Abstract

OBJECTIVE: Trigeminal neuralgia is a disorder associated with severe episodes of lancinating pain in the distribution of trigeminal nerve. The majority of these patients eventually requires surgical management to achieve remission of symptoms. Microvascular decompression addresses the root cause of the disease and is more effective than ablative procedures at preventing recurrence of symptoms. However, several long-term follow-up studies have disclosed that the efficacy of the procedure gradually decreases over time and have related recurrence to some clinical variables. Our objective is to study the impact of the type of interposing materials used for decompression on long-term success rate.

MATERIALS and METHODS: We conducted a retrospective chart review of 65 patients with trigeminal neuralgia operated between 2007 and 2010 in an otology/base of skull tertiary referral center. Endoscopy-assisted microvascular decompression was used for all patients. Three types of interposing material were used: Teflon in 30 patients (Group I); muscle in 19 patients (Group II); and a combination of both in 16 patients (Group III). The minimum follow-up period was 3 years.   

RESULTS: In total, 17 (26.1%) of the 65 patients had recurrence of their symptoms. Average time for recurrence was 7.82+/-4.31 months; 95% of recurrences appeared within the first year. Recurrence rate was lower in Group II (5.2%) as compared to Group I (40%) and Group III (23%), and the difference was statistically significant (p≤0.05).

CONCLUSION: Microvascular decompression with interposition of a muscle pad carries a lower recurrence rate as compared to interposition of Teflon alone or in combination with muscle.