MICROVASCULAR DECOMPRESSION FOR PEDIATRIC ONSET TRIGEMINAL NEURALGIA

BACKGROUND: Trigeminal neuralgia (TGN) is generally a disease of the e lderly. Vascular compression, the causative agent in the majority of c ases, is thought to result from atherosclerotic changes within the ves sels of the posterior fossa. Rarely, the disease presents during child hood, before the onset of severe atherosclerotic changes. We therefore sought to explore the role of vascular compression in pediatric patie nts with medically refractory TGN. PATIENTS AND METHODS: Twenty-three patients were identified in whom the onset of typical TGN had occurred during childhood (age 18 yr or younger) and who underwent exploration of the cerebellopontine angle. Twenty-two of 23 underwent microvascul ar decompression (MVD) of the trigeminal nerve. Twenty-one of these pa tients were followed for more than 1 year. A retrospective chart revie w was conducted to determine the efficacy of MVD for the treatment of TGN in this select population. Operative findings were recorded and co rrelated with patient outcome. RESULTS: Twenty-two of 23 patients (96% ) were found to have vascular compression of the trigeminal nerve at t he time of exploration. One patient was found to have an epidermoid tu mor. MVD resulted in complete pain relief at the time of discharge in 16 of 22 patients (73%), with an additional 4 patients (18%) having a greater than 75% diminution of pain. The 21 patients who were followed for at least 1 year were followed for a mean of 105 months. At the ti me of their last follow-up, 9 of these patients (43%) continued to hav e complete pain relief and 3 (14%) had a greater than 75% diminution o f pain. The most common operative finding was a vein compressing the n erve, often in combination with a branch of the superior cerebellar ar tery. DISCUSSION: MVD has been demonstrated to be a safe and efficacio us treatment for TGN in the adult population. Patients whose symptoms begin in childhood do not enjoy the same therapeutic response to MVD a s do patients with TGN onset in adulthood. An increased incidence of v enous compression was noted in this population, as was a longer durati on of symptoms before MVD. These factors may be responsible for the de creased efficacy of MVD in this patient population.