Outcome of medical and surgical management in intractable idiopathic trigeminal neuralgia.
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.
Salama
Hassan
H
Department of Neurology and Neurosurgery, Sebea Hospital, Tripoli, Libya.
Ben-Khayal
Hesham
H
Mohamed
Mohamed Abdel Salam
MA
El-Mitwalli
Ashraf
A
Zaher
Ashraf Ahmed
AA
Ezzeldin
Ashraf
A
Badr
Hatem
H
Vorkapic
Peter
P