Pittsburgh, April 24, 1996 -- The first long-term study of patients who were treated with microvascular decompression surgery for medically intractable trigeminal neuralgia, published in the April 25, 1996 issue of The New England Journal of Medicine (NEJM), shows the procedure to be safe and effective.

The study tracked 1,185 patients treated at Presbyterian University Hospital, part of the University of Pittsburgh Medical Center, between January 1972 and December 1991. Peter Jannetta, MD, DSc, professor and chairman of neurological surgery pioneered this procedure and was the surgeon for the majority of cases.

The trigeminal nerve, the fifth of the twelve paired cranial nerves, has three large branches: the ophthalmic, the maxillary and the mandibular, which control sensation in the face, eyes and the front of the mouth and tongue.

Trigeminal neuralgia is a syndrome of chronic facial pain which severely affects quality of life. Although it usually begins as a relapsing disease, with pain-free intervals lasting months or years, these intervals grow shorter and ultimately disappear. As the disease progresses, patients can have difficulty talking, eating and maintaining facial hygiene.

Although many patients are successfully treated with medication, some require operations because drugs are ineffective or because their side effects are intolerable. About half of patients who do suffer with trigeminal neuralgia may eventually require surgical treatment.

Microvascular decompression preserves the trigeminal nerve. The procedure involves a small opening in the skull behind the ear, microsurgical examination of the trigeminal nerve and repositioning of any compressive arteries, with a small protective pad placed between the nerve and the artery. If the blood vessel pressing on the nerve is a vein, it may treated by removal or by being moved and separated from the nerve as arteries are.

Other surgical approaches cause controlled injury to the trigeminal nerve, ganglion or root, often resulting in facial numbness.

The study shows the procedure to be extremely safe and effective, with excellent quality of life but not numbness. Dr. Jannetta says microvascular decompression is a center-oriented procedure demanding special training and experience to keep the procedure extremely safe. He notes approximately ten percent of cases involve extremely subtle blood vessels. The NEJM study reported a mortality rate of less than 0.02 percent. Intraoperative monitoring of brain-stem and nerve functions, now routinely employed at the UPMC, has greatly reduced operative complications since its introduction in 1980.

Dr. Jannetta notes that the procedure is not brain surgery, but rather surgery around a nerve leading from the brain. The operation is generally performed on the same day as admission, followed by an overnight stay in an intensive care unit and discharge within 72 hours of hospital admission.

In addition to Dr. Jannetta, those participating in this study were David J. Bissonette, PA-C, and Hae Dong Jho, MD, PhD, from the Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Mark V. Larkin, MD, from Southwest Ohio Neurosurgery, Piqua, and Fred G. Barker II, MD, from the Neurological Service, Massachusetts General Hospital, Boston