Abstract Details

Title Microvascular Decompression for Trigeminal Neuralgia

Topic Clinical Neurophysiology

Presentation(s) S59 - (-)

Poster/Presentation
Number 001

Objective

Background Trigeminal neuralgia (TN) is commonly treated initially with medication to reduce pain. Patients with medically refractory TN may be treated with microvascular decompression (MVD) of the trigeminal nerve. Blink reflex (BR) and brain MRI studies are often performed to assess the trigeminal nerve.

Design/Methods The Mayo Clinic Arizona (MCA) EMG Laboratory database was searched from 1997 - 2010 for patients with diagnostic codes for TN or atypical facial pain. The records of 476 consecutive patients were retrospectively reviewed to identify 201 patients who met the following criteria: age 18-100, clinical features of TN, blink reflex study and brain imaging (MRI or CT). Medical records were retrospectively reviewed for clinical information.

Results Of 201 patients, complete remission (CR) was reported with carbamazepine or oxcarbazepine in 11 (5%), with gabapentin in 4 (2%), and baclofen in 2 (1%). A MVD procedure was performed in 113 patients (56%). The indications for MVD surgery were incomplete response to medications (71%), medication side effects (9%), or patient desire to be off medication (20%). The outcome of MVD at 1-8 weeks was CR in 85 patients (76%), partial remission in 12 (11%) and no change in 7 (6%). Complications of MVD seen in 27 patients (24%), included new facial numbness in 9 (8%) and a variety of surgical complications in 11 (10%). 31 patients (27%) had recurrence of TN at a mean time of 12.5 months after MVD.

Conclusions Only about 8% of patients with TN experience complete remission with medical therapy. The majority of patients in this series elected to undergo MVD for refractory TN. The outcome of MVD at 1-8 weeks is favorable but roughly 25% of patients experience complications and 25% experience delayed recurrence of TN.

Authors/Disclosures
Nancy Bello, DO (Yuma Regional Medical Center) PRESENTER	No disclosure on file
Mark A. Ross, MD, FAAN (Specialty Care)	No disclosure on file
	No disclosure on file

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