title: Trigeminal root compression for trigeminal neuralgia in patients with no vascular compression.
abstract: BACKGROUND
  Trigeminal neuralgia (TN) may be present in the absence of vascular compressiom, and surgical treatment in these cases is controversial. Our objective is to evaluate the efficacy and safety of trigeminal root compression in this situation.
  
  
  METHODS
  A prospective collection of clinical data on all patients diagnosed with idiopathic TN in our institution. Cases with no visible offending vessel intraoperatively were included in this study. These patients underwent trigeminal root compression and long-term follow-up. The basic characteristics and outcomes were analyzed.
  
  
  RESULTS
  From February 2005 to November 2010, 381 patients underwent microvascular decompression for TN at our department. Among them, 28(7.3 %) patients (17 female, 11 male) had no visible vascular compression intraoperatively. The median observation period was 46 months (range, 8-60 months). Twenty patients (71.4 %) achieved complete pain relief without medication immediately postoperatively. However, the recurrence rate was 38.4 %, and only 13 patients (46.4 %) achieved complete pain relief without medication at follow-up. Ten patients (35.7 %) developed some degree of facial numbness, which was transient in six cases (21.4 %) and permanent in four (14.3 %).
  
  
  CONCLUSIONS
  Although trigeminal root compression provides good initial pain relief, the long-term efficacy, complication and recurrence rates are far from satisfactory. Further studies are needed to explore the possible mechanisms of underlying pain and to compare the outcomes of various types of interventions in cases without vascular compression.
authors.affiliation: Department of Neurosurgery West China Hospital, Sichuan University, Sichuan, 610041, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Cheng
authors.forename: Ding
authors.initials: D
authors.lastname: Lei
authors.forename: Heng
authors.initials: H
authors.lastname: Zhang
authors.forename: Ke
authors.initials: K
authors.lastname: Mao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D019051:Rhizotomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000601:surgery*