The Effectiveness Posterior Fossa Partial Sensory Rhizotomy for the Treatment of Idiopathic Trigeminal Neuralgia

Soo Hee Kim, MD, Hwan Soo Kim, MD, Jung Hwan Lee, MD, Jae Il Lee, MD, Jun Kyeung Ko, MD, PhD, Chang Hwa Choi, MD, PhD

Abstract

J Kor Soc Ster Func Neurosurg. 2017 13(1): 1-5

The Effectiveness Posterior Fossa Partial Sensory Rhizotomy for the Treatment of Idiopathic Trigeminal Neuralgia

Soo Hee Kim, MD, Hwan Soo Kim, MD, Jung Hwan Lee, MD, Jae Il Lee, MD, Jun Kyeung Ko, MD, PhD, Chang Hwa Choi, MD, PhD

Department of Neurosurgery, Pusan National University Hospital, Busan, Korea

Objective: Microvascular decompression (MVD) is the most effective procedure for the treatment of trigeminal neuralgia (TN). In some cases, however, there is no significant vascular compressive lesion of the trigeminal nerve during posterior fossa craniotomy, or pain relief fails despite appropriate MVD. The aim of this study is to report the efficacy of Partial sensory rhizotomy (PSR) of the trigeminal nerve at the posterior fossa in those patients with idiopathic TN. Methods: Nine patients who underwent PSR for idiopathic TN were analyzed retrospectively. The mean age at the time of surgery was 58.0 years. The mean follow-up period was 46.3 months. Four patients without evidence of vascular compression underwent PSR only. Five patients underwent MVD with PSR because the vascular contact was insignificant. We analyzed patient characteristics, clinical results, offending vessels, and postoperative complications. Results: Clinical outcome showed excellent results in 33.3% (3 patients), good in 33.3% (3 patients), poor in 22.2% (2 patients), and recurrence in 11.2% (1 patient) at six months follow-up after the last operation. The overall efficacy rate of MVD of TN was 84.1%. The efficacy rate after MVD with PSR was 60.0%, and performed only PSR was 75.0%. Postoperative complications were transient in 6 patients, which was facial numbness or hypoesthesia. Conclusion: PSR at the posterior fossa for the treatment of idiopathic TN can be an alternative surgical procedure, when vascular compression is considered insignificant at operation field or MVD cannot be performed because there is no offending vessel.

Key words : Microvascular decompression, Rhizotomy, Trigeminal neuralgia.

중심단어 : Microvascular decompression, Rhizotomy, Trigeminal neuralgia.