Management of Primary Bilateral Trigeminal Neuralgia with Microvascular Decompression: 13-Case Series

World Neurosurg. 2018 Jan:109:e724-e730. doi: 10.1016/j.wneu.2017.10.072. Epub 2017 Oct 21.

Abstract

Background: Bilateral trigeminal neuralgia is a relatively rare disease. Microvascular decompression (MVD) is a safe and effective treatment for unilateral trigeminal neuralgia; however, its utility in bilateral trigeminal neuralgia is unclear. Here, we report our experience with MVD in 13 cases of primary bilateral trigeminal neuralgia.

Methods: We retrospectively analyzed 13 cases of bilateral trigeminal neuralgia that were treated with MVD between January 2013 and January 2015. Surgical outcomes and complications were explored in each case.

Results: Postoperatively, 11 patients had excellent outcomes and 2 patients had good outcomes on the operative side. Three patients also reported the amelioration of contralateral symptoms after MVD. Of 10 cases indicating no contralateral improvement, 1 refused to undergo a second MVD procedure on the opposite side and 9 underwent a second MVD procedure and experienced symptom relief. The superior cerebellar artery was the most common offending vessel. There were no severe MVD-related complications.

Conclusion: Vascular compression plays a causative role in bilateral and unilateral trigeminal neuralgia. MVD appears to be a safe and effective treatment option in patients who are refractory to pharmacotherapy.

Keywords: Bilateral; Etiology; Microvascular decompression; Trigeminal neuralgia.

MeSH terms

  • Aged
  • Disease Management*
  • Female
  • Humans
  • Male
  • Microvascular Decompression Surgery / methods*
  • Middle Aged
  • Retrospective Studies
  • Trigeminal Neuralgia / diagnostic imaging*
  • Trigeminal Neuralgia / surgery*