MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA USING THE SLING RETRACTION METHOD

Abstract

Trigeminal neuralgia (TN) is a debilitating facial pain disorder, characterized by recurrent brief episodes of severe, unilateral, electric shock-like painsabrupt in onset and termination 1 or more divisions of the trigeminal nerve triggered by innocuous stimuli. It has been dubbed “the Suicide disease”. TN is more common in women, with an incidence of about 5.7 per 100 000 women and 2.5 per 100 000 men. Peak incidence occurs between 50 and 60 years with increase in prevalence with age; but the condition has also been reported in children and young adults. Studies by PJJanneta et al. showed that vascular compression of the trigeminal nerve at or near the root entry zone is the most plausible and is now the most widely accepted etiology for this malady. The first line of treatment is anticonvulsant medical therapy. For cases refractory cases, a range of surgical options are available. Microvascular decompression (MVD), popularised by PJ Janneta et al., is considered the most definitive and durable treatment for trigeminal neuralgia. Patients who undergo MVD can have complete resolution of pain immediately after surgery. I present a 51year old male who was diagnosed with a severe form of left TN that had become refractory to medical therapy. MVD was done with complete resolution of symptoms. This case, done in our low resource setting, demonstrates and confirms that stitched sling retraction technique is safe and effective, and results in immediate pain relief in well selected cases, even as was shown by Masuoka, J et al. in their study.