Modern approaches to surgical treatment of classic trigeminal neuralgia
Abstract Short- and long-term results of microvascular decompression in treatment of trigeminal neuralgia are presented in the literature in a very wide range caused by inadequate selection of patients for surgical treatment and peculiarities of the equipment applied to eliminate neurovascular conflict. This retrospective study of microvascular decompression results of 182 patients with verified conflict between superior cerebellar artery and trigeminal root was aimed to improve outcomes of microvascular decompression in the treatment of patients with trigeminal neuralgia. Level of evidence II. In 145 patients neurovascular conflict was resolved by concluding artery in motobrendy polypropylene microprotector. 37 patients un- derwent translocation loop of superior cerebellar artery in a conflict-free position, i.e., in the space between the upper surface of the trigeminal root and the tentorium of the cerebellum. If clinical picture differed from that of classic trigeminal neuralgia (type 1A) patients underwent spiral 3D CT angiography, only subjects with visualized neurovascular conflict underwent surgical treatment. Catamnesis of operated patients included data of the follow-up for 1–15 years. In 37 patients who underwent translocation of the superior cerebellar artery pain relapse did not occur. 17 (11.7%) of 145 patients in whom the translocation was not performed developed recurrent disease at different times after microvascular decompression: 5 patients – within 1 year, the others – within 2–10 years. 8 of them had rare pain attacks which were controlled by taking 1 or 2 tablets of carbamazepine a day. 9 other patients within the period of 2–10 years got previous intensity of the pain, and they underwent repeated revision. It was found that in 6 of them the protector shifted from the field of conflict and came down along the lateral ponto-mesencephalic segment of the artery. 3 others underwent partial rhizotomy. The authors come to the conclusion that translocation of the loop of the superior cerebellar artery is a reliable method to eliminate the neurovascular conflict in patients with classic trigeminal neuralgia.
Keywords:trigeminal neuralgia, microvascular decompression
Clin. Experiment. Surg. Petrovsky J. 2016. № 3. Р. 89–96.
Received: 24.06.2016. Accepted: 22.07.2016.
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