La descompresión microvascular en el tratamiento de la neuralgia esencial del trigémino
Introduction and objective. We pretend to evaluate the surgical procedure and clinical results of microvascular decompression (MVD) of 21 patients suffering from essential trigeminal neuralgia between 1989 and 1997. Patients and methods. Selection criteria included: ineffectiveness of pharmacological treatment, good general condition, more than five years life expectancy, and do not have undergone ablative-lesive surgical procedures before. Results. After a post-surgical follow-up of between three months and three years, it was obtained a 100% success rate of immediate pain relief, with only a 14.2% recurrence. There were no sequels as those typically found in lesive techniques as paresthesias and dysesthesias, painful and/or corneal anaesthesia and motor disorders. There were no deaths, although there were three cases of post-surgical complications. Conclusions. To evaluate the long-term results of different surgical techniques in the treatment of the essential trigeminal neuralgia is outstanding the patients satisfaction rate, which not only depends on pain relief and absence of recurrence, but also and very specially on the neurological deficiencies following the procedure. So, we consider that MVD is the most effective technique both in symptoms relief and neural functions and structures preservation, even though the possibility of appearance of complications following any major surgery
Pacientes y métodos Los criterios de selección de la muestra incluían: ineficacia del tratamiento farmacológico, buen estado general y expectativas de sobrevida superiores a 5 años y no haber sido sometido anteriormente a tratamientos quirúrgicos ablativo-lesivos.
Resultados Con un seguimiento postoperatorio oscilante entre 3 meses y 3 años, se comprobó que el 100% de los casos obtenían un alivio inmediato del dolor, con una recurrencia del 14,2%. No aparecieron secuelas propias de las técnicas lesivas como parestesias y disestesias, anestesia dolorosa, corneal o alteraciones motoras. No hubo ningún fallecimiento, aunque sí tres casos con complicaciones posquirúrgicas.
Conclusiones Al evaluar los resultados a largo plazo de los tratamientos quirúrgicos de la neuralgia del trigémino es muy importante el grado de satisfacción del paciente, que no depende únicamente del alivio y no recurrencia del dolor, sino también de los déficit neurológicos secundarios al procedimiento. Consideramos que la DMV es la técnica más eficaz tanto en el alivio sintomático como en la preservación de funciones y estructuras neurales, a pesar de las potenciales complicaciones derivadas de toda cirugía mayor
