• Shahbaz Ali Khan Department of Neurosurgery, Ayub Medical College, Abbottabad
  • Baynazir Khan Department of Neurosurgery, Ayub Medical College, Abbottabad
  • Abdul Aziz Khan Department of Neurosurgery, Ayub Medical College, Abbottabad
  • Ehtisham Ahmed Khan Afridi Department of Neurosurgery, Ayub Medical College, Abbottabad
  • Shakir Mehmood Department of Neurosurgery, Ayub Medical College, Abbottabad
  • Gul Muhammad Department of Neurosurgery, Ayub Medical College, Abbottabad
  • Iqbal Hussain Department of Neurosurgery, Ayub Medical College, Abbottabad
  • Khalid Khan Zadran Department of Neurosurgery, Ayub Medical College, Abbottabad
  • Sajid Nazir Bhatti Department of Neurosurgery, Ayub Medical College, Abbottabad


Background: Trigeminal Neuralgia (TGN) is the most frequently diagnosed type of facial pain. In idiopathic type of TGN it is caused by the neuro-vascular conflict involving trigeminal nerve. Microvascular decompression (MVD) aims at addressing this basic pathology in the idiopathic type of TGN. This study was conducted to determine the outcome and complications of patients with idiopathic TGN undergoing MVD. Methods: In a descriptive case series patients with idiopathic TGN undergoing MVD were included in consecutive manner. Patients were diagnosed on the basis of detailed history and clinical examination. Retromastoid approach with craniectomy was used to access cerebellopontine angle (CP-angle) and microsurgical decompression was done. Patients were followed up for 6 months. Results: A total of 53 patients underwent MVD with mean age of 51.6±4.2 years and male predominance. In majority of cases (58.4%) both Maxillary and Mandibular divisions were involved. Per-operatively superior cerebellar artery (SCA) was causing the neuro-vascular conflict in 33 (62.2%) of the cases, anterior inferior cerebellar artery (AICA) in 6 (11.3%) cases, both CSA and AICA in 3 (5.6%) cases, venous compressions in only 1 (1.8%) patient and thick arachnoid adhesions were seen in 10 (18.9%) patients. Postoperatively, 33 (68%) patients were pain free, in 14 (26.45%) patients pain was significantly improved whereas in 3 (5.6%) patients there was mild improvement in symptoms. Three (5.6%) patients did not improve after the primary surgery. Cerebrospinal fluid (CSF) leak was encountered in 7 (13.2%) patients post-operatively, 4 (7.5%) patients developed wound infection and 1 (1.8%) patient developed aseptic meningitis. Three (5.6%) patients had transient VII nerve palsy while one patient developed permanent VII nerve palsy. Conclusion: MVD is a safe and effective surgical option for treating patients with idiopathic TGN with better surgical outcome and fewer complications.


Obermann M. Treatment options in trigeminal neuralgia. Ther Adv Neurol Disord 2010;3(2):107–15.

Katusic S, Beard CM, Bergstralh E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol 1990;27(1):89–95.

Emril DR, Ho KY. Treatment of trigeminal neuralgia: role of radiofrequency ablation. J Pain Res 2010;3:249–54.

De Simone R, Marano E, Brescia Morra V, Ranieri A, Ripa P, Esposito M, et al. A clinical comparison of trigeminal neuralgic pain in patients with and without underlying multiple sclerosis. Neurol Sci 2005;26 Suppl 2:s150–1.

Cheshire WP. Trigeminal neuralgia feigns the terrorist. Cephalalgia 2003;23(3):230.

Tölle T, Dukes E, Sadosky A. Patient burden of trigeminal neuralgia: results from a cross-sectional survey of health state impairment and treatment patterns in six European countries. Pain Pract 2006;6(3):153–60.

Zakrzewska JM. Diagnosis and differential diagnosis of trigeminal neuralgia. Clin J Pain 2002;18(1):14–21.

Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004;24 Suppl 1:9–160.

Zebenholzer K, Wöber C, Vigl M, Wessely P, Wöber-Bingöl C. Facial pain and the second edition of the International Classification of Headache Disorders. Headache 2006;46(2):259–63.

Cheshire WP. Trigeminal neuralgia: for one nerve a multitude of treatments. Expert Rev Neurother 2007;7(11):1565–79.

Woolfall P, Coulthard A. Pictorial review: Trigeminal nerve: anatomy and pathology. Br J Radiol 2001;74(881):458–67.

Nurmikko TJ, Eldridge PR. Trigeminal neuralgia--pathophysiology, diagnosis and current treatment. Br J Anaesth 2001;87(1):117–32.

Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol 2008;15(10):1013–28.

Omeis I, Smith D, Kim S, Murali R. Percutaneous balloon compression for the treatment of recurrent trigeminal neuralgia: long-term outcome in 29 patients. Stereotact Funct Neurosurg 2008;86(4):259–65.

Skirving DJ, Dan NG. A 20-year review of percutaneous balloon compression of the trigeminal ganglion. J Neurosurg 2001;94(6):913–7.

Rehman A, Abbas I, Khan SA, Ahmed E, Fatima F, Anwar AS. Spectrum of Trigeminal Neuralgia. J Ayub Med Coll Abbottabad 2013;25(1-2):168–71.

Love S, Coakham HB. Trigeminal neuralgia: pathology and pathogenesis. Brain 2001;124(Pt 12):2347–60.

Khan Afridi EA, Khan SA, Qureshi WU, Bhatti SN, Muhammad G, Mahmood S, et al. Frequency of cerebellopontine angle tumours in patients with trigeminal neuralgia. J Ayub Med Coll Abbottabad. 2014;26(3):331-3.

Forbes J, Cooper C, Jermakowicz W, Neimat J, Konrad P. Microvascular decompression: salient surgical principles and technical nuances. J Vis Exp 2011;5(53):e2590.

Zhang L, Zhang Y, Li C, Zhu S. Surgical treatment of primary trigeminal neuralgia: comparison of the effectiveness between MVD and MVD+PSR in a series of 210 patients. Turk Neurosurg 2012;22(1):32–8.

Alberione F, Arena A, Matera R. [Microvascular descompression for trigeminal neuralgia: prognostic [corrected] factors]. Neurocirugia (Astur) 2008;19(3):242–7.

Broggi G, Ferroli P, Franzini A, Servello D, Dones I. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2000;68(1):59–64.

Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996;334(17):1077–83.

Jellish WS, Benedict W, Owen K, Anderson D, Fluder E, Shea JF. Perioperative and long-term operative outcomes after surgery for trigeminal neuralgia: microvascular decompression vs percutaneous balloon ablation. Head Face Med 2008;4:11



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