Abstract
Our experience in treating patients with trigeminal neuralgia is reported and current concepts of its pathogenesis and treatment is presented.
Seventy-four patients with trigeminal neuralgia were treated at our hospital between 1976 and 1983. Sixty-three patients could be controlled successfully with medication and/or trigeminal nerve block. In 11 patients surgical treatment was carried out. Among them 9 patients underwent suboccipital craniectomy, and operative findings were as follows. In 7 patients causative lesions were found (5 C-P angle tumors, 1 vertebrobasilar aneurysm and 1 adhesive arachnoiditis). In 2 cases trigeminal nerve root seemed intact, and trigeminal rhizotomy was carried out. Other 2 patients underwent trigeminal rhizotomy by subtemporal approach. Operative results were satisfactory in all cases.
The pathogenesis of trigeminal neuralgias has been controversial, but recently mechanical compression on nerve root at its entry zone by aberrant vessels (vascular cross-compression) is believed to be causative in majority of patients with this disease. As for its treatment, microvascular decompression by suboccipital craniectomy has been proposed and developed by Janetta, and now this procedure is widely accepted. Though our cases do not include typical microvascular decompression, candidates for such operation should exist in medically controlled group. If any of these patients become refractory to medical treatment, posterior fossa exploration should be necessary for vascular decompression.
We believe patient: with this disease should be treated medically at first, and surgical treatment is restricted to patients who are refractory to medication or in whom causative lesions are discovered by preoperative examinations such as CT scan and angiography.
