Management of Primary Bilateral Trigeminal Neuralgia with Microvascular Decompression: 13-Case Series.

BACKGROUND: Bilateral trigeminal neuralgia is a relatively rare disease. Microvascular decompression (MVD) is a safe and effective treatment for unilateral trigeminal neuralgia; however, its utility in bilateral trigeminal neuralgia is unclear. Here, we report our experience with MVD in 13 cases of primary bilateral trigeminal neuralgia. METHODS: We retrospectively analyzed 13 cases of bilateral trigeminal neuralgia that were treated with MVD between January 2013 and January 2015. Surgical outcomes and complications were explored in each case. RESULTS: Postoperatively, 11 patients had excellent outcomes and 2 patients had good outcomes on the operative side. Three patients also reported the amelioration of contralateral symptoms after MVD. Of 10 cases indicating no contralateral improvement, 1 refused to undergo a second MVD procedure on the opposite side and 9 underwent a second MVD procedure and experienced symptom relief. The superior cerebellar artery was the most common offending vessel. There were no severe MVD-related complications. CONCLUSION: Vascular compression plays a causative role in bilateral and unilateral trigeminal neuralgia. MVD appears to be a safe and effective treatment option in patients who are refractory to pharmacotherapy.