Microvascular Decompression for Pediatric Onset Trigeminal Neuralgia

BACKGROUND: Trigeminal neuralgia (TGN) is generally a disease of the elderly. Vascular compression, the causative agent in the majority of cases, is thought to result from atherosclerotic changes within the vessels of the posterior fossa. Rarely, the disease presents during childhood, before the onset of severe atherosclerotic changes. We therefore sought to explore the role of vascular compression in pediatric patients with medically refractory TGN. PATIENTS AND METHODS: Twenty-three patients were identified in whom the onset of typical TGN had occurred during childhood (age 18 yr or younger) and who underwent exploration of the cerebellopontine angle. Twenty-two of 23 underwent microvascular decompression (MVD) of the trigeminal nerve. Twenty-one of these patients were followed for more than 1 year. A retrospective chart review was conducted to determine the efficacy of MVD for the treatment of TGN in this select population. Operative findings were recorded and correlated with patient outcome. RESULTS: Twenty-two of 23 patients (96%) were found to have vascular compression of the trigeminal nerve at the time of exploration. One patient was found to have an epidermoid tumor. MVD resulted in complete pain relief at the time of discharge in 16 of 22 patients (73%), with an additional 4 patients (18%) having a greater than 75% diminution of pain. The 21 patients who were followed for at least 1 year were followed for a mean of 105 months. At the time of their last follow-up, 9 of these patients (43%) continued to have complete pain relief and 3 (14%) had a greater than 75% diminution of pain. The most common operative finding was a vein compressing the nerve, often in combination with a branch of the superior cerebellar artery. DISCUSSION: MVD has been demonstrated to be a safe and efficacious treatment for TGN in the adult population. Patients whose symptoms begin in childhood do not enjoy the same therapeutic response to MVD as do patients with TGN onset in adulthood. An increased incidence of venous compression was noted in this population, as was a longer duration of symptoms before MVD. These factors may be responsible for the decreased efficacy of MVD in this patient population.