Treatment of trigeminal neuralgia by posterior fossa microvascular decompression.

A series of 109 cases of microvascular decompression for intractable trigeminal neuralgia was reviewed. Operations were performed by a single surgeon and cases were reviewed independently by the one author. The failure rate in this study was 17.6%. A further 6.5% of cases endured brief recurrences not requiring treatment. Two-thirds of significant recurrences occurred within the initial 12 months. Long-term complications were experienced in 7.4% of cases. There was one postoperative mortality occurring in a patient with a large fibroblastic meningioma invading the brain stem. The classic Jannetta approach was modified following the first 32 cases allowing the cerebellum to be depressed inferiorly with a subsequent decline in the rate of loss of hearing from 12.5 to 3.7%. In over 70% of cases an aberrant superior cerebellar artery was found compressing the fifth cranial nerve. Patients had dental work performed in an attempt to control the pain prior to operation in 44% of cases.