title: Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis.
abstract: OBJECTIVE
  To assess whether microvascular decompression (MVD) is a safe and efficacious treatment for patients with trigeminal neuralgia (TGN) and multiple sclerosis (MS).
  
  
  METHODS
  Case records were reviewed of all patients with TGN and MS who underwent posterior fossa exploration with a view to MVD between 1993 and 2001. In all patients, magnetic resonance tomoangiography (MRTA) demonstrated vascular compression.
  
  
  RESULTS
  Nine patients were included in the study. Seven patients underwent MVD alone; in 2 patients a partial sensory rhizotomy of the trigeminal nerve was added to the decompression. All patients had excellent initial pain relief. Recurrence of neuralgia was noted in 5 patients after MVD and in 1 of the 2 patients after partial sensory rhizotomy. Long-term pain relief was obtained in 1 patient who underwent a redo MVD after postoperative MRTA scans demonstrated recurrent vascular compression of the root entry zone (REZ). Thus only 4 out of 9 patients maintained pain relief. In addition, 3 patients experienced transient worsening of their MS.
  
  
  CONCLUSIONS
  Although MVD provides good initial pain relief, the recurrence rate is much higher than that obtained in 'idiopathic' TGN. Although all procedures for the treatment of TGN are worse than those for idiopathic TGN, it is concluded that because of the high recurrence rate together with the morbidity associated with the procedure MVD should not be offered to patients with TGN and MS.
authors.affiliation: Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool, UK. paul.eldridge@thewaltoncentre.nhs.uk
authors.forename: P R
authors.initials: PR
authors.lastname: Eldridge
authors.forename: A K
authors.initials: AK
authors.lastname: Sinha
authors.forename: M
authors.initials: M
authors.lastname: Javadpour
authors.forename: P
authors.initials: P
authors.lastname: Littlechild
authors.forename: T R K
authors.initials: TR
authors.lastname: Varma
mesh_terms: D000328:Adult; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000150:complications* / Q000601:surgery*