Download PDF
Seminars in Neurosurgery 2004; 15(2/03): 143-150
DOI: 10.1055/s-2004-835704
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Trigeminal Neuralgia: Microvascular Decompression

W. Jeffrey Elias1 , Kim J. Burchiel2
  • 1Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia
  • 2Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
Further Information

Publication History

Publication Date:
25 October 2004 (online)

    Permissions and Reprints

Early surgical observations during microvascular decompression (MVD) procedures have contributed to our knowledge and theories regarding the pathophysiology of trigeminal neuralgia. This procedure represents the only therapy that directly addresses the presumed etiology of the disease and is associated with the longest duration of pain relief. Once thought to represent a major operation with significant risks and rate of mortality, MVD is now performed routinely and safely worldwide because of advances in anesthesia, monitoring, and microsurgical technique. Modern imaging now provides accurate preoperative assessment of the trigeminal nerve, which should increase surgical success rates and limit failures or complications.

KEYWORDS

Microvascular decompression - trigeminal neuralgia - neurovascular compression - root entry zone

REFERENCES

  • 1 Horsley V, Taylor J, Colman W S. Remarks on the various surgical procedures devised for the relief or cure of trigeminal neuralgia (tic douloureux).  Br Med J. 1891;  2 1139-1143 1191-1193 1249-1252
    PubMedGoogle Scholar
  • 2 Spiller W G, Frazier C H. The division of the sensory root of the trigeminus for relief of tic douloureux: an experimental, pathological, and clinical study with a preliminary report of one surgically successful case.  Phila Med J. 1901;  8 1039-1049
    PubMedGoogle Scholar
  • 3 Dandy W E. Concerning the cause of trigeminal neuralgia.  Am J Surg. 1934;  24 447-455
    CrossrefPubMedGoogle Scholar
  • 4 Gardner W J. Concerning the mechanism of trigeminal neuralgia and hemifacial spasm.  J Neurosurg. 1962;  19 947-958
    CrossrefPubMedGoogle Scholar
  • 5 Jannetta P J. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia.  J Neurosurg. 1967;  26 159-162
    CrossrefPubMedGoogle Scholar
  • 6 Burchiel K J, Slavin K V. On the natural history of trigeminal neuralgia.  Neurosurgery. 2000;  46 152-155
    PubMedGoogle Scholar
  • 7 Javadpour M, Eldridge P R, Varma T R, Miles J B, Nurmikko T J. Microvascular decompression for trigeminal neuralgia in patients over 70 years of age.  Neurology. 2003;  60 520
    CrossrefPubMedGoogle Scholar
  • 8 Akimoto H, Nagaoka T, Nariai T, Takada Y, Ohno K, Yoshino N. Preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia by use of three-dimensional reconstruction from two types of high resolution magnetic resonance imaging.  Neurosurgery. 2002;  51 956-961
    PubMedGoogle Scholar
  • 9 Hutchins L G, Harnsberger H R, Jacobs J M et al.. Trigeminal neuralgia: MR imaging assessment.  Radiology. 1990;  175 837-841
    PubMedGoogle Scholar
  • 10 Jawahar A, Kondziolka D, Kanal E, Bissonett D J, Lunsford L D. Imaging the trigeminal nerve and pons before and after surgical intervention for trigeminal neuralgia.  Neurosurgery. 2001;  48 101-107
    PubMedGoogle Scholar
  • 11 Majoie C BLM, Hulsmans F JH, Castelijns J A et al.. Symptoms and signs related to the trigeminal nerve: diagnostic yield of MR imaging.  Radiology. 1998;  209 557-562
    PubMedGoogle Scholar
  • 12 Majoie C BLM, Hulsmans F JH, Verbeeten B et al.. Trigeminal neuralgia: comparison of two MR imaging techniques in the demonstration of neurovascular contact.  Radiology. 1997;  204 455-460
    PubMedGoogle Scholar
  • 13 Meaney J FM, Eldridge P R, Dunn L T, Nixon T E, Whitehouse G H, Miles J B. Demonstration of neurovascular compression in trigeminal neuralgia with magnetic resonance imaging.  J Neurosurg. 1995;  83 799-805
    CrossrefPubMedGoogle Scholar
  • 14 Worthington C, Hutson K, Boulware R et al.. Computerized tomography cisternography of the trigeminal nerve for stereotactic radiosurgery.  J Neurosurg. 2000;  93(suppl 3) 169-171
    PubMedGoogle Scholar
  • 15 McLaughlin M R, Jannetta P J, Clyde B L, Subach B R, Comey C H, Resnick D K. Microvascular decompression of cranial nerves: lessons learned after 4400 operations.  J Neurosurg. 1999;  90 1-8
    CrossrefPubMedGoogle Scholar
  • 16 Kondo A. Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm.  Neurosurgery. 1997;  40 46-52
    PubMedGoogle Scholar
  • 17 Hussein M, Wilson L, Illingworth R. Patterns of sensory loss following fractional posterior fossa Vth nerve section for trigeminal neuralgia.  J Neurol Neurosurg Psychiatry. 1982;  45 786-790
    PubMedGoogle Scholar
  • 18 Apfelbaum R I. Surgery for tic douloureux. In: Weiss M Clinical Neurosurgery. Vol 31. Baltimore; Williams & Wilkins 1983: 351-358
    Google Scholar
  • 19 Barker F G, Jannetta P J, Bissonette D J, Larkins M V, Jho H D. The long term outcome of microvascular decompression for trigeminal neuralgia.  N Engl J Med. 1996;  334 1077-1083
    CrossrefPubMedGoogle Scholar
  • 20 Kaye A H. Trigeminal neuralgia: vascular compression theory. In Grady S Clinical Neurosurgery. Vol 46 Baltimore; Lippincott Williams & Wilkins 1998: 499-506
    Google Scholar
  • 21 Sindou M, Howeidy T, Acevedo G. Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict).  Acta Neurochir (Wien). 2002;  144 1-12
    CrossrefPubMedGoogle Scholar
  • 22 Piatt J H, Wilkins R H. Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships.  Neurosurgery. 1984;  14 462-471
    CrossrefPubMedGoogle Scholar
  • 23 Apfelbaum R. Neurovascular decompression: the procedure of choice?. In Grady S Clinical Neurosurgery. Vol 46 Baltimore; Lippincott, Williams & Wilkins 1998: 473-498
    Google Scholar
  • 24 Klun B. Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia.  Neurosurgery. 1992;  30 49-52
    CrossrefPubMedGoogle Scholar
  • 25 Tyler-Kabara E C, Kassam A B, Horowitz M H et al.. Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression.  J Neurosurg. 2002;  96 527-531
    PubMedGoogle Scholar
  • 26 Bederson J B, Wilson C B. Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia.  J Neurosurg. 1989;  71 359-367
    CrossrefPubMedGoogle Scholar
  • 27 Kolluri S, Heros R C. Microvascular decompression for trigeminal neuralgia.  Surg Neurol. 1984;  22 235-240
    CrossrefPubMedGoogle Scholar
  • 28 Theodosopoulos P V, Marco E, Applebury C, Lamborn K R, Wilson C B. Predictive model for pain recurrence after posterior fossa surgery for trigeminal neuralgia.  Arch Neurol. 2002;  59 1297-1302
    CrossrefPubMedGoogle Scholar
  • 29 Burchiel K J, Clarke H, Haglund M, Loeser J D. Long term efficacy of microvascular decompression in trigeminal neuralgia.  J Neurosurg. 1988;  69 35-38
    CrossrefPubMedGoogle Scholar
  • 30 Barker F G, Jannetta P J, Bissonette D J, Jho H D. Trigeminal numbness and tic relief after microvascular decompression for typical trigeminal neuralgia.  Neurosurgery. 1997;  40 39-45
    PubMedGoogle Scholar
  • 31 Kureshi S A, Wilkins R H. Posterior fossa reexploration for persistent or recurrent trigeminal neuralgia or hemifacial spasm: surgical findings and therapeutic implications.  Neurosurgery. 1998;  43 1111-1117
    CrossrefPubMedGoogle Scholar
  • 32 Jannetta P J, Bissonette D J. Management of the failed patient with trigeminal neuralgia.  Clin Neurosurg. 1985;  32 334-347
    PubMedGoogle Scholar
  • 33 Taarnhoj P. Decompression of the posterior root in trigeminal neuralgia.  J Neurosurg. 1982;  57 14-17
    CrossrefPubMedGoogle Scholar

W. Jeffrey EliasM.D. 

Department of Neurosurgery, UVA Health Sciences Center

Box 800212, Charlottesville, VA 22908

Email: wje4r@virginia.edu

      >