The treatment of trigeminal neuralgia by microvascular decompression and partial sensory rhizotomy.

A retrospective study was carried out on 60 cases that had microvascular decompression or partial rhizotomy for trigeminal neuralgia. There were 25 males and 35 females with a mean age of 59.5 years. The mean duration of symptoms prior to surgery was 6.9 years. Thirty seven cases (61.6%) has previous ablative surgical procedure for the trigeminal neuralgia. In 42 cases (70%), there was evidence of arterial compression of the trigeminal root, venous compression in five cases (8.3%), and compression by a small meningioma in two cases (3.3%). There was no evidence of any compression in 11 cases (18.3%). There was no mortality. Minor morbidity was transient in 11.7%, and permanent in 3.3% of cases. The trigeminal neuralgia recurred within the first year after surgery in 8.3% of cases. 88.3% of the cases were pain-free or had minimal pain which did not require treatment. 11.7% continued to have pain which was controlled on drug therapy. There was a mean follow-up of 23 months. This form of surgical treatment has become the first line treatment in cases of trigeminal neuralgia which failed to respond to medical treatment.