RETROMASTOID SUBOCCIPITAL MICROVASCULAR DECOMPRESSION TECHNIQUE FOR THE TREATMENT OF TRIGEMINAL NEURALGIA

Abstract

ABSTRACT

Introduction: Trigeminal neuralgia is a condition of craniofacial pain which is characterized by sudden, excruciating, and brief pain in the sensory distribution of one or more branches of the fifth cranial nerve resulting in decreased quality of life of the affected patient. In patient’s refractory to pharmacological or conservative treatment, the surgical procedure of choice is microvascular decompression. The aim of our study was to determine the outcome of retro mastoid suboccipital microvascular decompression technique for the trigeminal neuralgia.

Material & Methods: This case series study was conducted in Department of Neurosurgery Prime Teaching Hospital and Irfan General Hospital Peshawar from January 2020 to January 2022. Consent from the ethical committee and patients were taken. All patients of trigeminal neuralgia were included. Those patients having mass lesion were excluded. All information were put in proforma. Results were analysed by SPSS version 20.

Results: Total sample size of our study was 58 patients. Majority of the patients were female (n 34 59%). Mean age of the patients was 44+ 5 years (range 25-60 years). The common level of pain distribution was in maxillary and mandibular branches V2-V3, 39(67.8%). The most common aetiology of trigeminal neuralgia was superior cerebellar artery loop in 41(70.7%) patients. Surgical outcome in terms of pain relief was in 49 (84.5 %) patients, after 6-8 months follow-up, The most common complication of surgery was CSF leak in 3(5.2%) patients, followed by post operative Sub arachnoid haemorrhage in 1(1.8%) patient, mortality was reported in 2 (3.4%) patients.

Conclusion: The results of our study concluded that microvascular decompression surgery is effective in reducing pain, improving patient satisfaction in trigeminal neuralgia patients who are refractory to conservative treatment options such as carbamazepine’s. The procedure also has some complications such as cerebrospinal fluid leakage and sub arachnoid haemorrhage

Key Words: Decompression, microvascular, neuralgia, retro mastoid, suboccipital, superior cerebellar artery