Microvascular Decompression In The Management Of Trigeminal Neuralgia

Case Report And Review Of Literature

Abstract

Trigeminal neuralgia (TN) is a debilitating condition characterized by recurrent, severe facial pain, usually unilateral and often triggered by minimal stimuli. This case report highlights the successful treatment of a 45-year-old male who had experienced four years of right-sided facial pain refractory to pharmacological management. He had also undergone multiple tooth extractions in an attempt to alleviate the pain. Following comprehensive diagnostic evaluation, including a CISS-MRI sequence, vascular compression of the trigeminal nerve by a loop of the superior cerebellar artery was identified. Microvascular decompression (MVD) was selected as the definitive treatment modality due to the patient's lack of response to medical therapies.

MVD is recognised as the gold-standard surgical intervention for TN, particularly in cases where neurovascular compression is confirmed. In this patient, intraoperative findings corroborated arterial compression at the nerve root entry zone of the trigerminal nerve. A comprehensive understanding of the intricate neuroanatomy of the cerebellopontine angle (CPA) was essential in correctly positioning the patient on the operating table and safely exposing the trigeminal nerve and surrounding vasculature. The utilisation of refined microsurgical techniques, including the use of an operating microscope, meticulous dissection, and precise placement of a Teflon sponge between the nerve and artery, successfully alleviated the compression.

Postoperatively, the patient experienced immediate and complete resolution of pain without complications. This case underscores the critical role of sound neuroanatomical knowledge in identifying the neurovascular conflict and the application of precise microsurgical skills in achieving favourable outcomes. The success of MVD in this case emphasises the importance of accurate surgical technique to avoid damage to adjacent cranial nerves or blood vessels, ensuring both the efficacy of the procedure and the minimisation of risks. In conclusion, MVD remains a highly effective management strategy for TN when performed with a robust foundation in neuroanatomy and meticulous microsurgical execution.