Original ArticleManagement of Primary Bilateral Trigeminal Neuralgia with Microvascular Decompression: 13-Case Series
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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Sequential onset of bilateral trigeminal neuralgia: clinical presentation and outcomes
2023, Clinical Neurology and NeurosurgeryContralateral trigeminal neuralgia arising due to CSF leak after microvascular decompression surgery for unilateral trigeminal neuralgia
2022, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCitation Excerpt :The time interval between the first onset of unilateral TGN and subsequent contralateral TGN is variable, and has been reported to range from around 13 to 16 months. A standard method of treatment has yet to be established for bilateral TGN, and there is still some debate regarding whether it should be treated in one or two phases [2]. Despite many reports regarding the pathogenesis of TGN [5–11], its precise etiology has not been elucidated.
Treatment Outcomes in Trigeminal Neuralgia–A Systematic Review of Domains, Dimensions and Measures
2020, World Neurosurgery: XCitation Excerpt :The IMMPACT Outcome Domains are as follows: 1) Pain; 2) Physical functioning; 3) Emotional functioning; 4) Participant ratings of global improvement/satisfaction; 5) Symptoms and adverse events; and 6) Participant disposition. With the exception of 8 papers, all studies used pain as an outcome domain (Figure 2 and Table 1).13-459 Symptoms and adverse events also were described in a high number of papers (n = 386); however, the impact of treatment on physical and emotional functioning was significantly less evaluated, in 46 and 17 studies, respectively (Tables 2 and 3).460-464
Combined Hyperactive Dysfunction Syndrome of the Cranial Nerves: Analysis of 37 Cases and Literature Review
2019, World NeurosurgeryCitation Excerpt :The right side was more commonly affected, with a greater incidence of pain, than that reported in previous studies.22,23 In published studies, bilateral symptoms are reported in 0.6% to 5.9% of patients, although most symptoms are reported to be of the idiopathic variety.23-28 In the comprehensive review by White and Sweet,29 486 bilateral cases (3.3%) were identified among 14,692 patients with TN.
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.