Outcome of medical and surgical management in intractable idiopathic trigeminal neuralgia.

Original article


Hassan Salama 1,2 Hesham Ben-Khayal 1, Mohamed Abdel Salam Mohamed 2, Ashraf El-Mitwalli 2, Ashraf Ahmed Zaher 2, Ashraf EzzEldin 3, Hatem Badr 3, Peter Vorkapic 1,4

1-Department of Neurology and Neurosurgery, Sebea Hospital, Tripoli, Libya 2-Department of Neurology Mansoura University, Egypt 3-Department of Neurosurgery, Mansoura University, Germany 4-Department of Neurosurgery, Hanover University, Germany,

Ann Indian Acad Neurol. 2009 Jul;12(3):173-8.


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.
Aim: 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.
Materials and 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). Conclusion: 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. Keywords: Microvascular decompression, trigeminal neuralgia Link/DOI: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824934/?tool=pubmed