[Trigeminal neuralgia: results of microsurgical and endoscopic-assisted vascular decompression].

INTRODUCTION

Vascular compression of the Vth cranial nerve is the leading cause of trigeminal neuralgia. Microvascular decompression has been promoted by Jannetta since 1970. We used the minimally invasive retrosigmoid approach, with the complementary help of endoscopic procedure.

OBJECTIVES

MRI results, surgical findings and pain relief were studied after endoscopic assisted microvascular decompression.

MATERIAL AND METHODS

Between 1991 and 2000, 98 surgeries were performed on 79 patients unresponsive to medical treatment, after an average of 6 years from the onset of the disorder. The mean follow-up period after operation was 28 months.

RESULTS

MRI predicted neurovascular conflict with sensitivity of 93.6% and specificity of 100%. Pain relief after surgery was complete in 69% of the cases, partial in 21%. Surgery was a failure in 6% of the cases and 4% of patients were lost. Complications were limited to 10% of CSF disorders but only 1% (1 patient) needed a surgical revision.

CONCLUSION

Microvascular decompression, performed through a key-hole approach, without cerebellum retraction and with endoscopic assisted surgery, yields a low risk of morbidity, even in elderly patients, and could be considered acceptable causal treatment of trigeminal neuralgia.