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Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression
I F Pollack1, P J Jannetta, D J Bissonette
1Department of Neurosurgery, University of Pittsburgh School of Medicine, Pennsylvania.
Journal of Neurosurgery
|April 1, 1988
Summary
Posterior fossa microvascular decompression (MVD) effectively treats bilateral trigeminal neuralgia (TN), offering long-term pain relief for most patients. This safe procedure avoids risks associated with other surgical approaches.
Area of Science:
- Neurosurgery
- Neurology
Background:
- Trigeminal neuralgia (TN) is a debilitating condition affecting cranial nerves.
- Bilateral TN presents unique challenges compared to unilateral cases.
- Microvascular decompression (MVD) is a surgical option for TN.
Purpose of the Study:
- To evaluate the efficacy and safety of posterior fossa MVD in patients with bilateral TN.
- To compare characteristics of patients with bilateral TN to those with unilateral TN.
- To assess long-term pain control and outcomes after MVD for bilateral TN.
Main Methods:
- Retrospective analysis of 35 patients with bilateral TN undergoing posterior fossa MVD (1971-1984).
- Comparison of demographic and clinical features between bilateral and unilateral TN patient subgroups.
- Life-table analysis to determine long-term pain control rates post-MVD.
Main Results:
- Bilateral TN patients showed higher rates of female gender, familial TN, cranial nerve dysfunction, and hypertension.
- Good or excellent pain control was achieved in 89% of treated sides after initial MVD.
- Long-term pain relief (1, 5, 10 years) was maintained in 60-82% of sides, with higher rates after repeat procedures.
- Overall, 74% of patients experienced sustained pain relief without regular medication.
Conclusions:
- Posterior fossa MVD is an effective and safe treatment for bilateral "idiopathic" TN.
- The procedure offers significant long-term pain relief and avoids risks of bilateral nerve injury.
- MVD provides a viable alternative to ablative procedures for managing bilateral trigeminal neuralgia.