Posterior fossa exploration in treatment of trigeminal neuralgia associated with multiple sclerosis.
BACKGROUND
The possible surgical options during PFE in treatment of TN in patients with MS are MVD and PSR. Only sporadic cases of PSR in treatment of TN patients with MS have been reported.


METHODS
We retrospectively analyzed the outcome of surgical treatment in 8 patients with MS who underwent PFE due to surgical treatment of medically intractable TN. MVD was projected in severe neurovascular conflict, MVD + PSR in mild conflict, and PSR alone in cases without neurovascular conflict.


RESULTS
There were no patients with severe neurovascular contact. In 5 patients with mild neurovascular contact and in 3 without neurovascular contact, MVD + PSR and PSR alone were performed, respectively. An immediate BNI-score of I was achieved in all patients. There were 2 minor and 1 major recurrences. Nine years after surgery, 75% of the patients were free of pain. There was no immediate postoperative mortality. Postoperative cerebrospinal fluid rhinorrhea in 1 patient was resolved with spinal drainage. Two patients died during the follow-up period due to the complications of MS.


CONCLUSIONS
In our experience, MVD + PSR or PSR alone are safe and effective surgical procedures in the management of TN complicating MS. In MVD + PSR patients, PSR seems to play more significant role than MVD in pain relief. Since there were not severe neurovascular conflicts in our patients with MS, MVD alone was never justified.
Antic
Branislav
B
Department of Neurosurgery, Military Medical Academy, 11000 Belgrade, Serbia. dr_branislav_antic@yahoo.com
Peric
Predrag
P
D000328:Adult; D001488:Basilar Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000401:mortality; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D019051:Rhizotomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*