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Bilateral trigeminal neuralgia
Surgical Neurology
|August 1, 1981
Summary
This case study presents a successful trigeminal nerve decompression for left-sided trigeminal neuralgia in a patient with prior contralateral surgery. The procedure relieved pain while preserving facial sensation, offering hope for bilateral cases.
Area of Science:
- Neurosurgery
- Neurology
- Pain Management
Background:
- Trigeminal neuralgia (TN) is a debilitating neuropathic pain condition.
- Previous retrogasserian neurectomy for right TN resulted in contralateral pain development.
- Patient refused further ablative surgery due to fear of bilateral facial anesthesia.
Observation:
- A 56-year-old woman presented with new-onset left trigeminal neuralgia.
- She had a history of right-sided tic douloureux treated with neurectomy, causing ipsilateral facial anesthesia.
Findings:
- Microvascular decompression via suboccipital craniectomy was performed for the left TN.
- The decompression addressed a thickened arachnoid membrane and bridging vein compressing the trigeminal nerve root.
- Post-operatively, the patient experienced complete pain relief on the left side with preserved facial sensation.
Implications:
- Microvascular decompression is a viable option for managing bilateral trigeminal neuralgia, even after previous ablative procedures.
- Preservation of sensation is achievable with decompression, contrasting with the sensory loss from neurectomy.
- This case highlights the importance of considering nerve decompression for recalcitrant TN, especially in bilateral presentations.