Preoperative evaluation of neurovascular relationships for microvascular decompression: Visualization using Brainvis in patients with idiopathic trigeminal neuralgia

Object In this paper the authors' goal was to evaluate the feasibility and efficacy of a virtual reality (VR) system in preoperative planning for microvascular decompression (MVD) procedures treating idiopathic trigeminal neuralgia and hemifacial spasm. The system's role in surgical simulation and training was also assessed. Methods Between May 2008 and April 2009, the authors used the Dextroscope system to visualize the neurovascular complex and simulate MVD in the cerebellopontine angle in a VR environment in 16 patients (6 patients had trigeminal neuralgia and 10 had hemifacial spasm). Reconstructions were carried out 2–3 days before MVD. Images were printed in a red-blue stereoscopic format for teaching and discussion and were brought into the operating room to be compared with real-time intraoperative findings. Results The VR environment was a powerful aid for spatial understanding of the neurovascular relationship in MVD for operating surgeons and trainees. Through an initial series of comparison/confirmation experiences, the senior neurosurgeon became accustomed to the system. He could predict intraoperative problems and simulate surgical maneuvering, which increased his confidence in performing the procedure. Conclusions The Dextroscope system is an easy and rapid method to create a stereoscopic neurovascular model for MVD that is highly concordant with intraoperative findings. It effectively shortens the learning curve and adds to the surgeon's confidence.

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Anatomical Observations During Microvascular Decompression for Idiopathic Trigeminal Neuralgia (with Correlations Between Topography of Pain and Site of the Neurovascular Conflict). Prospective Study in a Series of 579 Patients

Acta Neurochirurgica ◽

10.1007/s701-002-8269-4 ◽

2002 ◽

Vol 144 (1) ◽

pp. 1-13 ◽

Cited By ~ 207

Author(s):

M. Sindou ◽

T. Howeidy ◽

G. Acevedo

Keyword(s):

Trigeminal Neuralgia ◽

Prospective Study ◽

Microvascular Decompression ◽

Neurovascular Conflict ◽

Idiopathic Trigeminal Neuralgia

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Arteriovenous Micromalformation of the Trigeminal Root: Intraoperative Diagnosis With Indocyanine Green Videoangiography: Case Report

Operative Neurosurgery ◽

10.1227/01.neu.0000381769.15291.4c ◽

2010 ◽

Vol 67 (3) ◽

pp. onsE309-onsE310 ◽

Cited By ~ 8

Author(s):

Paolo Ferroli ◽

Francesco Acerbi ◽

Morgan Broggi ◽

Giovanni Broggi

Keyword(s):

Trigeminal Neuralgia ◽

Indocyanine Green ◽

Microvascular Decompression ◽

Single Case ◽

Preoperative Evaluation ◽

Vascular Compression ◽

Contrast Administration ◽

Intraoperative Diagnosis ◽

Petrosal Vein ◽

Trigeminal Root

Abstract BACKGROUND AND IMPORTANCE: To report on a single case of arteriovenous micromalformation (micro-AVM) of the trigeminal root that was diagnosed during microvascular decompression for trigeminal neuralgia with the use of indocyanine green (ICG) videoangiography. CLINICAL PRESENTATION: A 52-year-old woman with drug-resistant trigeminal neuralgia underwent a key hole suboccipital cerebellopontine angle exploration after the usual magnetic resonance imaging (MRI) screening had raised the suspicion of a vascular compression. In surgery, the petrosal vein was found to be bigger than usual and arterialized; the trigeminal root was embedded in a tangle of abnormal arterialized vessels. Intraoperative ICG videoangiography showed that the direction of flow in the arterialized petrosal vein was anterograde, thus allowing for the differential diagnosis between micro-AVM and tentorial dural fistula. It was possible to achieve only a partial nerve decompression because of the intimate relationship between the trigeminal root and the pathological vessels. Postoperative angiography and MRI with contrast administration confirmed the intraoperative diagnosis of micro-AVM. The patient was discharged neurologically intact on postoperative day 4. One month after surgery, she remains pain-free despite a 50% reduction in antiepileptic drugs. CONCLUSION: Surgeons performing microvascular decompression should be aware that a diagnosis of vascular compression based on MRI without contrast administration could not exclude the presence of a pontine micro-AVM. ICG videoangiography provides an elegant means of showing the flow dynamics of these pathological vessels. An MRI protocol that is suitable to avoid this kind of intraoperative drawback should be defined and systematically used in the preoperative evaluation of all such surgical candidates.

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Idiopathic Trigeminal Neuralgia in the Healthy Patient

Pain Neurosurgery ◽

10.1093/med/9780190887674.003.0001 ◽

2019 ◽

pp. 1-8

Author(s):

Oren Sagher

Keyword(s):

Health Status ◽

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Treatment Options ◽

Pain Syndrome ◽

Operative Management ◽

Differential Diagnoses ◽

Healthy Patient ◽

Pain Syndromes ◽

Idiopathic Trigeminal Neuralgia

Abstract: Idiopathic trigeminal neuralgia is one of the most common pain syndromes encountered in a typical neurosurgical practice. The approach to these patients is nuanced, and is based on their overall health status, the characteristics of their pain, and the distribution of symptoms. This chapter describes the assessment of a healthy patient with trigeminal neuralgia and provides key differential diagnoses of this pain syndrome. The counseling of the patient regarding treatment options is also described. Finally, the chapter outlines the operative management of a healthy patient using a microvascular decompression (MVD), including surgical pearls and strategies for complication avoidance and management.

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Sensory effects of microvascular decompression in trigeminal neuralgia

Journal of Neurosurgery ◽

10.3171/jns.1997.86.2.0193 ◽

1997 ◽

Vol 86 (2) ◽

pp. 193-196 ◽

Cited By ~ 31

Author(s):

John B. Miles ◽

Paul R. Eldridge ◽

Carol E. Haggett ◽

David Bowsher

Keyword(s):

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Nerve Root ◽

Content Type ◽

Idiopathic Trigeminal Neuralgia ◽

Sensory Effects ◽

Tomographic Angiography ◽

Fine Print ◽

Von Frey Filaments

✓ Nineteen patients with “idiopathic” trigeminal neuralgia, who had not undergone any previous interventional procedures, possessed a vessel or vessels compressing the preganglionic nerve root that was demonstrated by magnetic resonance tomographic angiography. Pain was relieved immediately in all of these patients after they underwent microvascular decompression without observed nerve damage. Although preoperative measurement of sensory perception thresholds showed elevations in the thresholds for touch (von Frey filaments) and warmth and coolness sensations, these thresholds normalized during the postoperative period. An apparent deficit in the pinprick (sharpness) sensation appeared postoperatively, but the deficit gradually regressed and completely disappeared by 1 year after surgery; this phenomenon may have been a statistical anomaly. The patients' pain disappeared immediately postoperatively and remained absent throughout the follow-up period. The authors conclude that damage to the nerve or nerve root is not essential for the relief of trigeminal neuralgia.

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Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia

Journal of Neurosurgery ◽

10.3171/2014.7.jns132667 ◽

2014 ◽

Vol 121 (4) ◽

pp. 936-939 ◽

Cited By ~ 17

Author(s):

Nicolaas A. Bakker ◽

J. Marc C. Van Dijk ◽

Steven Immenga ◽

Michiel Wagemakers ◽

Jan D. M. Metzemaekers

Keyword(s):

Risk Factors ◽

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Therapeutic Option ◽

Significant Risk ◽

Case Series ◽

Binary Logistic Regression Analysis ◽

Complication Rates ◽

Idiopathic Trigeminal Neuralgia ◽

Facial Numbness

Object Microvascular decompression (MVD) is considered the method of choice to treat idiopathic trigeminal neuralgia (TN) refractory to medical treatment. However, repeat MVD for recurrent TN is not well established. In this paper, the authors describe a large case series in which patients underwent repeat MVD for recurrent TN, focusing on outcome, risk factors, and complication rates. Methods Between 1990 and 2012, a total of 33 consecutive patients underwent repeat MVD for recurrent TN at the University Medical Center Groningen. The authors performed a retrospective chart review and telephone interviews. Risk factors were analyzed by binary logistic regression analysis. Results After 12 months of follow-up, 22 (67%) operations were successful, of which 19 patients were completely free of pain without medication. With multivariate analysis significant risk factors for success were older age (OR 1.11, p < 0.01) and direct absence of pain after repeat MVD (OR 25.2, p < 0.01). Previous neurodestructive procedures did not influence success rates. Facial numbness occurred in 9 patients (27%), while other morbidity was minimal. There was no mortality. Conclusions This study demonstrates that repeat MVD is a feasible therapeutic option with good chances of success, even in patients who have undergone neurodestructive procedures. Complication rates, particularly facial numbness, can be avoided if only a limited neurolysis is performed.

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