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August 1985

Case Against Microvascular Decompression in the Treatment of Trigeminal Neuralgia

Author Affiliations

From the Division of Neurosurgery, Toronto General Hospital and University of Toronto.

Arch Neurol. 1985;42(8):801-802. doi:10.1001/archneur.1985.04210090069019

My thesis is that there is no place for the treatment of trigeminal neuralgia by the posterior fossa microsurgical operation as advocated1 and practiced by Jannetta, following the experience of Gardner and Miklos in 1959.2

The hypothesis on which the microvascular decompression (MVD) is based has its flaws, but the success of the operation in relieving pain in rougly 80% of reporteded cases is a persuasive argument in its favor, although it discounts the failure in the remaining 20%.

My objection arises from the 1% mortality and the 10% significant neurologic complications that follow the operation. These include acute cerebellar swelling or hemorrhage, subdural and epidural hematoma, and permanent ipsilateral deafness. Mortality and morbidity incidence is similar in all series reported by experienced neurosurgeons.3 The incidence is probably higher in the many pstients Wno receive the operation at the hands of less experienced neurosurgeons.

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