Short- and Long-Term Effectiveness of Keyhole
Microvascular Decompression for Trigeminal Neuralgia
1 Department of Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
Affiliation :
Methee Wongsirisuwan MD1
Background : Trigeminal neuralgic pain most commonly occurs after neurovascular con(cid:976)lict and can be treated by microvascular
decompression [MVD].
Objective : To discuss the effectiveness of keyhole retromastoid retrosigmoid MVD for pain control both in the short- and long-term.
Materials and Methods: Between 2007 and 2016, 444 patients affected by trigeminal neuralgia [TN] underwent keyhole
retromastoid retrosigmoid MVD. All patients had already tried conservative treatment using a variety of medications without
effective bene(cid:976)it. Clinical presentation, preoperative imaging results, operative (cid:976)indings (causes of compression), pain outcomes,
and recurrence rates were reviewed.
Results : In the early phase, the (cid:976)irst keyhole MVD provided excellent outcomes in terms of achieving immediate pain control (436 of
444 patients, 98.19%, p = 0.000), while the second (re-)MVD of this group achieved favorable outcomes in only 66.66% of cases
(p = 0.059). In the long-term group, 89.59% (198 of 221 patients) still reported complete pain remission, but the re-MVD for this
group resulted in pain relief for only 38.46% of cases (p = 0.405). The number of serious complications found in the present series
was very low.
Conclusion : Keyhole MVD is an effective and reliable method of pain relief after TN both in the short- and long-term. Re-MVD in
both groups attained less favorable outcomes, but the differences were not statistically signi(cid:976)icant. Thorough intraoperative
exploration of the dorsal root entry zone [DREZ], and meticulous dissection by neurosurgeons are both mandatory to achieve pain
relief and reduce the incidence of complications after MVD.
Keywords : Trigeminal neuralgia, Microvascular decompression, Keyhole
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