Outcome of medical and surgical management in intractable idiopathic trigeminal neuralgia

Background: The neurovascular conflict in trigeminal neuralgia is considered as annoying and intractable condition for patients and clinicians, so the chance of medical treatment should take reasonable duration. Objectives: This prospective study was designed to assess the outcome of microvascular decompression (MVD) in patients with a more than 3-year history of intractable idiopathic trigeminal neuralgia (TN) and poor drugs response. Methods: Twenty one patients (8 females/13 males) with intractable idiopathic TN (group-1) were enrolled to MVD and followed up for two years postoperatively. Group-2 (n=15, 6 females/9 males), continued on drug under their will. The outcome responses, pain relief and morbidity, were evaluated using: Ten-cm visual analog scale (VAS), and the Barrow Neurological Institute (BNI) scoring. Results: All patients, who disclosed the inclusion criteria, clinically and MRI brain, got benefits as of MVD surgery. The immediate efficiency in group-1 was 95.2% (n=20) and 90.5% (n=19) pain freedom during follow-up. Gaze at the morbidity rate in both groups, group-1 had no significant signs of recurrence or surgical complications (P>0.5), although group-2 showed 53.3% (n=8) poor response to medical therapy over the same period of time with experience of drug intolerance (P<0.01). Conclusion: We concluded that MVD should be done early to avoid drug side effects and psychological drawbacks of long term pharmacotherapy and disease comorbidity.