Yu.A. Shulev, K.S. Gordienko
(Municipal Multi-Field Hospital N 2, Neurosurgical Department N 1, Saint Petersburg)
Male patient M., aged 45, was admitted with complaints of paroxysmal pain and periodical lasting and burning pain in the right half of the face.
Paroxysmal pain in the above area appeared about 10 years ago. It was moderate at first, but its intensity increased with a passage of time. The patient underwent the following interventions for trigeminal neuralgia: alcoholization of a peripheral branch (1995), transcutaneous rhizotomy of the trigeminal nerve root (1996, 2001), laser destruction of the Gasserian ganglion (2003). All these manipulations had no marked effect. The patient complained of more severe pain and an increasing number of pain episodes. On admission the score, characterizing pain severity and estimated on the basis of the visual analogue scale, was 10. The patients took 1600 mg of CBZ daily, but it had only a partial effect.
Targeted MRI, used for examination of the trigeminal nerve, demonstrated marked compression of its root by the superior cerebellar artery.
Microvascular decompression of the trigeminal nerve on the right was performed on October 7, 2005.
Pain disappeared immediately after recovery from anesthesia. There was no need of taking CBZ. The patient was discharged in 7 days.