Dr. Chandra Prakash Limbu
Senior Consultant in Neurosurgery
ADK Hospital, Male'

 

Ali Niyaf, Ram Kumar Shrestha

 

Trigeminal Neuralgia is chronic pain syndrome characterized by severe, paroxysmal and electric shock-like pain occurring in one or more branches of trigeminal nerve in one side of face. Microvascular decompression remains the main stay of treatment in case of idiopathic trigeminal neuralgia.

Total 8 patients underwent microvascular decompression in our institute, from 2016 to 2018. All the patients were investigated with MRI Brain prior to surgery and operated through retromastoid suboccipital approach with autologous muscle graft. Patients were assessed for pain relief and complications. The outcome data was analyzed.

Among operated patients 4 (50%) were male and 4(50%) were female. Duration of pain was varying form 6 months to 5 years. 6(75%) patients were having right sided symptoms and 2(25%) patients were having left sided symptoms. 3(37%) patients had pain in V3 distribution whereas 3(37%) patients had pain in both V2 and V3 distribution. 1(14%) patient had pain in both V1 and V2 division and another 1 (14%) had involvement of all V1, V2 and V3 divisions. Impending vessel was artery in 7(87%) patients and vein was found compressing trigeminal nerve in 1(13%) patient. Pseudomeningocele developed in 2(28%) patients and 1(14%) patient required reopening to close CSF leak. 1(14%) patient had residual pain in V2 distribution immediately after surgery. 1(14%) patient had an injury of upper trunk of brachial plexus immediately after surgery.

Microvascular decompression is the best alternative treatment in case of trigeminal neuralgia. Careful clinical evaluation, proper positioning prior to surgery, meticulous microsurgical dissection and watertight dural closure will give better outcome and minimal complications. Autologous muscle graft is also one of the best alternatives to synthetic Teflon.

Trigeminal Neuralgia, Microvascular decompression