Abstract
Objective: To evaluate the clinical characteristics, magnetic resonance imaging (MRI) findings, and surgical outcomes of microvascular decompression (MVD) in patients with trigeminal neuralgia. Background: Microvascular decompression (the Jannetta procedure) is an effective surgical treatment for trigeminal neuralgia caused by neurovascular conflict between the trigeminal nerve and an offending artery. Methods: Over a two-year period, 57 patients with trigeminal neuralgia secondary to vascular compression of the trigeminal nerve underwent microvascular decompression. All procedures were performed via a retrosigmoid approach at the Department of Neurosurgery, Saint Paul General Hospital, Hanoi, Vietnam. Results: The study included 20 men and 37 women, of whom 78.9% were older than 50 years. Pain most commonly involved the V2 and V3 divisions of the trigeminal nerve. Three-dimensional T2-weighted SPACE sequences obtained on 3.0-T MRI identified the superior cerebellar artery (SCA) as the most frequent offending vessel. A neuro-patch was interposed between the offending artery and the compressed trigeminal nerve. An excellent outcome, defined as complete pain relief without the need for additional treatment, was achieved in 91.3% of patients at hospital discharge. No recurrence was observed during the 2-year follow-up period. Postoperative complications included meningitis in one patient and cerebrospinal fluid (CSF) leakage in one patient. Conclusions: Microvascular decompression via the retrosigmoid approach is the treatment of choice for trigeminal neuralgia caused by neurovascular compression, providing excellent pain relief with a low rate of complications and durable long-term outcomes.
