R García De Sola1, M Escosa Bagé. 1. Servicio de Neurocirugía, Hospital Universitario de la Princesa, Madrid, 28006, Spain. rgsola@retemail.es
Abstract
INTRODUCTION: Trigeminal neuralgia due to vertebrobasilar dolichoectasia is an acquired disease whose true incidence is not known. Microvascular decompression is the most effective technique both for symptomatic relief and for the conservation of nerve structure and function, in spite of the potential complications of all major surgery. In cases which are drug-resistant and have a life expectancy of over five years, microvascular decompression may be done using several techniques. CLINICAL CASES: We present three cases with drug-resistant trigeminal neuralgia. One patient had a history of previous cerebrovascular ischaemia, another had arterial and pulmonary hypertension. In all cases vertebrobasilar dolichoectasia was seen on magnetic resonance. Microvascular decompression of the trigeminal nerve was done, placing pieces of Teflon between the tentorium and the artery to displace it. Postoperatively the pain disappeared in two cases and was much relieved in the other, making good progress with no complications. CONCLUSIONS: Trigeminal neuralgia due to vertebrobasilar dolichoectasia is a progressive acquired disease. The imaging technique of choice is magnetic resonance. Cerebral angiography may be useful for confirmation. This new technique of microvascular decompression avoids excessive manipulation of the ectatic, arteriosclerotic basilar artery and also pulsatile compression, so that the risk of secondary effects is reduced and the efficacy of the decompression maintained. Further cases are needed to confirm the usefulness of this technique.
INTRODUCTION:Trigeminal neuralgia due to vertebrobasilar dolichoectasia is an acquired disease whose true incidence is not known. Microvascular decompression is the most effective technique both for symptomatic relief and for the conservation of nerve structure and function, in spite of the potential complications of all major surgery. In cases which are drug-resistant and have a life expectancy of over five years, microvascular decompression may be done using several techniques. CLINICAL CASES: We present three cases with drug-resistant trigeminal neuralgia. One patient had a history of previous cerebrovascular ischaemia, another had arterial and pulmonary hypertension. In all cases vertebrobasilar dolichoectasia was seen on magnetic resonance. Microvascular decompression of the trigeminal nerve was done, placing pieces of Teflon between the tentorium and the artery to displace it. Postoperatively the pain disappeared in two cases and was much relieved in the other, making good progress with no complications. CONCLUSIONS:Trigeminal neuralgia due to vertebrobasilar dolichoectasia is a progressive acquired disease. The imaging technique of choice is magnetic resonance. Cerebral angiography may be useful for confirmation. This new technique of microvascular decompression avoids excessive manipulation of the ectatic, arteriosclerotic basilar artery and also pulsatile compression, so that the risk of secondary effects is reduced and the efficacy of the decompression maintained. Further cases are needed to confirm the usefulness of this technique.