Mark E. Linskey, M.D.
Department of Neurological Surgery
University of California, Irvine Medical Center
101 The City Drive, Bldg. 56, Suite 400
Orange, CA 92868
714-456-6966
http://neurosurgery.uci.edu/facultybio/linskey/
Transcript: When is the best time to have a microvascular decompression or other trigeminal neuralgia surgery?
The best time for a patient with classical trigeminal neuralgia to have an operative procedure in particular a microvascular decompression will vary patient to patient. And that has to be carefully and individually considered.
Generally we recommend that patients consider microvascular decompression or another operative procedure if one front line medicine has been taken to sufficient dose without a good response or where the response that is no longer effective. Those medicines we consider front line are Tegretol, Trileptal, and Neurontin. There are limiting returns for adding more and more medicines on top of each other once the patient has failed one front line therapy.
There are a couple of other things to keep in mind. Joanna Zakrzewska from Great Britain has done a wonderful survey of patients who’ve had surgery for trigeminal neuralgia and one of the consistent findings among all patients surveyed was in retrospect they felt that they waited too long. So the general tendency is for patients to wait to time intervals that after the fact they perhaps regret. We need to remember that time is an important factor in terms of outcome for particularly microvascular decompression. One study has shown a statistical breakpoint at eight years, a more recent one at three years. That’s clearly going to vary individual to individual. But time is a factor and if you wait too long you can have a worsened outcome.
Trigeminal neuralgia also tends to evolve and you’ll know that. You’ll know that you start to get a dull aching component in between your shock-like episodes. You may notice that you start to get tingling paresthesias. We generally recommend that patients act before they get to this point and if they’ve gotten to this point that should be a clear alarm bell that it’s time to do something more definitive.