title: Outcome of medical and surgical management in intractable idiopathic trigeminal neuralgia.
abstract: BACKGROUND
  The neurovascular conflict in trigeminal neuralgia is an intractable condition; medical treatment is usually of long duration and can be annoying for both patients and clinicians.
  
  
  OBJECTIVE
  This prospective study was designed to assess the outcome of microvascular decompression (MVD) in patients with more than 3 years' history of intractable idiopathic trigeminal neuralgia (TN) and poor response to drugs.
  
  
  METHODS
  Twenty-one patients (8 females and 13 males) with intractable idiopathic TN (group 1) underwent MVD and were followed up for 2 years. Group 2 (n = 15), which included 6 females and 9 males, received pharmacotherapy. The outcome responses of pain relief were evaluated using a 10-cm visual analog scale (VAS) and the Barrow Neurological Institute (BNI) scoring system. The patients' morbidity was recorded as well.
  
  
  RESULTS
  All patients fulfilling the inclusion criteria were offered MVD surgery. Freedom from pain was achieved immediately after surgery in 95.2% (n = 20) of patients in group 1, and 90.5% (n = 19) had sustained relief over the follow-up period. There were no statistical significance recurrences or surgical complications in group 1 (P>0.5), while 53.3% (n = 8) of the subjects in group 2 showed poor response with pharmacotherapy over the same period of time and many patients experienced drug intolerance that had statistical significance (P<0.01).
  
  
  CONCLUSIONS
  Early MVD in TN can help patients avoid the side effects of drugs and the adverse psychological effects of long-term pharmacotherapy and prolonged morbidity.
authors.affiliation: Department of Neurology and Neurosurgery, Sebea Hospital, Tripoli, Libya.
authors.forename: Hassan
authors.initials: H
authors.lastname: Salama
authors.forename: Hesham
authors.initials: H
authors.lastname: Ben-Khayal
authors.forename: Mohamed Abdel Salam
authors.initials: MA
authors.lastname: Mohamed
authors.forename: Ashraf
authors.initials: A
authors.lastname: El-Mitwalli
authors.forename: Ashraf Ahmed
authors.initials: AA
authors.lastname: Zaher
authors.forename: Ashraf
authors.initials: A
authors.lastname: Ezzeldin
authors.forename: Hatem
authors.initials: H
authors.lastname: Badr
authors.forename: Peter
authors.initials: P
authors.lastname: Vorkapic