Disclosures: George Schilling, DO: No financial relationships or conflicts of interest

Case Description: The patient presented with a 20-year history of progressively worsening pain from trigeminal neuralgia which had thus far been refractory to all attempted pharmaceutical interventions and modalities, including carbamazepine, baclofen, amitriptyline, pregabalin, phenytoin, and B12 injections. Brain stereotactic radiosurgery resulted in worsening of symptomatology. As a result, the patient underwent retromastoid craniectomy and microvascular decompression (MVD) of CN V with immediate resolution of his pain. Postoperatively, the patient experienced new onset disequilibrium. He was admitted to inpatient rehabilitation where several of his chronic pain medications were tapered. The patient underwent therapies for disequilibrium in order to be discharged to a safe level of supervision at home.

Setting: Academic Acute Inpatient Rehabilitation Hospital

Patient: A 72 year old male with trigeminal neuralgia Assessment/

Results: Postoperative MRI was significant for surgical material at the left cerebellopontine angle as well as expected postoperative subarachnoid and subdural gas. The patient had no exacerbation of pain upon palpation of the left CN V sensory distribution whereas previously his pain was severe at rest.

Discussion: Disequilibrium is a rare post-surgical complication of MVD for trigeminal neuralgia. This can occur due to the close proximity to the cerebellopontine angle. Patients are at a high risk for falls at home if discharged without treatment of their decreased balance. Inpatient rehabilitation is important for a safe transition to home and community to prevent further complications. In this patient, MVD has been shown to be an extremely effective treatment for trigeminal neuralgia as his chronic pain medications were tapered down during his inpatient rehabilitation course.

Conclusion: Inpatient rehabilitation is an effective treatment for disequilibrium and an essential step for safe post procedure discharges home. MVD is also an effective treatment for trigeminal neuralgia in patients refractory to medical management.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2020

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/disequilibrium-secondary-to-retromastoid-craniectomy-and-microvascular-decompression-for-refractory-trigeminal-neuralgia-a-case-report/