Surgical Treatment of Trigeminal Neuralgia

I.A. Otarashvili, A.N. Konovalov, U.B. Mahmudov, V.N. Shimanskiy, S.V. Tanyashin, M.A. Lebedeva

Burdenko Research Institute of Neurosurgery, Moscow, Russia


Introduction. Every year trigeminal neuralgia (TN) is diagnosed in 4 out of 100000 men. As a rule, it is watched above 50 and its rate is 2 times higher in women. It has been proved, that the main cause of this disease is compression of the trigeminal nerve root by an arterial or venous vessel just near the brain stem.

The study goal has been substantiation of indications for vascular decompression and estimation of its efficacy in TN.

Material and Methods. A number of cases with TN, treated in the Burdenko Research Neurosurgical Institute in 1998-2008, was 175. There were 108 females (62%) and 67 males (38%). Mean age was 53 years. As for our group of cases, the rate of TN, watched on the right side, was two times higher. Preoperative MR-examination was carried out in all cases. It revealed, that the trigeminal nerve root was very close to some blood vessel in 86% of patients. The diagnosis was considered to be confirmed, if a patient had 4 out of 5 criteria, proposed by the International Society of Headache in 1994.

Results. Pain syndrome regression was achieved in 171 cases immediately after vascular decompression of the trigeminal nerve. The first postoperative hours demonstrated preserved pain syndrome in 2 cases. Repeated operations, performed during the nearest 24 hours, revealed dislocation of a protector. Reoperation resulted in complete regression of facial pain. Absence of facial pain was watched in 95% of cases a year after single vascular decompression of the trigeminal nerve.

Conclusion. Vascular decompression of the trigeminal nerve root is a highly effective pathognomonic method of TN treatment.