Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Trigeminal neuralgia management after microvascular decompression surgery: two case reports

  • Hwang, Victor (Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC) ;
  • Gomez-Marroquin, Erick (Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC) ;
  • Enciso, Reyes (Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of University of Southern California) ;
  • Padilla, Mariela (Herman Ostrow School of Dentistry of USC)
  • Received : 2020.09.13
  • Accepted : 2020.12.15
  • Published : 2020.12.31
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Abstract

Trigeminal neuralgia (TN) involves chronic neuropathic pain, characterized by attacks of repeating short episodes of unilateral shock-like pain, which are abrupt in onset and termination. Anticonvulsants, such as carbamazepine, are the gold standard first-line drugs for pharmacological treatment. Microvascular decompression (MVD) surgery is often the course of action if pharmacological management with anticonvulsants is unsuccessful. MVD surgery is an effective therapy in approximately 83% of cases. However, persistent neuropathic pain after MVD surgery may require reintroduction of pharmacotherapy. This case report presents two patients with persistent pain after MVD requiring reintroduction of pharmacological therapy. Although MVD is successful for patients with failed pharmacological management, it is an invasive procedure and requires hospitalization of the patient. About one-third of patients suffer from recurrent TN after MVD. Often, alternative treatment protocols, including the reintroduction of medications, may be necessary to achieve improvement. This case report presents two cases of post-MVD recurrent pain. Further research is lacking on the success rates of subsequent medication therapy after MVD has proven less effective in managing TN.

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References

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