Internal Neurolysis with and without Microvascular Decompression for Trigeminal Neuralgia: Case Series

Victor Sabourin, Jacob Mazza, Tomas Garzon, Jeffrey Head, Donald Ye, Anthony Stefanelli, Fadi Al-Saiegh, Pascal Lavergne, James Evans
World Neurosurgery 2020 July 13

OBJECTIVE: Microvascular decompression remains the first line surgical treatment for trigeminal neuralgia when an offending vessel can be identified causing neurovascular compression. However, there are patients without neurovascular compression who either develop trigeminal neuralgia or have recurrence after MVD. In addition, patients with venous and less severe arterial compression are known to have reduced efficacy after microvascular decompression. Internal neurolysis (IN), is a surgical technique of separating the fascicles of the trigeminal nerve and may be a good option for trigeminal neuralgia patients without vascular compression.

METHODS: A retrospective, IRB-approved chart review was performed for adult patients with trigeminal neuralgia who underwent an internal neurolysis. The search resulted in 32 patients who had been treated between the years 2016 - 2019. The Barrow Neurological Institute Pain Scale and Hypesthesia Scale were used to determine outcomes.

RESULTS: The average follow-up was 20 months with a range of 3-40 months. Post-operative outcomes showed a BNI-PS: I - 50%, Excellent control: 56%, Successful control: 78%, Adequate control: 94%, and Poor control: 6%. Significantly more patients without previous treatment had successful pain control; 95% vs 54%. Six patients (19%) had recurrence of pain and were significantly more likely to have return of pain compared to patients who did not have a previous procedure; 39% vs 5%. The overall rate of hypesthesia post-operatively was: BNI-HS: I - 28%, BNI-HS: II - 69%, and BNI-HS: III - 3%.

CONCLUSIONS: Internal neurolysis with and without MVD has shown efficacy in treating trigeminal neuralgia in carefully selected patients.

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