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Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis
P R Eldridge1, A K Sinha, M Javadpour
1Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool, UK. paul.eldridge@thewaltoncentre.nhs.uk
Stereotactic and Functional Neurosurgery
|January 27, 2004
Summary
Microvascular decompression (MVD) offers initial pain relief for trigeminal neuralgia (TGN) with multiple sclerosis (MS), but high recurrence rates and potential MS worsening suggest it may not be suitable for these patients.
Area of Science:
- Neurosurgery
- Neurology
- Medical Technology
Background:
- Trigeminal neuralgia (TGN) is a debilitating condition often caused by vascular compression.
- Multiple sclerosis (MS) can present with TGN, complicating treatment decisions.
- Microvascular decompression (MVD) is a surgical option for TGN, but its efficacy in MS patients is debated.
Purpose of the Study:
- To evaluate the safety and effectiveness of microvascular decompression (MVD) for patients diagnosed with both trigeminal neuralgia (TGN) and multiple sclerosis (MS).
Main Methods:
- A retrospective review of medical records was conducted for patients with TGN and MS who underwent posterior fossa exploration for MVD between 1993 and 2001.
- Magnetic resonance tomoangiography (MRTA) was used to confirm vascular compression in all cases.
- Surgical interventions included MVD alone or MVD combined with partial sensory rhizotomy.
Main Results:
- Nine patients with TGN and MS were included. All experienced initial pain relief.
- Recurrence of TGN occurred in 5 of 7 patients after MVD and 1 of 2 patients after MVD with rhizotomy.
- Long-term pain relief was achieved in only 1 patient; 3 patients experienced transient MS exacerbation.
Conclusions:
- While MVD provides initial pain relief for TGN in MS patients, the high recurrence rate is a significant concern.
- The procedure carries morbidity, and the recurrence rate exceeds that seen in idiopathic TGN.
- MVD is not recommended for patients with TGN and MS due to high recurrence and associated risks.