Unilateral Approach to Primary Bilateral Trigeminal Neuralgia Via Bilateral Microvascular Decompression

Background: Primary bilateral trigeminal neuralgia is a rare disease characterized by paroxysmal bilateral facial pain confined to the somatosensory distribution of the trigeminal nerve. Nonetheless, while treatment of bilateral trigeminal neuralgia with microvascular decompression (MVD) has been reported, there have been no trials of a unilateral approach for bilateral MVD. Methods: The authors retrospectively analyzed the outcomes and complications of 2 cases of bilateral trigeminal neuralgia treated with MVD by unilateral craniotomy. The 2 patients were followed up for 27 and 32 months, with satisfactory results. One patient developed facial numbness on 1 side postoperatively, which disappeared 3 months later. Conclusions: Microvascular decompression is an effective and safe opinion for primary bilateral trigeminal neuralgia that fails to respond adequately to medical therapy. The authors suggest that the initial surgery be performed on the more seriously affected side. Unilateral craniotomy for bilateral MVD represents a new therapeutic approach in patients with an enlarged superior trigeminal nerve space.