Efficacy and Safety of Root Compression of Trigeminal Nerve for Trigeminal Neuralgia without Evidence of Vascular Compression

Objective Trigeminal neuralgia (TN) surgical treatment with microvascular decompression is highly effective and safe, but for a percentage of patients who undergo this procedure, no vascular compression is found. The purpose of this study was to evaluate the long-term efficacy with trigeminal root compression of the trigeminal nerve in patients with TN refractory to medical treatment who underwent neurosurgical management by a retrosigmoid approach of the cerebellopontine angle and were found to be negative for vascular compression. Methods A prospective collection of clinical data on all patients with a diagnosis of idiopathic TN was conducted at our institution. A total of 277 patients with TN were treated by a keyhole retrosigmoid approach for exploration of the cerebellopontine angle between January of 2000 and August of 2010. A total of 44 patients were found to be negative for vascular compression of the trigeminal nerve; all of these patients underwent trigeminal root compression. Results We found that all patients were pain free after the procedure. There was a 27% relapse in a mean time of 10 months, but 83% of these patients were adequately controlled by medical treatment, and only 17% needed a complementary procedure for pain relief. We also found that 63% of the patients complained of a partial loss of facial sensitivity, but only 1 patient presented with a corneal ulcer. There was a 6.7% rate of significant complications. Conclusions We concluded that trigeminal root compression is a safe and effective option for patients with primary TN without vascular compression.