Microvascular Decompression in Treatment Neuralgias of Cranial Nerves

Yu.A. Shulev, K.S. Gordienko, V.V. Rudenko, V.N. Bikmullin, A.V. Vorobyev, V.V. Rynkov,
V.V. Stepanenko, V.V. Remenets, D.A. Rzaev, B.S. Krutikov

(Municipal Multifield Hospital N2, Department of Neurosurgery N1, Medical Academy of Postgraduate Education, Saint Petersburg)

We stick to the opinion, that microvascular decompression (MVD) is an extremely important pathogenetic method, used for treatment of neuralgias of cranial nerves (trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, intermittent torticollis). Thanks to it, a main cause of these diseases is eliminated and persistent recovery is achieved. Due to Peter Janetta and his followers, who made more than 4000 operations during 20 years (P. Janetta et al., 1998), MVD has become a widely acknowledged and reproducible operation in treatment of these severe states. A success of surgical treatment is strongly dependent on careful selection of patients and strict observance of surgical technologies.

The Goal of the Present Study: To estimate possibility of wide use of MVD and to propose a system of methods for effective and safe introduction of MVD technology in Russia.

Material and Methods: We performed 46 operations of this type for trigeminal neuralgia, 6 interventions for hemifacial spasm and 5 operations for glossopharyngeal neuralgia (some patients had a combination of these syndromes). The disease duration varied from 1 up to 30 years. A postoperative diagnostic complex included clinical examination with application of standardized questionnaires (Facial Pain Survey 2000, McGill Questionnaire) and scales (Visual Analogue Scale, Verbal Scale), neurovisualization (CT, MRI, transcranial Doppler, cerebral angiography). Diagnostic criteria of the Headache Classification Committee of the International Headache Society (1988) served as clinical criteria for selection of patients. Interventions were performed in a lateral position, using a retrosigmoid approach and operating microscope (Opmi CS, Carl Zeiss). A success of surgical treatment was determined by the following factors:

  1. Careful preoperative planning, based on correct positioning of a patient with taking into account a shape and anatomic peculiarities of a skull and a neck length.
  2. Rigid three-point fixation of a patient's head (we used Mayfield's clip).
  3. Use of an operating microscope.
  4. High technology of microsurgical intervention (retractor-free surgery).
  5. Use of modern nerve protectors (Teflon implant).
  6. Intraoperative monitoring.

Results: Excellent results (complete regression of symptoms) were watched in 51 cases (90%). Good results (periodic minor pain without necessity to take drugs) were achieved in 4 patients (7%). Relapse of pain syndrome in trigeminal neuralgia was a cause of repeated operation in 2 cases (3%). It consisted in additional decompression of a trigeminal nerve trunk. The result was considered to be good.