Early surgical observations during microvascular decompression (MVD) procedures have
contributed to our knowledge and theories regarding the pathophysiology of trigeminal
neuralgia. This procedure represents the only therapy that directly addresses the
presumed etiology of the disease and is associated with the longest duration of pain
relief. Once thought to represent a major operation with significant risks and rate
of mortality, MVD is now performed routinely and safely worldwide because of advances
in anesthesia, monitoring, and microsurgical technique. Modern imaging now provides
accurate preoperative assessment of the trigeminal nerve, which should increase surgical
success rates and limit failures or complications.
KEYWORDS
Microvascular decompression - trigeminal neuralgia - neurovascular compression - root
entry zone
REFERENCES
- 1
Horsley V, Taylor J, Colman W S.
Remarks on the various surgical procedures devised for the relief or cure of trigeminal
neuralgia (tic douloureux).
Br Med J.
1891;
2
1139-1143
1191-1193
1249-1252
- 2
Spiller W G, Frazier C H.
The division of the sensory root of the trigeminus for relief of tic douloureux: an
experimental, pathological, and clinical study with a preliminary report of one surgically
successful case.
Phila Med J.
1901;
8
1039-1049
- 3
Dandy W E.
Concerning the cause of trigeminal neuralgia.
Am J Surg.
1934;
24
447-455
- 4
Gardner W J.
Concerning the mechanism of trigeminal neuralgia and hemifacial spasm.
J Neurosurg.
1962;
19
947-958
- 5
Jannetta P J.
Arterial compression of the trigeminal nerve at the pons in patients with trigeminal
neuralgia.
J Neurosurg.
1967;
26
159-162
- 6
Burchiel K J, Slavin K V.
On the natural history of trigeminal neuralgia.
Neurosurgery.
2000;
46
152-155
- 7
Javadpour M, Eldridge P R, Varma T R, Miles J B, Nurmikko T J.
Microvascular decompression for trigeminal neuralgia in patients over 70 years of
age.
Neurology.
2003;
60
520
- 8
Akimoto H, Nagaoka T, Nariai T, Takada Y, Ohno K, Yoshino N.
Preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia
by use of three-dimensional reconstruction from two types of high resolution magnetic
resonance imaging.
Neurosurgery.
2002;
51
956-961
- 9
Hutchins L G, Harnsberger H R, Jacobs J M et al..
Trigeminal neuralgia: MR imaging assessment.
Radiology.
1990;
175
837-841
- 10
Jawahar A, Kondziolka D, Kanal E, Bissonett D J, Lunsford L D.
Imaging the trigeminal nerve and pons before and after surgical intervention for trigeminal
neuralgia.
Neurosurgery.
2001;
48
101-107
- 11
Majoie C BLM, Hulsmans F JH, Castelijns J A et al..
Symptoms and signs related to the trigeminal nerve: diagnostic yield of MR imaging.
Radiology.
1998;
209
557-562
- 12
Majoie C BLM, Hulsmans F JH, Verbeeten B et al..
Trigeminal neuralgia: comparison of two MR imaging techniques in the demonstration
of neurovascular contact.
Radiology.
1997;
204
455-460
- 13
Meaney J FM, Eldridge P R, Dunn L T, Nixon T E, Whitehouse G H, Miles J B.
Demonstration of neurovascular compression in trigeminal neuralgia with magnetic resonance
imaging.
J Neurosurg.
1995;
83
799-805
- 14
Worthington C, Hutson K, Boulware R et al..
Computerized tomography cisternography of the trigeminal nerve for stereotactic radiosurgery.
J Neurosurg.
2000;
93(suppl 3)
169-171
- 15
McLaughlin M R, Jannetta P J, Clyde B L, Subach B R, Comey C H, Resnick D K.
Microvascular decompression of cranial nerves: lessons learned after 4400 operations.
J Neurosurg.
1999;
90
1-8
- 16
Kondo A.
Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial
spasm.
Neurosurgery.
1997;
40
46-52
- 17
Hussein M, Wilson L, Illingworth R.
Patterns of sensory loss following fractional posterior fossa Vth nerve section for
trigeminal neuralgia.
J Neurol Neurosurg Psychiatry.
1982;
45
786-790
- 18 Apfelbaum R I. Surgery for tic douloureux. In: Weiss M Clinical Neurosurgery. Vol
31. Baltimore; Williams & Wilkins 1983: 351-358
- 19
Barker F G, Jannetta P J, Bissonette D J, Larkins M V, Jho H D.
The long term outcome of microvascular decompression for trigeminal neuralgia.
N Engl J Med.
1996;
334
1077-1083
- 20 Kaye A H. Trigeminal neuralgia: vascular compression theory. In Grady S Clinical
Neurosurgery. Vol 46 Baltimore; Lippincott Williams & Wilkins 1998: 499-506
- 21
Sindou M, Howeidy T, Acevedo G.
Anatomical observations during microvascular decompression for idiopathic trigeminal
neuralgia (with correlations between topography of pain and site of the neurovascular
conflict).
Acta Neurochir (Wien).
2002;
144
1-12
- 22
Piatt J H, Wilkins R H.
Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic
implications of various neurovascular relationships.
Neurosurgery.
1984;
14
462-471
- 23 Apfelbaum R. Neurovascular decompression: the procedure of choice?. In Grady S
Clinical Neurosurgery. Vol 46 Baltimore; Lippincott, Williams & Wilkins 1998: 473-498
- 24
Klun B.
Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal
neuralgia.
Neurosurgery.
1992;
30
49-52
- 25
Tyler-Kabara E C, Kassam A B, Horowitz M H et al..
Predictors of outcome in surgically managed patients with typical and atypical trigeminal
neuralgia: comparison of results following microvascular decompression.
J Neurosurg.
2002;
96
527-531
- 26
Bederson J B, Wilson C B.
Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases
of trigeminal neuralgia.
J Neurosurg.
1989;
71
359-367
- 27
Kolluri S, Heros R C.
Microvascular decompression for trigeminal neuralgia.
Surg Neurol.
1984;
22
235-240
- 28
Theodosopoulos P V, Marco E, Applebury C, Lamborn K R, Wilson C B.
Predictive model for pain recurrence after posterior fossa surgery for trigeminal
neuralgia.
Arch Neurol.
2002;
59
1297-1302
- 29
Burchiel K J, Clarke H, Haglund M, Loeser J D.
Long term efficacy of microvascular decompression in trigeminal neuralgia.
J Neurosurg.
1988;
69
35-38
- 30
Barker F G, Jannetta P J, Bissonette D J, Jho H D.
Trigeminal numbness and tic relief after microvascular decompression for typical trigeminal
neuralgia.
Neurosurgery.
1997;
40
39-45
- 31
Kureshi S A, Wilkins R H.
Posterior fossa reexploration for persistent or recurrent trigeminal neuralgia or
hemifacial spasm: surgical findings and therapeutic implications.
Neurosurgery.
1998;
43
1111-1117
- 32
Jannetta P J, Bissonette D J.
Management of the failed patient with trigeminal neuralgia.
Clin Neurosurg.
1985;
32
334-347
- 33
Taarnhoj P.
Decompression of the posterior root in trigeminal neuralgia.
J Neurosurg.
1982;
57
14-17
W. Jeffrey EliasM.D.
Department of Neurosurgery, UVA Health Sciences Center
Box 800212, Charlottesville, VA 22908
Email: wje4r@virginia.edu
