Surgical treatment of trigeminal neuralgia without vascular compression: 20 years of experience.
BACKGROUND
There are few reports on the outcome of surgical treatment of TGN without vascular compression.


METHODS
Between 1984 and 2004, 668 patients underwent MVD for TGN. In 21 patients (3.1%), vascular compression was absent. The surgical strategy in these cases involved the following: (1) dissection and exposure of the entire trigeminal nerve root; (2) slight neurapraxia with bipolar tips at the trigeminal nerve root; and (3) isolation of trigeminal nerve with Teflon sponge fragments.


RESULTS
The patients' (female/male, 20:1) ages ranged from 33 to 77 years. Their right side was the most frequently involved (61.9%). Their mean duration of pain before treatment was 7.6 years (range = 1-20 years). At surgical exploration, vascular compression or anatomical abnormalities were absent in 15 patients (71.4%), arachnoidal thickening was present in 5 (23.8%), and fiber dissociation of the trigeminal nerve was present in 1 (4.8%). Mean follow-up after surgery was 17.7 months (range = 4-65 months). Immediate relief from pain occurred in all 21 patients. On Kaplan-Meier analysis, recurrence was maintained at 14.8% for 12, 24, and 36 months, increasing to 43.2% at 48 months. Permanent hypoesthesia was present in 6 patients (28.6%), whereas loss of corneal reflex was observed transiently in 1 (4.8%). Motor function of the trigeminal nerve was intact in all patients. No other complication was found.


CONCLUSIONS
The proposed surgical plan of standard MVD plus slight trigeminal nerve root neurapraxia is a safe and effective management option for TGN without vascular compression.
Revuelta-Gutiérrez
Rogelio
R
Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City 14269, Mexico. miguel_lg@hotmail.com
López-González
Miguel Angel
MA
Soto-Hernández
José Luis
JL
D000328:Adult; D000368:Aged; D001099:Arachnoid / Q000473:pathology / Q000503:physiopathology; D001488:Basilar Artery / Q000473:pathology / Q000503:physiopathology; D035301:Cranial Fossa, Middle / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000473:pathology / Q000503:physiopathology