD in its treatment.
METHODS—Between 1990 and 1998, 250 patients affected by trigeminal neuralgia underwent MVD in the Department of Neurosurgery of the "Istituto Nazionale Neurologico C Besta" in Milan. Limiting the review to the period 1991-6, to exclude the "learning period" (the first 50 cases) and patients with less than 1 year follow up, surgical findings and results were critically analysed in 148 consecutive cases, including 10 patients with multiple sclerosis.
RESULTS—Vascular compression of the trigeminal nerve was found in all cases. The recurrence rate was 15.3% (follow up 1-7 years, mean 38 months). In five of 10 patients with multiple sclerosis an excellent result was achieved (follow up 12-39 months, mean 24months). Patients with TN for more than 84 months did significantly worse than those with a shorter history (p<0.05). There was no mortality and most complications occurred in the learning period. Surgical complicationswere not related to age of the patients.
CONCLUSIONS—Aetiopathogenesisof trigeminal neuralgia remains a mystery. These findings suggest acommon neuromodulatory role of microvascular compression in bothpatients with or without multiple sclerosis rather than a direct causalrole. MVD was found to be a safe and effective procedure to relievetypical TN in patients of all ages. It should be proposed as firstchoice surgery to all patients affected by TN, even in selected caseswith multiple sclerosis, to give them the opportunity of pain reliefwithout sensory deficits.