Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia

David Barba Division of Neurological Surgery, University Hospital, University of California Medical Center, San Diego, California

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John F. Alksne Division of Neurological Surgery, University Hospital, University of California Medical Center, San Diego, California

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✓ Clinical records and patient interviews in 37 cases of trigeminal neuralgia treated by microvascular decompression by a single surgeon were studied retrospectively. Outcomes were determined with an average follow-up period of 43 months. Abnormalities in the region of the trigeminal nerve were identified in each case. Patients undergoing microvascular decompression as a primary procedure were cured (total pain relief without further therapy) at a rate of 91%, versus 43% in patients treated with destructive procedures (rhizotomies) prior to microvascular decompression (p < 0.005). Analysis also suggests that trigeminal neuralgia of greater than 9 years' duration was cured at a rate of only 42%, versus 88% in cases of less lengthy duration (p < 0.005). Sex and age at time of surgery were not significant predictors of outcome. There were no deaths in this group of patients aged from 32 to 90 years. A horizontal surgical approach is described.

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