AUTHORS: Abdulrauf S et al
World Neurosurgery (Feb 2018)
OBJECTIVE The option of performing MVD under awake anesthesia protocol (‘awake’MVD) was examined in this initial series to assess whether intraoperative pain evaluation can identify and mitigate insufficient decompression of the trigeminal nerve, improving surgical outcomes. Additionally,’awake’MVD could expand procedure indications for those with comorbidities that would prohibit general endotracheal anesthesia (GEA).
METHODS An IRB-approved prospective study of 10 consecutive adults who underwent MVD for TN was conducted. The primary outcome measure was postoperative TN pain quantified on the Barrow Neurological Institute Pain Severity Scale.
RESULTS The median patient age was 65.5 years with a female:male ratio of 6:4. All 10 patients tolerated the procedure well and did not require GEA intra- or postoperatively. Nine patients had a successful surgical outcome (BNI Score I: n = 5, BNI Score II: n = 4). One patient did not have pain relief (BNI Score IV). This same patient also developed a pseudomeningocele, which was the only surgical complication observed in this series. A single patient had a recurrence of pain at 11 months, with BNI increasing from I to II. The median follow-up time was 16.5 months. Two patients did not have resolution of evoked pain during intraoperative awake testing following decompression. Further intraoperative exploration revealed secondary offending vessels that were subsequently decompressed, leading to resolution of pain.
CONCLUSIONS Intraoperative awake testing for treatment efficacy may increase the success rate of MVD by rapidly identifying and mitigating insufficient CN V decompression.