Elsevier

World Neurosurgery

Volume 109, January 2018, Pages e724-e730
World Neurosurgery

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

https://doi.org/10.1016/j.wneu.2017.10.072Get rights and content

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.

Introduction

Trigeminal neuralgia (TN) is a debilitating disorder characterized by lancinating facial pain confined to 1 or more divisions of the trigeminal nerve1 and an incidence of 5 people per 100,000 per year.2 Primary bilateral TN (PBTN) accounts for 0.3%–6% of TN cases.3, 4 In 1934, Dandy et al5 proposed that vascular compression of the cranial nerves could cause clinical syndromes, leading to the proposal of the neurovascular conflict theory. While this theory is widely accepted as a cause of unilateral TN, the exact pathology underlying PBTN remains unclear. To this end, there is no current consensus regarding a standard treatment for PBTN. While different ablative surgeries have been proposed for PBTN, these procedures are associated with a risk of neurologic sequelae including bilateral trigeminal sensory deficits.6

In the present case series, we summarize the demographic and clinical features of 13 cases of PBTN that were treated with microvascular decompression (MVD) and discuss the validity of the neurovascular conflict theory in PBTN.

Section snippets

Patient Population

A total of 545 patients with TN underwent MVD at the Department of Neurosurgery of XinHua Hospital (affiliated with the Shanghai Jiao Tong University School of Medicine) between January 2013 and January 2015. Of these, 13 cases had PBTN. All patients completed 3-dimensional time-of-flight magnetic resonance imaging (3D-TOF-MRI) before the MVD procedure (Figure 1). Patients and their families provided written informed consent for treatment, and the study was approved by the hospital ethics

Results

The analysis included 13 patients with PBTN (9 female patients and 4 male patients) ages 48–74 years. The prevalence of PBTN in the total population was 2.39%. Table 2 shows the characteristics of patients with unilateral and bilateral TN. Compared with unilateral TN, PBTN more frequently affected female patients, was more likely to be familial, and was associated with smaller volumetry of posterior fossa.

Table 3 shows the clinical and surgical features of the 13 cases of PBTN. In 1 of 13

Discussion

The present case series characterizes the successful treatment of bilateral TN with MVD in a cohort of 13 patients. The prevalence of bilateral TN in our study population of 545 patients was 2.39%. PBTN was most commonly diagnosed in women (with a female-to-male ratio of 2.25:1) and in individuals with a family history of TN. Pollack et al7 reported a slightly higher prevalence of PTBN (4.5%) among 664 patients with TN, but our value is consistent with the prevalence range indicated by other

Conclusions

In conclusion, we suggest that vascular compression is a common cause of PBTN; specifically, crowding of the cerebellopontine angle space may be important. MVD is a safe and effective treatment option for patients with PBTN who are refractory to pharmacologic treatment.

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Conflict of interest statement: This study was supported by the Shanghai Xinhua Hospital Foundation (Grants 15LC21 and 15YJ05), Shanghai Jiao Tong University Medical and Engineering Cross Fund (Grant YG2016ZD11 and YG2016QN68), and the Natural Science Foundation of China (Grant 81401033 and 81671205).

Hua Zhao and Xu-hui Wang are co-first authors.

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