TY - JOUR T1 - Trigeminal root massage in microsurgical treatment of trigeminal neuralgia patients without arterial compression: When, how and why JO - Neurocirugía T2 - AU - Urculo,Enrique AU - Elua,Alejandro AU - Arrazola,Mariano AU - Torres,Patricia AU - Torres,Sergio AU - Undabeitia,Jose SN - 11301473 M3 - 10.1016/j.neucir.2019.07.003 DO - 10.1016/j.neucir.2019.07.003 UR - https://www.revistaneurocirugia.com/es-trigeminal-root-massage-in-microsurgical-articulo-S1130147319300892 AB - BackgroundDuring the microsurgical exploration of trigeminal root in the pontocerebellar angle in patients with primary trigeminal neuralgia (TN) without an evident arterial compression, the surgeon is in an engaged situation because there are not well-established surgical strategies. The aim of this study is to describe in these cases the surgical maneuver we call “trigeminal root massage” (TRM). Methods52 consecutive patients with primary trigeminal neuralgia who had undergone a microsurgical suboccipital retrosigmoid exploration of trigeminal root were reviewed. Among them we found 10 patients without an evident arterial compression after a thorough microsurgical exploration. In the great majority of these 10 cases, we noticed a venous contact to the trigeminal root along this cisternal trajectory, in most cases we have had to coagulate the compressive vein/s and then cut. All underwent a simple trigeminal root massage, without interposition of any material implant. ResultsAll 10 patients experienced immediate pain disappearance and the postoperative course was uneventful except one case with a severe complication: cerebellar swelling, meningitis and hydrocephaly. The recurrence rate was 40%. Six patients achieved pain relief without specific medication with an average follow-up period of 5 years. There have been no mortalities nor any postoperative anesthesia dolorosa. ConclusionsThe described maneuver provides an easy and simple alternative way in cases where during a microsurgical exploration of trigeminal root, where we don’t find a clear arterial compression, with similar results than other possibilities such as partial sensory rhizotomy or more complicated and time consuming surgery as “nerve combing”. Nevertheless, a 40% of pain recurrence after an average follow-up of 5 years means that is a good alternative, but not a definitive technique at the moment for permanent cure of trigeminal neuralgia without arterial compression. ER -