Abstract

Summary
,
Objective
To evaluate the outcomes of a minimally invasive endoscopic technique for the treatment of classical trigeminal neuralgia aimed at optimizing surgical strategy.
Materials and Methods
The study included 52 patients with classical trigeminal neuralgia: 39 women (75%) and 13 men (25%). The mean age was 50.7 ± 14.2 years, with a mean age at disease onset of 55 years. Pain was more frequently localized on the right side (43 cases), while left-sided pain was observed in 9 patients. Pain intensity was assessed using the Visual Analog Scale (VAS). The diagnosis was confirmed according to international diagnostic criteria. All patients underwent endoscopic microvascular decompression of the trigeminal nerve root using a minimally invasive approach.
Results
Intraoperative endoscopic findings demonstrated compression of the trigeminal nerve root by the superior cerebellar artery in 38 patients (73.1%), by the petrosal venous complex in 5 patients (9.6%), and a loop of the anterior inferior cerebellar artery (AICA) without classical compression in 9 patients (17.3%). Complete pain relief in the immediate postoperative period was achieved in 43 patients (83%). At admission, pain was assessed as intolerable in 46 patients (88.4%) and very severe in 6 patients (11.5%). Delayed pain regression with analgesic therapy was observed in 7 patients (13.4%), while no clinical improvement was noted in 2 patients (3.8%). No early postoperative complications were recorded. During follow-up, 29 patients (55.7%) remained pain-free.
Conclusion
Minimally invasive endoscopic decompression of the trigeminal nerve root demonstrates high clinical efficacy in the treatment of classical trigeminal neuralgia and allows significant improvement in surgical outcomes in this category of patients.

Keywords

magnetic resonance imaging; endoscopy; minimally invasive approach; microvascular decompression; neurovascular conflict; trigeminal neuralgia

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