Evaluation of Microvascular Decompression Efficacy and Security for Trigeminal Neuralgia: A Retrospective Study of 86 Patients

Background and objective: Facial neuralgia (FN) is most of time joined to neurovascular conflict which imply superior cerebellar artery (SCA) and trigeminal nerve. The first-line treatment is carbamazepine. In case of resistance to medical treatment, lesion surgical techniques (LST) are possible: thermocoagulation, balloon compression, glycerol rhizotomy, radiosurgery. Their tolerances and efficiencies are often limited in time. The surgical reference treatment is microvascular decompression (MVD). What are immediate and long term effectiveness of MVD in our pratice.

Methods: Monocentric, retrospective and descriptive study (2005-2015) including all patients treated by MVD retrosigmoid approach who have clinical NF with neurovascular conflict visualized on MRI. All patients were in failure of their medical or LST treatment.

Results: 86 patients (55.7% women) were included. Average age to surgery is 53,8 years old [21-81], V2 territory and right side were preferentially reached. SCA was responsible in 81,4% of cases. All Patients are in failure of their medical treatment (average dose of carbamazepine : 991mg). 22,1% cases of them had already a LST, and 47,4% of them had sensitive sequelle.

Conflict is released without teflon interposition in 79% of cases.

The cured rate was 91.6% at 1 year and 86.8% at 10 years without medical treatment.

There is no postoperative death, complications were limited (cerebrospinal fluid leak 2,32%, meningitis 2.32%, vestibulocochlear syndrome 1,16%).

10 patients recurred (11,6%), 8 before 1 year and 2 after 10 years. 70% of those had been already treated with LST and/or teflon interposition.

Conclusion: MVD in a case of a conflict responsible of a FN is successful on a short and long term. It needs to be considered before failure or intolerance of medical treatment and in order to LST to avoid more recurred cases and nerves sequela.