Vascular cross-compression of the Vllth and VIIIth cranial nerves

1992 ◽  
Vol 106 (5) ◽  
pp. 436-439 ◽  
Author(s):  
Naoki Ohashi ◽  
Satsuki Yasumura ◽  
Hajime Nakagawa ◽  
Kanemasa Mizukoshi ◽  
Shougo Kuze
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Stellate Ganglion ◽  
Cranial Nerves ◽  
Sodium Bicarbonate Solution ◽  
Stellate Ganglion Block ◽  
Ganglion Block ◽  
Ct Cisternography ◽  
Facial Spasm

AbstractA 53-year-old male patient had been suffering from severe aural symptoms (pulsatile right-sided tinnitus and paroxysmal dizziness attacks with nausea) and right hemifacial spasm. Treatment had involved stellate ganglion block with lignocaine and the injection of intravenous sodium bicarbonate solution for attacks of Meniere's syndrome and facial nerve block with lidocaine for hemi-facial spasm. Despite these treatments, the dizzy attacks became more frequent, developing into the clustering state. Air CT cisternography and vertebral angiography demonstrated an enlarged and curved vertebral artery. Vascular cross-compression of the Vllth and VHIth cranial nerves was therefore suspected. Microvascular decompression was performed. After operation, the pulsatile tinnitus, dizziness and hemifacial spasm disappeared. From the present case and a review of the literature, we conclude that vascular cross-compression of the VHIth cranial nerve should be an indication for microvascular decompression only when symptoms of vascular cross-compression of the Vllth cranial nerve are also seen.

scholarly journals Microvascular transposition using Teflon sling technique

2020 ◽  
Vol 3 (2) ◽  
pp. V2
Author(s):  
Mitchell W. Couldwell ◽  
Vance Mortimer, AS ◽  
William T. Couldwell
Keyword(s):  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Vascular Compression ◽  
Link Type ◽  
Pain Syndromes ◽  
Established Technique

Microvascular decompression is a well-established technique used to relieve abnormal vascular compression of cranial nerves and associated pain. Here the authors describe three cases in which a sling technique was used in the treatment of cranial nerve pain syndromes: trigeminal neuralgia with predominant V2 distribution, hemifacial spasm, and geniculate neuralgia and right-sided ear pain. In each case, the artery was mobilized from the nerve and tethered with a sling. All three patients had reduction of symptoms within 6 weeks.The video can be found here: https://youtu.be/iM7gukvPz6E

Cerebellopontine Angle Epidermoids Presenting with Cranial Nerve Hyperactive Dysfunction: Pathogenesis and Long-term Surgical Results in 30 Patients

Neurosurgery ◽  
2002 ◽  
Vol 50 (2) ◽  
pp. 276-286 ◽  
Author(s):  
Hitoshi Kobata ◽  
Akinori Kondo ◽  
Koichi Iwasaki
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
Surgical Results ◽  
Neurovascular Structures

ABSTRACT OBJECTIVE To provide the characteristics and long-term surgical results of patients who present with cerebellopontine angle epidermoids and trigeminal neuralgia (TN) or hemifacial spasm. METHODS A total of 30 patients (23 women, 7 men) who presented with cerebellopontine angle epidermoids and TN (28 patients) or hemifacial spasm (2 patients) between 1982 and 1995 were reviewed, with emphasis being placed on the clinical manifestations, the mechanisms of symptom development, the long-term follow-up results, and the anatomic relationship between the tumor and the surrounding neurovascular structures. RESULTS The average age of the patients was 37.8 years at symptom onset and 49.3 years at the time of the operation. The tumor-nerve relationships were classified into four types: complete encasement of the nerve by the tumor, compression and distortion of the nerve by the tumor, compression of the nerve by an artery located on the opposite side of the unilateral tumor, and compression of the nerve by an artery on the same side of the tumor. Total resection was achieved in 17 patients (56.7%). Microvascular decompression of the respective cranial nerve was achieved in nine cases of direct arterial compression in addition to tumor removal. The symptom was relieved completely in all cases. In an average follow-up period of 11.5 years, three patients developed recurrent symptoms: two experienced tumor regrowth, and one had arachnoid adhesion. CONCLUSION Hyperactive dysfunction of the cranial nerves, especially TN, may be the initial and only symptom that patients with cerebellopontine angle epidermoids experience. The occurrence of TN at a younger age was characteristic of TN patients with epidermoids, in contrast to patients with TN due to a vascular cause. The symptom is elicited by compression of the nerve by the tumor per se, by an artery that is displaced to the nerve, or by both. Careful resection of the tumor, whose capsule occasionally is strongly adherent to the neurovascular structures, is necessary, and microvascular decompression to straighten the neuraxis should be performed in some cases to achieve a complete, permanent cure of symptoms with a low rate of recurrence.

Microvascular decompression of cranial nerves: lessons learned after 4400 operations

1998 ◽  
Vol 5 (5) ◽  
pp. E1 ◽  
Author(s):  
Mark R. McLaughlin ◽  
Peter J. Jannetta ◽  
Brent L. Clyde ◽  
Brian R. Subach ◽  
Christopher H. Comey ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Lessons Learned ◽  
Glossopharyngeal Neuralgia ◽  
Complication Rates ◽  
Csf Leakage

Object Microvascular decompression has become an accepted surgical technique for the treatment of trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and other cranial nerve rhizopathies. The senior author (P.J.J.) began performing this procedure in 1969 and has performed more than 4400 operations. The purpose of this article is to review some of the nuances of the technical aspects of this procedure. Methods A review of 4415 operations shows that numerous modifications to the technique of microvascular decompression have occurred during the last 29 years. Of the 2420 operations performed for trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia before 1990, cerebellar injury occurred in 21 cases (0.87%), hearing loss in 48 (1.98%), and cerebrospinal fluid (CSF) leakage in 59 cases (2.44%). Of the 1995 operations performed since 1990, cerebellar injuries declined to nine cases (0.45%), hearing loss to 16 (0.8%), and CSF leakage to 37 (1.85%) (p < 0.01, test for equality of distributions). The authors describe slight variations made to maximize surgical exposure and minimize potential complications in each of the six principal steps of this operation. These modifications have led to decreasing complication rates in recent years. Conclusions Using the techniques described in this report, microvascular decompression is an extremely safe and effective treatment for many cranial nerve rhizopathies.

Decrease of blood flow velocity in the middle cerebral artery after stellate ganglion block following aneurysmal subarachnoid hemorrhage: a potential vasospasm treatment?

2020 ◽  
Vol 133 (3) ◽  
pp. 773-779
Author(s):  
Christopher Wendel ◽  
Ricardo Scheibe ◽  
Sören Wagner ◽  
Wiebke Tangemann ◽  
Hans Henkes ◽  
...  
Keyword(s):  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Neurological Deficit ◽  
Blood Flow Velocity ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Stellate Ganglion ◽  
Stellate Ganglion Block ◽  
Ganglion Block

OBJECTIVECerebral vasospasm (CV) is a delayed, sustained contraction of the cerebral arteries that tends to occur 3–14 days after aneurysmal subarachnoid hemorrhage (aSAH) from a ruptured aneurysm. Vasospasm potentially leads to delayed cerebral ischemia, and despite medical treatment, 1 of 3 patients suffer a persistent neurological deficit. Bedside transcranial Doppler (TCD) ultrasonography is used to indirectly detect CV through recognition of an increase in cerebral blood flow velocity (CBFV). The present study aimed to use TCD ultrasonography to monitor how CBFV changes on both the ipsi- and contralateral sides of the brain in the first 24 hours after patients have received a stellate ganglion block (SGB) to treat CV that persists despite maximum standard therapy.METHODSThe data were culled from records of patients treated between 2013 and 2017. Patients were included if an SGB was administered following aSAH, whose CBFV was ≥ 120 cm/sec and who had either a focal neurological deficit or reduced consciousness despite having received medical treatment and blood pressure management. The SGB was performed on the side where the highest CBFV had been recorded with 8–10 ml ropivacaine 0.2%. The patient’s CBFV was reassessed after 2 and 24 hours.RESULTSThirty-seven patients (male/female ratio 18:19), age 17–70 years (mean age 49.9 ± 11.1), who harbored 13 clipped and 22 coiled aneurysms (1 patient received both a coil and a clip, and 3 patients had 3 untreated aneurysms) had at least one SGB. Patients received up to 4 SGBs, and thus the study comprised a total of 76 SGBs.After the first SGB, CBFV decreased in 80.5% of patients after 2 hours, from a mean of 160.3 ± 28.2 cm/sec to 127.5 ± 34.3 cm/sec (p < 0.001), and it further decreased in 63.4% after 24 hours to 137.2 ± 38.2 cm/sec (p = 0.007). A similar significant effect was found for the subsequent SGB. Adding clonidine showed no significant effect on either the onset or the duration of the SGB. Contralateral middle cerebral artery (MCA) blood flow was not reduced by the SGB.CONCLUSIONSTo the authors’ knowledge, this is the largest study on the effects of administering an SGB to aSAH patients after aneurysm rupture. The data showed a significant reduction in ipsilateral CBFV (MCA 20.5%) after SGB, lasting in about two-thirds of cases for over 24 hours with no major complications resulting from the SGB.

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