Trigeminal neuralgia: a plea for microvascular decompression as the first surgical option. Anatomy should prevail

Abstract

Arguments are given to plead why microvascular decompression should be the first surgical option to treat primary trigeminal neuralgias resistant to anticonvulsants.

Microvascular Decompression for Trigeminal Neuralgia

“…As a matter of fact, as phrased by Sindou, it is an anatomic-based operation; therefore, it is actually a conservative method as compared with the destructive procedures. 21 In conclusion, it is the authors' opinion that MVD should be considered the first line of surgical treatment in patients with TN, including carefully selected candidates in the elderly population (provided that there are no significant medical comorbidities associated), and in whom the pathophysiology of the pain is most likely to be the neurovascular compression and no other alternative mechanisms (ie, multiple sclerosis, herpetic neuralgia) are likely.…”

Management of trigeminal neuralgia in sclerosteosis

“…Several authors recommend that MVD must be the method of choice even in elderly patients, since they present with good health conditions. [2526] The MVD has low rates of sensory dysfunction, but the complications have a propensity to be more severe as meningitis, CSF leakage, stroke, and even death. [2526] Although patients underwent to MVD presents with long-term pain relief, this procedure must be avoided in sclerosteosis patients.…”

“…[2526] The MVD has low rates of sensory dysfunction, but the complications have a propensity to be more severe as meningitis, CSF leakage, stroke, and even death. [2526] Although patients underwent to MVD presents with long-term pain relief, this procedure must be avoided in sclerosteosis patients. There is a marked difficulty in the surgical approach due to the prominent hyperostosis near the skull base and this procedure can be dangerous when performed in patients with markedly increased ICP secondary to a reduce cranial capacity.…”

Trigeminal neuralgia and persistent trigeminal artery

“…As Sindou and Pollock [9, 12], we considered that, although no procedure is best for patients affected by trigeminal neuralgia, posterior fossa exploration is associated with better facial pain outcomes. In this case, our therapeutic strategy must consider the cavernoma and the neurovascular conflict; during drug treatment of blood hypertension, spontaneous recovery of neuralgia was observed.…”