[Direct and late outcome in trigeminal neuralgia treated by means of microvascular decompression in cerebellopontine angle].

Background: Microvascular decompression (MVD) is a method of choice in the surgical treatment of trigeminal neuralgia (TN).
Objective: To evaluate direct and long-term results of MVD in TN.
Material and Methods: The authors analyzed 20 patients (9 women and 11 men, mean age 62.2 years) with TN who had been treated surgically at the Department of Neurosurgery of the University Hospital in Cracow between October 1998 and September 2002. MVD was performed using Janetta technique via suboccipital retro-sigmoid craniectomy. All patients underwent additional neurolysis. Indentations in portio major of the trigeminal nerve were present in 5 cases. Short- and long-term pain relief was assessed according to Slettebo-Eide scale.
Results: Complete short-term pain relief was observed in 15 patients (75%), in 3 patients (15%) significant pain control was achieved. Very good and good long-term result was reported by 70% of patients. Pre-operative invasive treatment of neuralgia did not affect the long-term outcome. MVD of the trigeminal nerve indented by compression of the adjacent vessels yielded very good and good long-term result in 80% of patients compared with 66% in the group of patients with no trigeminal nerve indentation. In all of the 6 octogenarians very good or good pain control was observed. Duration of the history of trigeminal neuralgia did not influence the outcome. Severe postoperative complication (hemorrhagic cerebellar infarction) was observed in one case.
Conclusion: Microvascular decompression is safe and effective method in the treatment of trigeminal neuralgia. MVD yields beneficial results in elderly patients.