Microvascular decompression in trigeminal neuralgia with no vascular compression

Background: Microvascular decompression (MVD) is a wellknown surgical procedure with one of the best long-term results in the therapy of trigeminal neuralgia. But the exact pathophysiology of this disease has not yet been elucidated. Cases with undetectable vascular compression who are cured after MVD make this dilemma clear. Autopsy studies have also shown vascular compression in asymptomatic cases. Methods: Five of 40 cases with TN treated with MVD in our clinic had no visible vascular compression. Diagnosis was made with MRI and MRA. Results: Surprisingly all of these 5 patients were cured with MVD. Two of them needed only one operation to become pain free and 3 a second operation. Conclusion: We think that the therapeutic effect of MVD is due to minimal trauma of the nerve. It seems that MVD is a good alternative strategy with low complication rates in comparison to ablative procedures. Copyright (c) 2007 S. Karger AG, Basel.