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Ann Indian Acad Neurol. 2009 Jul;12(3):173-8. doi: 10.4103/0972-2327.56317.

Outcome of medical and surgical management in intractable idiopathic trigeminal neuralgia.

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  • 1Department of Neurology and Neurosurgery, Sebea Hospital, Tripoli, Libya.

Abstract

BACKGROUND:

The neurovascular conflict in trigeminal neuralgia is an intractable condition; medical treatment is usually of long duration and can be annoying for both patients and clinicians.

AIM:

This prospective study was designed to assess the outcome of microvascular decompression (MVD) in patients with more than 3 years' history of intractable idiopathic trigeminal neuralgia (TN) and poor response to drugs.

MATERIALS AND METHODS:

Twenty-one patients (8 females and 13 males) with intractable idiopathic TN (group 1) underwent MVD and were followed up for 2 years. Group 2 (n = 15), which included 6 females and 9 males, received pharmacotherapy. The outcome responses of pain relief were evaluated using a 10-cm visual analog scale (VAS) and the Barrow Neurological Institute (BNI) scoring system. The patients' morbidity was recorded as well.

RESULTS:

All patients fulfilling the inclusion criteria were offered MVD surgery. Freedom from pain was achieved immediately after surgery in 95.2% (n = 20) of patients in group 1, and 90.5% (n = 19) had sustained relief over the follow-up period. There were no statistical significance recurrences or surgical complications in group 1 (P>0.5), while 53.3% (n = 8) of the subjects in group 2 showed poor response with pharmacotherapy over the same period of time and many patients experienced drug intolerance that had statistical significance (P<0.01).

CONCLUSION:

Early MVD in TN can help patients avoid the side effects of drugs and the adverse psychological effects of long-term pharmacotherapy and prolonged morbidity.

KEYWORDS:

Microvascular decompression; trigeminal neuralgia

PMID:
20174498
[PubMed]
PMCID:
PMC2824934
Free PMC Article
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