scholarly journals Neurovascular Compression at the Root Entry Zone Correlates with Trigeminal Neuralgia and Early Microvascular Decompression Outcome

2016 ◽  
Vol 95 ◽  
pp. 208-213 ◽  
Author(s):  
Akshitkumar M. Mistry ◽  
Kurt J. Niesner ◽  
Wendell B. Lake ◽  
Jonathan A. Forbes ◽  
Chevis N. Shannon ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Neurovascular Compression ◽  
Entry Zone ◽  
Root Entry Zone

scholarly journals Surgical Outcomes After Microvascular Decompression With Internal Neurolysis and Partial Neurectomy for Patients With Trigeminal Neuralgia and Negative Neurovascular Compression

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Amanda Carpenter ◽  
James K Liu
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Neurovascular Compression ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Root Entry Zone ◽  
Internal Neurolysis ◽  
Facial Numbness

Abstract INTRODUCTION Microvascular decompression (MVD) is an effective and durable treatment for patients with trigeminal neuralgia (TN) due to neurovascular compression (NVC). In the absence of NVC, the traditional MVD is less effective in achieving long-term pain relief. Internal neurolysis at the root entry zone (REZ) of the trigeminal nerve has been described in the literature; however, there are few reports of long-term outcome after this procedure. Furthermore, this is the first study to combine this procedure with additional partial neurectomy. METHODS This is a retrospective review of the senior author's patients with TN who underwent retrosigmoid craniectomy for MVD with internal neurolysis and partial neurectomy. Primary indications were patients with TN and no evidence of NVC intraoperatively. A total of 9 patients were included in the analysis. Three cases were of recurrent TN. The technique was performed with an 11-blade or arachnoid knife to open the perineurium in a longitudinal fashion at the REZ. A disc dissector was used to comb the fascicles along the longitudinal course, and a partial neurectomy was performed with a microscissors to make three selective cuts into the fascicles at the REZ. Barrow Neurological Institute (BNI) facial pain and numbness scales were used as postoperative assessment. RESULTS At median follow up of 12 mo (range: 2 to 34), 8 of 9 patients (89%) had a BNI-pain score of I (no trigeminal pain, no medications). Two of nine patients (22%) had a BNI-numbness score of I (no numbness); seven (78%) had a BNI-numbness score of II (mild facial numbness that is not bothersome). CONCLUSION Internal neurolysis with partial neurectomy appears to be an effective and potentially durable treatment option for patients with TN (primary or recurrent) without NVC. Larger series with longer follow-up is indicated to further evaluate the utility of this procedure.

Diffusivity signatures characterize trigeminal neuralgia associated with multiple sclerosis

2015 ◽  
Vol 22 (1) ◽  
pp. 51-63 ◽  
Author(s):  
David Q Chen ◽  
Danielle D DeSouza ◽  
David J Hayes ◽  
Karen D Davis ◽  
Paul O’Connor ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Pain Syndrome ◽  
Neurovascular Compression ◽  
Neuropathic Pain Syndrome ◽  
Entry Zone ◽  
Non Invasive ◽  
Root Entry Zone ◽  
Mr Diffusion ◽  
3T Mr

Background: Trigeminal neuralgia secondary to multiple sclerosis (MS-TN) is a facial neuropathic pain syndrome similar to classic trigeminal neuralgia (TN). While TN is caused by neurovascular compression of the fifth cranial nerve (CN V), how MS-related demyelination correlates with pain in MS-TN is not understood. Objectives: We aim to examine diffusivities along CN V in MS-TN, TN, and controls in order to reveal differential neuroimaging correlates across groups. Methods: 3T MR diffusion weighted, T1, T2 and FLAIR sequences were acquired for MS-TN, TN, and controls. Multi-tensor tractography was used to delineate CN V across cisternal, root entry zone (REZ), pontine and peri-lesional segments. Diffusion metrics including fractional anisotropy (FA), and radial (RD), axial (AD), and mean diffusivities (MD) were measured from each segment. Results: CN V segments showed distinctive diffusivity patterns. The TN group showed higher FA in the cisternal segment ipsilateral to the side of pain, and lower FA in the ipsilateral REZ segment. The MS-TN group showed lower FA in the ipsilateral peri-lesional segments, suggesting differential microstructural changes along CN V in these conditions. Conclusions: The study demonstrates objective differences in CN V microstrucuture in TN and MS-TN using non-invasive neuroimaging. This represents a significant improvement in the methods currently available to study pain in MS.

A 10-year experience in the treatment of trigeminal neuralgia

1982 ◽  
Vol 57 (6) ◽  
pp. 757-764 ◽  
Author(s):  
Harry van Loveren ◽  
John M. Tew ◽  
Jeffrey T. Keller ◽  
Mary A. Nurre
Keyword(s):  
Trigeminal Neuralgia ◽  
Neurovascular Compression ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Significant Difference ◽  
Technical Advances ◽  
Trigeminal Root ◽  
Fine Print

✓ Of 1000 patients with classic trigeminal neuralgia who were treated during the last 10 years, 90% had an initial favorable response to medical therapy, but 75% (750 patients) failed to achieve satisfactory long-term relief. Of these, 700 patients were treated by percutaneous stereotaxic rhizotomy (PSR) and 50 were selected for posterior fossa exploration (PFE). Of the 50 patients undergoing PFE, 82% had neurovascular contact at the trigeminal root entry zone, but only 46% were judged to have had significant neurovascular compression. Exploration was negative in 16% of patients and revealed neural compression by bone in 2%. Patients with neurovascular compression were treated by microvascular decompression (MVD); all other patients with exploratory surgery underwent partial sensory rhizotomy. At 3 years after PFE, 84% of patients are pain-free. Results are excellent in 68%, good in 12%, fair in 4%; 12% had a recurrence of their neuralgia. The 700 patients treated by PSR have been followed for 6 years. Results are excellent in 61%, good in 13%, fair in 5%, and poor in 1%; 20% had a recurrence. This study indicates that there is no significant difference in results between PSR and PFE in the treatment of trigeminal neuralgia. The concept that neurovascular compression is a mechanical factor in the etiology of trigeminal neuralgia was supported, but neurovascular compression was less common than previously reported. Percutaneous stereotaxic rhizotomy is a less formidable procedure than PFE, and is easily repeated. Recent technical advances have improved the results obtained with PSR. Therefore, PSR remains the procedure of choice for the majority of patients with trigeminal neuralgia.

Microvascular decompression for trigeminal neuralgia

1982 ◽  
Vol 57 (4) ◽  
pp. 487-490 ◽  
Author(s):  
Robert Breeze ◽  
Ronald J. Ignelzi
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Late Recurrence ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Early Success ◽  
Trigeminal Nerve Root ◽  
Fine Print

✓ Fifty-one consecutive patients with trigeminal neuralgia underwent 52 procedures for microvascular decompression of the trigeminal nerve root entry zone. There was an 85% early success rate; however, after a longer follow-up period, a 13% late recurrence rate was found. In all, 60% of the patients experienced some form of complication, but in only 23% was the complication persistent.

Endoscope-Assisted Microvascular Decompression for Trigeminal Neuralgia:Technical Case Report

2006 ◽  
Vol 59 (suppl_4) ◽  
pp. ONS-E489-ONS-E490 ◽  
Author(s):  
Charles Teo ◽  
Peter Nakaji ◽  
Ralph J. Mobbs
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Trigeminal Neuralgia ◽  
Wound Infection ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Complication Rate ◽  
Entry Zone ◽  
Root Entry Zone

Abstract OBJECTIVE: Microvascular decompression may fail to relieve trigeminal neuralgia because a compressing vessel at the root entry zone may be overlooked during surgery. Alternatively, effective decompression may not always be achieved with the visualization provided by the microscope alone. We theorized that the addition of an endoscope would improve the efficacy of microvascular decompression. METHODS: We retrospectively reviewed microvascular decompression of the trigeminal nerve in 114 patients. Before closure, the endoscope was used to inspect the root entry zone. When visualization with the microscope was poor, the endoscope was used to identify an aberrant vessel and to perform or improve the subsequent decompression. RESULTS: Of 114 patients who underwent microvascular decompression, 113 successfully underwent endoscopy. In 38 patients (33%), endoscopy revealed arteries that were poorly seen (25%) or not seen at all (8%) with the microscope. At a mean follow-up period of 29 months, the pain was completely relieved in 112 patients (99.1%), all of whom were off medication. Complications included trigeminal dyses-thesias in nine patients and a wound infection, partial hearing loss, and complete hearing loss in one patient each. The overall complication rate was 9%. CONCLUSION: Endoscopy is a simple and safe adjunct to microscopic exploration of the trigeminal nerve. The markedly improved visualization increases the likelihood of identifying the offending vessel and consequently of achieving satisfactory decompression of the nerve. Thus far, the success rate has been high, and the complication profile is comparable to that of other large series.

Teflon-induced granuloma following treatment of trigeminal neuralgia by microvascular decompression

1997 ◽  
Vol 87 (3) ◽  
pp. 454-457 ◽  
Author(s):  
Ishwar C. Premsagar ◽  
Timothy Moss ◽  
Hugh B. Coakham
Keyword(s):  
Foreign Body ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Foreign Body Reaction ◽  
Inert Material ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Sensory Root ◽  
Fine Print

✓ The authors report two cases of Teflon-induced granuloma occurring as a result of microvascular decompression using Teflon wool for the treatment of trigeminal neuralgia (TN). Teflon, which is used to separate a compressing vessel from the root entry zone (REZ) of the trigeminal nerve at the brainstem, is presumed to be an inert material. In the two cases reported here, however, Teflon induced a foreign body reaction at the REZ, causing recurrence of TN. The patients' pain was cured by complete decompression or partial sensory rhizotomy of the trigeminal sensory root at reoperation. Teflon-induced granuloma has occurred in 1.3% of the authors' series of 155 patients with TN treated using microvascular decompression. Recommendations for avoiding this complication are offered.

PREOPERATIVE SIMULATION FOR MICROVASCULAR DECOMPRESSION IN PATIENTS WITH IDIOPATHIC TRIGEMINAL NEURALGIA

Neurosurgery ◽  
2007 ◽  
Vol 60 (1) ◽  
pp. 104-114 ◽  
Author(s):  
Toru Satoh ◽  
Keisuke Onoda ◽  
Isao Date
Keyword(s):  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Fusion Imaging ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Idiopathic Trigeminal Neuralgia ◽  
Preoperative Simulation ◽  
Magnetic Resonance Cisternography

Abstract OBJECTIVE Precise assessment of the complex nerve-vessel relationship at the root entry zone of the trigeminal nerve is useful for planning microvascular decompression in patients with idiopathic trigeminal neuralgia. We have applied a fusion imaging technique of three-dimensional (3-D) magnetic resonance cisternography and co-registered 3-D magnetic resonance angiography (MRA) that allows virtual reality for the preoperative simulation of the neurovascular conflict at the trigeminal nerve root entry zone. METHODS Fusion images of 3-D magnetic resonance cisternograms and angiograms were reconstructed by a perspective volume-rendering algorithm from the volumetric data sets of magnetic resonance cisternography, obtained by a T2-weighted 3-D fast spin echo sequence, and co-registered MRA, by a 3-D time-of-flight sequence. Consecutive series of 12 patients with idiopathic trigeminal neuralgia were studied with fusion 3-D magnetic resonance cisternogram and MRA in the preoperative assessment for the microvascular decompression of the affected trigeminal nerve. RESULTS The complex anatomical relationship of the offending vessels to the trigeminal nerve root entry zone was depicted on the fusion 3-D magnetic resonance cisternogram and MRA. The presence of offending vessels and compressive site of neurovascular conflict was assessed from the various viewpoints within the cistern and was presumed by the preoperative simulation through the surgical access (surgeon's-eye view). The blinded surgical trajectory was discerned by the virtual image through the opposite direction projected from above (bird's-eye view). The 3-D visualization of the nerve-vessel relationship with fusion images was consistent with the intraoperative trajectory and findings. CONCLUSION Fusion imaging of 3-D magnetic resonance cisternogram and MRA may prove a useful adjunct for the diagnosis and decision-making process to execute the microvascular decompression in patients with idiopathic trigeminal neuralgia.

scholarly journals Teflon bridge technique for endoscopic-assisted microvascular decompression of ectatic basilar artery and anterior inferior cerebellar artery for trigeminal neuralgia: operative video and technical nuances

2020 ◽  
Vol 3 (2) ◽  
pp. V5
Author(s):  
James K. Liu ◽  
Asif Shafiq
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Basilar Artery ◽  
Microvascular Decompression ◽  
Facial Pain ◽  
Anterior Inferior Cerebellar Artery ◽  
Safe Alternative ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery

In this illustrative operative video, the authors demonstrate a Teflon bridge technique to achieve safe transposition of a large, tortuous ectatic basilar artery (BA) and anterior inferior cerebellar artery (AICA) complex to decompress the root entry zone (REZ) of the trigeminal nerve in a 61-year-old woman with refractory trigeminal neuralgia via an endoscopic-assisted retractorless microvascular decompression. Postoperatively, the patient experienced immediate facial pain relief without requiring further medications. The Teflon bridge technique can be a safe alternative to sling techniques when working in narrow surgical corridors between delicate nerves and vessels. The operative technique and surgical nuances are demonstrated.The video can be found here: https://youtu.be/hIHX7EvZc1c

Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia

2015 ◽  
Vol 123 (6) ◽  
pp. 1512-1518 ◽  
Author(s):  
Yifei Duan ◽  
Jennifer Sweet ◽  
Charles Munyon ◽  
Jonathan Miller
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Cross Sectional Area ◽  
Vascular Compression ◽  
Sectional Area ◽  
Cross Sectional ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Distal Nerve

OBJECT Trigeminal neuralgia is often associated with nerve atrophy, in addition to vascular compression. The authors evaluated whether cross-sectional areas of different portions of the trigeminal nerve on preoperative imaging could be used to predict outcome after microvascular decompression (MVD). METHODS A total of 26 consecutive patients with unilateral Type 1a trigeminal neuralgia underwent high-resolution fast-field echo MRI of the cerebellopontine angle followed by MVD. Preoperative images were reconstructed and reviewed by 2 examiners blinded to the side of symptoms and clinical outcome. For each nerve, a computerized automatic segmentation algorithm was used to calculate the coronal cross-sectional area at the proximal nerve near the root entry zone and the distal nerve at the exit from the porus trigeminus. Findings were correlated with outcome at 12 months. RESULTS After MVD, 17 patients were pain free and not taking medications compared with 9 with residual pain. Across all cases, the coronal cross-sectional area of the symptomatic trigeminal nerve was significantly smaller than the asymptomatic side in the proximal part of the nerve, which was correlated with degree of compression at surgery. Atrophy of the distal trigeminal nerve was more pronounced in patients who had residual pain than in those with excellent outcome. Among the 7 patients who had greater than 20% loss of nerve volume in the distal nerve, only 2 were pain free and not taking medications at long-term follow-up. CONCLUSIONS Trigeminal neuralgia is associated with atrophy of the root entry zone of the affected nerve compared with the asymptomatic side, but volume loss in different segments of the nerve has very different prognostic implications. Proximal atrophy is associated with vascular compression and correlates with improved outcome following MVD. However, distal atrophy is associated with a significantly worse outcome after MVD.

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