DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20173200

MVD for trigeminal neuralgia; neuralgia revisited with review of literature

Renuka S. Melkundi, Sateesh Melkundi

Abstract


Background: Trigeminal neuralgia (TN) s an uncommon facial pain syndrome. It is commonly characterized by sudden onset of an attack of intense electric shock like facial pain localized along the sensory distribution of the ninth cranial nerve. Although many patients respond to the medical line of treatment but when PTS symptoms become intractable and could not tolerate the medications have to go for surgical decompression. Our study aims to review about micro vascular decompression for trigeminal neuralgia and its outcome along with the review of literature.

Methods: It is a retrospective study conducted on 40 cases who were diagnosed with TN. between the period of July 2009 to July 2015. MVD has been performed on all the patients. Demographic data, clinical presentation, surgical findings, complications and long term follow-up were reviewed.  

Results: The median age of onset of TN is 50.4 years divided into five age groups ranging from 24 to 89 years with female preponderance showing 65.5% as compared to males. The distribution of location was in the ratio of right to left is 1.5:1. There was no mortality is seen in the study. 3 patients among them study population had complications 3 patients had facial hyposthesia, 1 patient had V3 paresis and 1 patient had CSF otorrhoea which got settled with drainage LP. All the patients had satisfactory improvement except one patient who had persistent pain.

Conclusions: To conclude micro vascular decompression (MVD) is the surgical procedure of choice for the treatment of medically refractory TN who is fit for surgery. Of all the currently available surgical methods MVD provides the highest rate of long term satisfaction for the patients and offers the lowest rate of pain recurrence.


Keywords


Microvascular decompression, Trigeminal neuralgia, Facial pain, Facial hyposthesia

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References


Dandy WE. Concering the cause of trigeminal neuralgia. Am J Surg. 1934;24:447–55.

Chawla JC, Falconer MA. Glossopharyngeal and vagal neuralgia. Br Med J. 1967;3:529–31.

Fraioli B, Esposito V, Ferrante L, Trubiani L, Lunardi P. Microsurgical treatment of glossopharyngeal neuralgia: Case reports. Neurosurgery. 1989;25:630–2.

Katusic S, Williams DB, Beard CM, Bergstralh EJ, Kurland LT. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: Similarities and differences, Rochester, Minnesota, 1945-1984. Neuroepidemiology. 1991;10:276–81.

Korkes H, de Oliveira EM, Brollo L, Hachul DT, Andrade JC, Peres MF, et al. Cardiac syncope induced by glossopharyngeal “neuralgia”: A rare presentation. Arq Bras Cardiol. 2006;87:e189–91.

Teixeira MJ, de Siqueira SR, Bor-Seng-Shu E. Glossopharyngeal neuralgia: Neurosurgical treatment and differential diagnosis. Acta Neurochir (Wien). 2008;150:471–5.

Thomson JL. Glossopharyngeal neuralgia accompanied by unconsciousness. J Neurosurg. 1954;11:511–4.

Dandy W. Glossopharyngeal neuralgia (tic doloreaux). Its diagnosis and treatment. Arch Surg. 1927;15:198–214.

Pearce JM. Glossopharyngeal neuralgia. Eur Neurol. 2006;55:49–52.

Barker FG, II, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334(17):1077–83.

Meaney JFM, Eldridge PR, Dunn LT, Nixon TE, Whitehouse GH, Miles JB. Demonstration of neurovascular compression in trigeminal neuralgia with magnetic resonance imaging. Comparison with surgical findings in 52 consecutive operative cases. J Neurosurg. 1995;83(5):799–805.

Hamlyn PJ, King TT. Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg. 1992;76(6):948–954.

Namba S, Shimizu Y, Wani T, Fujiwara N. An experimental model of deafferented pain in the cat. Appl Neurophysiol. 1985;48(1-6):201–11.

Devor M, Seltzer Z. Pathophysiology of damaged nerves in relation to chronic pain. In: Wall PD, Melzack R, editors. Textbook of Pain. 4th ed. London: Churchill Livingstone; 1999: 129–164.

Clavin WH, Howe JF, Loeser JD. Ectopic Repetitive Firing in Focally Demyelinated Axon and Some Implication for Trigeminal Region. Amsterdam: Elsevier/North-Holland; 1977: 125–136.

Burchiel KJ. Abnormal impulse generation in focally demyelinated trigeminal roots. J Neurosurg. 1980;53(5):674–83.

Chenour oesman et al. Long Term Follow-up of Microvascular Decompression for Trigeminal Neuralgia Skull Base. 2011;21(5):313–22.

Nurmikko TJ, Eldridge PR. Trigeminal neuralgia—pathophysiology, diagnosis and current treatment. Br J Anaesth. 2001;87(1):117–32.

Jannetta PJ. Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia. Definitive microsurgical treatment and results in 117 patients. Neurochirurgia (Stuttg). 1977;20:145–54.

Laha RK, Jannetta PJ. Glossopharyngeal neuralgia. J Neurosurg. 1977;47:316–20.

Slavin KV. Glossopharyngeal neuralgia. Semin Neurosurg. 2004;15:71–9.

Kandan SR, Khan S, Jeyaretna DS, Lhatoo S, Patel NK, Coakham HB. Neuralgia of the glossopharyngeal and vagal nerves: Long-term outcome following surgical treatment and literature review. Br J Neurosurg. 2010;24:441–6.

Taylor JC, Brauer S, Espir MLE. Long-term treatment of trigeminal neuralgia with carbamazepine. Postgrad Med J. 1981;57(663):16–18.

Rushton JG, Olafson RA. Trigeminal neuralgia associated with multiple sclerosis. A case report. Arch Neurol. 1965;13(4):383–6.

Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg. 1967;26(1):159–62.

Mendoza N, Illingworth R D. Trigeminal neuralgia treated by microvascular decompression: a long-term follow-up study. Br J Neurosurg. 1995;9(1):13–9.

Kawashima M, Matsushima T, Inoue T, Mineta T, Masuoka J, Hirakawa N. Microvascular decompression for glossopharyngeal neuralgia through the transcondylar fossa (supracondylar transjugular tubercle) approach. Neurosurgery. 2010;66:275–80.

Rey-Dios R, Cohen-Gadol AA. Current neurosurgical management of glossopharyngeal neuralgia and technical nuances for microvascular decompression surgery. Neurosurg Focus. 2013;34:E8.

Arbit E, Krol G. Percutaneous radiofrequency neurolysis guided by computed tomography for the treatment of glossopharyngeal neuralgia. Neurosurgery. 1991;29:580–2

Yomo S, Arkha Y, Donnet A, Régis J. Gamma knife surgery for glossopharyngeal neuralgia. J Neurosurg. 2009;110:559–63.

Lovely TJ, Jannetta PJ. Microvascular decompression for trigeminal neuralgia. Surgical technique and long-term results. Neurosurg Clin N Am. 1997;8(1):11–29.