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Microvascular decompression for pediatric onset trigeminal neuralgia

D K Resnick1, E I Levy, P J Jannetta

  • 1Department of Neurological Surgery, University of Wisconsin School of Medicine, Madison 53792, USA.

Neurosurgery
|October 10, 1998
PubMed
Summary

Microvascular decompression (MVD) offers some relief for pediatric trigeminal neuralgia (TGN) caused by vascular compression. However, outcomes are less favorable than in adults, possibly due to venous compression and longer symptom duration.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Pediatric Neurology

Background:

  • Trigeminal neuralgia (TGN) typically affects the elderly, often due to vascular compression from atherosclerosis.
  • Pediatric TGN is rare and presents before significant atherosclerotic changes, prompting investigation into its causes.
  • Vascular compression is the suspected cause in most TGN cases, but its role in children requires specific examination.

Purpose of the Study:

  • To investigate the efficacy of microvascular decompression (MVD) for pediatric patients with medically refractory trigeminal neuralgia.
  • To explore the specific causes of vascular compression in children experiencing TGN.
  • To compare the outcomes of MVD in pediatric TGN patients with those reported for adult populations.

Main Methods:

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  • Retrospective chart review of 23 pediatric patients (age ≤18) with typical TGN undergoing cerebellopontine angle exploration.
  • 22 patients underwent microvascular decompression (MVD) of the trigeminal nerve.
  • Patient outcomes were assessed post-MVD, with 21 patients followed for over 1 year.

    • Main Results:

    • Vascular compression of the trigeminal nerve was identified in 96% of patients; one had an epidermoid tumor.
    • Immediate post-MVD pain relief was achieved in 73% of patients, with 18% experiencing >75% pain reduction.
    • At a mean follow-up of 105 months, 43% had complete pain relief, and 14% had >75% pain reduction.

    Conclusions:

    • Microvascular decompression (MVD) is a safe and effective treatment for TGN in adults.
    • Pediatric TGN patients show a less favorable therapeutic response to MVD compared to adults.
    • Increased venous compression and longer symptom duration in pediatric TGN may contribute to reduced MVD efficacy.