Microvascular Decompression and Partial Sensory Rhizotomy for Trigeminal Neuralgia with Special Reference to Endoscopic-Assisted Microsurgery

Objective: Microsurgical approach for the treatment of trigeminal neuralgia (TN) is characterized by microvascular decompression (MVD) or partial sensory rhizotomy (PSR). Whether endoscopic-assistance is of benefit in the latter is discussed in the study.

Methods: The prospectively collected database revealed 162 patients treated for TN between 2004 and 2015. The average age was 62 years. Mean history of pain was 8 years. A vascular compression of the trigeminal nerve was found in 134 patients. No compression was found in 14 or expected in another 14 patients respectively.

Results: The use of the endoscope was of benefit in 31 patients (20.4%). In these cases, unexpected vascular or local anatomy was observed that could not be seen via the microscopic view. The endoscope was rarely used during dissection maneuvers. 92% of the patients reported an improvement of pain after surgery in a certain degree. Immediate pain improvement after MVD was observed in 103 patients (98%) with obvious arterial compression and in 26 patients (89.7%) with venous compression of the trigeminal nerve. 12 patients (86%) did benefit from PSR. Transient morbidity was observed in 14.2% and permanent morbidity in 1.2% respectively. Overall mean follow-up was 50.7 months. Five patients (3%) underwent a reoperation but partially improved.

Conclusion: Endoscopic-assisted technique did significantly affect the operative course in 20.4% of the microsurgical procedures. An overall immediate pain improvement after surgery was observed in 92% of the patients. Although, the results demonstrate a good early outcome, a longer follow-up is needed.