TRIGEMINAL NEURALGIA in KEMU

Think of excruciating pain paroxysmal attack very severe intense sharp shooting pain along the branches of Trigeminal divisions in face. Carbamazepine for months and years and still no relief.

Microvascular decompression is the treatment of choice. 100 percent result in our hospital.

Till date we have done and followed 10 patients. All in right side and mostly involving ophthalmic and maxillary divisons. In 9 of them Superior cerebellar artery was the offending vessel and in one case it was unnamed vessel . Result was no neuralgic pain in patients immediate post op. 3 developed hearing impairment but all recovered within few months.

So MVD is such a remarkable operation with 100 % cure rate in our setup.

All the patients underwent surgery under GA in lateral decubitus position neck and head slightly flexed and rotated at 15 degrees towards the contralateral position . The approach was infratentorial supracerebellar through a retromastoid keyhole craniectomy . The arachnoid covering the dorsolateral aspect of the cerebral peduncle was first incised from soperior petrsosal venous trunk in a medial direction parallel to tentorium incisura taking care not to insult the trochlear nerve then laterally and inferiorly to VII-VIII nerve complex . The superor petrosal vein and tributaries dissected free from the surrounding arachnoid membranes and preserved as much as possible. In all patients trunk and 3 main afferents mesencephalic , cerebellar and pontine veins respected . The aim was to preserve the venous return from the cerebellopontine angle, to avoid stretching of VII-VIII nerve complex . The entire trigeminal root was dissected free by dividing the arachnoid filaments and examined from the porus of meckels cave to root entry zone (REZ), so that all neurovascular conflicts could be identified .
Prolene mesh was kept between the Trigeminal nerve root and the offending vessel .