Microvascular decompression on patients with trigeminal neuralgia caused by ectatic vertebrobasilar artery complex: technique notes

2012 ◽  
Vol 154 (5) ◽  
pp. 793-797 ◽  
Author(s):  
Xiao-Sheng Yang ◽  
Shi-Ting Li ◽  
Jun Zhong ◽  
Jin Zhu ◽  
Quan Du ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Vertebrobasilar Artery

scholarly journals C.07 Trigeminal neuralgia due to dolichoectatic vertebrobasilar artery compression: a 20 year experience

2017 ◽  
Vol 44 (S2) ◽  
pp. S14-S14
Author(s):  
CM Honey ◽  
AM Kaufmann
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Senior Author ◽  
High Rate ◽  
Hospital Length Of Stay ◽  
Case Volume ◽  
Average Hospital ◽  
Vertebrobasilar Artery

Background: Trigeminal Neuralgia (TN) is rarely caused by a dolichoectatic vertebrobasilar artery (eVB) compression of the trigeminal nerve. These patients present a surgical challenge and are often not considered for microvascular decompression (MVD) due to assumed risk. We present our experience demonstrating the technique and outcomes of MVD in these patients. Methods: A retrospective chart review of patients who were surgically treated by the senior author between 1997 and 2016 with an admitting diagnosis of TN was performed. Patients with pre-operative neuroimaging demonstrating eVB compression of their trigeminal nerve root were included. Results: During the 20-year review, 552 patients underwent microvascular decompression for TN and 13 (2.4%) had dolichoectactic vertebrobasilar compressions (10 male, 3 female). The average hospital length of stay was 2.8 days (Range 2-7) with no major complications. At final follow-up (>2 years): 7 had no pain with no medications (78%), 2 had persistent pain (22%) – one of which underwent a successful glycerol rhizotomy at 8 months, 2 were lost to follow-up, and 2 had surgery within 2 years. Conclusions: Microvascular Decompression for Trigeminal Neuralgia caused by a dolichoectatic vertebrobasilar artery can be performed with a high rate of safety and success in the setting of a high case volume centre.

Microvascular sling decompression for trigeminal neuralgia secondary to ectatic vertebrobasilar compression

1993 ◽  
Vol 79 (6) ◽  
pp. 943-945 ◽  
Author(s):  
James L. Stone ◽  
Terry Lichtor ◽  
Robert M. Crowell
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Content Type ◽  
Vertebrobasilar Artery ◽  
Technical Details ◽  
Fine Print

✓ A patient with trigeminal neuralgia caused by a tortuous and ectatic vertebrobasilar artery is presented. He was treated with microvascular decompression using a fine silicone sling sutured to the dura over the petrous pyramid. The technical details are described.

scholarly journals Long-Term Retrospective Analysis of Microvascular Decompression in Patients With Recurrent Trigeminal Neuralgia

2020 ◽  
Vol 11 ◽  
Author(s):  
Jiayu Liu ◽  
Guangyong Wu ◽  
Hui Xiang ◽  
Ruen Liu ◽  
Fang Li ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Free Survival ◽  
Recurrent Group ◽  
Kaplan Meier ◽  
Vertebrobasilar Artery ◽  
Surgical Methods ◽  
First Onset

Objective: To explore the clinical characteristics of patients with recurrent trigeminal neuralgia (TN) and the experience of microvascular decompression (MVD) in the treatment of such patients.Methods: We retrospectively analyzed clinical data, imaging examination results, surgical methods, and treatment efficacies in 127 patients with recurrent typical TN from January 2005 to December 2014.Results: The age of the recurrent group was higher than that of the non-recurrent group (p < 0.05). The duration of pain before the first MVD procedure was longer in the recurrent group than in the non-recurrent group (p < 0.05). Patients in the recurrent group were more likely to have compression of the trigeminal nerve by the vertebrobasilar artery (VBA) or multiple vessels than patients in the non-recurrent group (p < 0.05). A Kaplan–Meier curve showed a median pain-free survival of 12 months after the first MVD procedure. The severity of pain (preoperative visual analog scale [VAS] score) in patients with recurrence was lower than that in patients with first-onset TN (p < 0.05). Vessel compression, Teflon compression or granuloma and arachnoid adhesion were considered the main causes of recurrence. Postoperative Barrow Neurological Institute (BNI) scores in the redo MVD group were excellent (T = 2) for 69 patients (53.33%) and good (T = 3) for 46 patients (36.22%). The postoperative follow-up was 63–167 months (105.92 ± 25.66). During the follow-up, no recurrence was noted. All complications were cured or improved.Conclusions: Microvascular decompression (MVD) is an effective surgical method for the treatment of TN. For recurrent patients, reoperation can achieve good results.

scholarly journals Intraoperative Hypertensive Urgency and Hemodynamic Instability during Microvascular Decompression for Trigeminal Neuralgia

2019 ◽  
Vol 08 (02) ◽  
pp. 103-107
Author(s):  
Pushkaran Jayapaul ◽  
Thanga T. Rajan ◽  
Aravind Sabeson
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Antihypertensive Drugs ◽  
Hypertensive Crisis ◽  
Hemodynamic Instability ◽  
Medical Emergency ◽  
National Committee ◽  
Hypertensive Urgency ◽  
Vertebrobasilar Artery

Abstract Objective To evaluate the factors predisposing to rare events of intraoperative hypertensive urgency during microvascular decompression (MVD) for trigeminal neuralgia (TGN) and outcome of MVD on long-term blood pressure (BP) control. Patients and Methods Total 54 consecutive TGN patients who failed medical management in two institutions from January 2012 to January 2017 were included in the study. MVD of TGN was done through retromastoid suboccipital craniotomy. Intraoperative “hypertensive urgency” and hemodynamic instability were observed in two patients with BP shooting up to > 180/120 mm Hg, which was controlled. Postoperative period was uneventful and patients were discharged. Patients were reviewed in the OPD clinic at 1 and 6 months after discharge and their clinical status was evaluated. The collected data were analyzed retrospectively. Results Of the 54 patients, 32 (59.26%) were male and 22 (40.74%) were female. Twenty-five (46.30%) patients were hypertensive, out of whom 19 (76%) were in Joint National Committee (JNC) 7 stage 1 and 6 (24%) were in stage 2. Two (3.70%) patients had an intraoperative hypertensive crisis, and in both the patients, the offending vessel was an atheromatous ectatic vertebrobasilar artery. Postoperative long-term BP control or normalization was observed in one of the two patients with a single antihypertensive drug who was on three antihypertensive drugs preoperatively. Conclusion Intraoperative hypertensive urgency is a medical emergency that can be encountered in MVD surgery for TGN, and an ectatic atheromatous vertebrobasilar arterial compression on the nerve is notorious for predisposing to hypertensive urgency. Postoperative long-term BP control in hypertensive patients is not feasible after MVD in this study, which needs further detailed analysis.

Microvascular Decompression in the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Ectasia

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 330-337 ◽  
Author(s):  
Nasser M.F. El-Ghandour
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Nerve Compression ◽  
Resonance Imaging ◽  
Duration Of Symptoms ◽  
Vertebrobasilar Artery ◽  
The Mean

Abstract BACKGROUND Vertebrobasilar ectasia (VBE) is a rare cause of trigeminal neuralgia (TN). It occurs in about 2% of all patients. OBJECTIVE This study reviewed the clinical features, radiological concomitants, and surgical findings of VBE and evaluate the microsurgical decompression procedure as a surgical line of treatment of the associated TN. METHODS Ten patients with TN caused by VBE and treated by microvascular decompression are the subject of this study. The study consisted of 6 men and 4 women with a mean age of 54 years. The mean duration of symptoms was 4.5 years. TN was the only symptom in 6 patients; it was associated with hemifacial spasm in 4. Arterial hypertension was present in 6 patients. Multiplanar high-resolution magnetic resonance imaging showed the accurate location and course of the ectatic vessel. Magnetic resonance angiography and digital subtraction angiography confirmed the diagnosis. Surgery demonstrated fifth nerve compression by an ectatic and tortuous vertebrobasilar artery in all cases and seventh nerve compression in 4 cases. Teflon felt was placed between the ectatic artery and compressed nerves. RESULTS There was complete resolution of TN in 8 patients (80%) and hemifacial spasm in 3 (75%) without medication. Four of 6 hypertensive patients (66.7%) achieved normotension without medication. There was no recurrence of symptoms in the mean follow-up period of 7.8 years. CONCLUSION Microvascular decompression is recommended for the treatment of TN caused by VBE if medical treatment has failed, if the patient is suitable for general anesthesia, and if there is evidence of vascular compression of the trigeminal nerve on magnetic resonance imaging.

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