Title: 199 Outcomes After Microvascular Decompression for Patients with Trigeminal Neuralgia and Suspected Multiple Sclerosis
Abstract: INTRODUCTION: Microvascular decompression (MVD) is the accepted surgical treatment of choice for patients with idiopathic trigeminal neuralgia (TN). The role of MVD in patients with multiple sclerosis (MS)-related TN is controversial. METHODS: Between July 1999 until January 2011, 9 patients (5 men, 4 women) having both areas of increased signal in the trigeminal pathways on long-TR imaging and neurovascular compression demonstrated on pre-operative MRI underwent MVD. All of the patients had failed medical therapy and no patient had other symptoms or signs of MS. One patient had failed prior percutaneous surgery; one patient had Burchiel Type 2 TN. Follow-up (median, 15 months) was censored at the time of additional surgery (n = 6) or last clinic visit (n = 3). RESULTS: The patients were similar with regard to age, gender, and pain duration compared to 350 patients with idiopathic TN having a MVD over the same time interval. At surgery, neurovascular compression was from the superior cerebellar artery (SCA) plus adjacent vein (n = 4), venous alone (n = 3), SCA alone (n = 1), and SCA plus anterior inferior cerebellar artery (n = 1). Initially, 7 patients (78%) were pain-free and able to discontinue medication use for TN. Five patients developed recurrent pain at a median of 5 months after surgery (range, 2-23). The actuarial rate of being pain-free without medications was 57% at 3-months and 17% at 2-years. Six patients underwent 9 additional operations including glycerol rhizotomy (n = 4), radiosurgery (n = 2), balloon compression (n = 2), and repeat MVD (n = 1). Five of these 6 patients were pain-free at last contact. CONCLUSION: The facial pain outcomes after MVD in patients suspected to have MS-related TN are worse compared to patients with idiopathic TN. These results support the hypothesis of a central mechanism of pain production for some patients with suspected or proven MS-related TN.