THE LONG-TERM OUTCOME OF MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA

Background. Several surgical procedures to treat trigeminal neuralgia (tic douloureux) are available, but most reports provide only short-te rm follow-up information. Methods. We describe the long-term results o f surgery in 1185 patients who underwent microvascular decompression o f the trigeminal nerve for medically intractable trigeminal neuralgia, The outcome of the procedure was assessed prospectively with annual q uestionnaires. Results. Of the 1185 patients who underwent microvascul ar decompression during the 20-year study period, 1155 were followed f or 1 year or more after the operation, The median follow-up period was 6.2 years, Most postoperative recurrences of tic took place in the fi rst two years after surgery, Thirty percent of the patients had recurr ences of tie during the study period, and 11 percent underwent second operations for the recurrences. Ten years after surgery, 70 percent of the patients (as determined by Kaplan-Meier analysis) had excellent f inal results - that is, they were free of pain without medication for tie. An additional 4 percent had occasional pain that did not require long-term medication, Ten years after the procedure, the annual rate o f the recurrence of tic was less than 1 percent, Female sex, symptoms lasting more than eight years, venous compression of the trigeminal-ro ot entry zone, and the lack of immediate postoperative cessation of ti c were significant predictors of eventual recurrence, Having undergone a previous ablative procedure did not lessen a patient's likelihood o f having a cessation of tic after microvascular decompression, but the rates of burning and aching facial pain, as reported on the last foll ow-up questionnaire, were higher if a trigeminal-ganglion lesion had b een created with radiofrequency current before microvascular decompres sion. Major complications included two deaths shortly after the operat ion (0.2 percent) and one brain-stem infarction (0.1 percent), Sixteen patients (1 percent) had ipsilateral hearing loss. Conclusions. Micro vascular decompression is a safe and effective treatment for trigemina l neuralgia, with a high rate of long-term success. (C) 1996, Massachu setts Medical Society.