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Microvascular decompression for trigeminal neuralgia: a surgical series
EANS Academy. Tavares S. 09/25/19; 275768; EP07017
Ms. Sofia Tavares
Ms. Sofia Tavares

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Abstract
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Trigeminal neuralgia (TN) is reportedly one of the most excruciating pain syndromes afflicting orofacial region. The goal of surgery is to decompress the trigeminal root from offending vessels, aiming at a permanent cure with little or none sensory deficit. Here we present our surgical experience in the treatment of this challenging pathology.
Patients submitted to microvascular decompression at our centre since 1993 were included. Outcome was evaluated by the Barrow Neurological Institute Scale and statistical data was analysed with SPSS® software.
118 patients were analysed, with a mean age of 61,59±11,84 years at the time of surgery with a female predominance (55,9%). 95,7% of the cases had a typical presentation, with a right side involvement in 60,2%. V2-V3 was the pain territory most often encountered, representing 31,4% of the cases, followed by V1-V2 territory (22,9%) and V2 (20,3%).
In 97,3% of the cases it was possible to identify a vascular contact, mainly of arterial nature (66,4%), being AICA the most frequently involved artery in 43,8% of the patients. Gore Tex® was the more often used vascular prosthesis (77,4%)
We had a 19,6% complication rate, hypoesthesia of one of the V pair branches being the most frequent one (38,5%).
In our series, we achieved significant symptomatic relief in 92,2% of patients.
At follow up 66,7% of the patients achieved a total pain relief without any need for medication, and only 3,5% continued with uncontrolled pain after surgery. 25% had recurrence of symptoms.
The type of prosthetic material used influenced clinical recurrence (p =0.006, Pearson Qui-Square), and patients with Gore-Tex® prosthetics had a higher recurrence rate (38%) than the group were Teflon® was used (9,5%). 2 cases of aseptic meningitis were associated in patients with Gore Tex® prosthetics.
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