Endoscopic-Assisted Microvascular Decompression of the Posterior Fossa: Early Experience in a Large Referral Center

2014 ◽  
Vol 75 (S 01) ◽  
Author(s):  
Francisco Vaz-Guimaraes Filho ◽  
Robert Miller ◽  
Juan Fernandez-Miranda ◽  
Paul Gardner
Keyword(s):  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Early Experience ◽  
Referral Center

Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression

1988 ◽  
Vol 68 (4) ◽  
pp. 559-565 ◽  
Author(s):  
Ian F. Pollack ◽  
Peter J. Jannetta ◽  
David J. Bissonette
Keyword(s):  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Pain Control ◽  
Symptom Control ◽  
Sensory Loss ◽  
Content Type ◽  
Cranial Nerve Dysfunction ◽  
Ablative Procedures ◽  
Fine Print

✓ Thirty-five patients with trigeminal neuralgia (TN) bilaterally underwent posterior fossa microvascular decompression (MVD) between 1971 and 1984. They comprised 5.0% of a larger series of 699 patients with TN who underwent MVD during that interval. Compared to the subgroup of 664 patients with only unilateral symptoms, the population with bilateral TN included a greater percentage of females (74% vs. 58%, p < 0.1), a higher rate of “familial” TN (17% vs. 4.1%, p < 0.001), and an increased incidence of additional cranial nerve dysfunction (17% vs. 6.6%, p < 0.05) and hypertension (34% vs. 19%, p < 0.05). Of the 35 patients with bilateral TN, 10 underwent bilateral MVD (22 procedures) and 25 underwent unilateral MVD (30 procedures). In the latter patients, pain on the nonoperative side was well controlled with medication alone or had previously been treated by ablative procedures. Good or excellent pain control was achieved after one MVD was performed in 40 of the 45 sides treated (89%), and was maintained 1, 5, and 10 years after surgery in 82%, 66%, and 60%, respectively, based on life-table analysis. Six of 10 patients with recurrent symptoms underwent repeat unilateral MVD. Good or excellent long-term pain control was maintained in all six. With these repeat procedures included, symptom control at 1, 5, and 10 years after initial surgery was maintained in 87%, 78%, and 78% of the treated sides, respectively. Overall, 26 of 35 patients (74%) maintained good or excellent pain relief throughout the duration of the study (mean follow-up period 75 months) without resumption of regular medication usage. Although preoperative neurological deficits resulting from previous ablative procedures were seen in the majority of patients before MVD, no patient developed new major trigeminal sensory loss or masseter weakness after MVD. Operative mortality was zero. The results indicate that posterior fossa MVD is an effective and relatively safe treatment for the majority of patients with bilateral “idiopathic” TN, avoiding the risks of bilateral trigeminal nerve injury seen with other approaches.

scholarly journals Fully Endoscopic Microvascular Decompression: Our Early Experience

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Casey H. Halpern ◽  
Shih-Shan Lang ◽  
John Y. K. Lee
Keyword(s):  
Microvascular Decompression ◽  
Facial Pain ◽  
Cerebellopontine Angle ◽  
Early Experience ◽  
Neurosurgical Procedures ◽  
Valuable Adjunct ◽  
Standard Tool ◽  
Pain Outcomes ◽  
Surgical Duration ◽  
Microscopic Techniques

Background. Microvascular decompression (MVD) is a widely accepted treatment for neurovascular disorders associated with facial pain and spasm. The endoscope has rapidly become a standard tool in neurosurgical procedures; however, its adoption in lateral approaches to the posterior fossa has been slower. The endoscope is used primarily to assist conventional microscopic techniques. We are interested in developing fully endoscopic approaches to the cerebellopontine angle, and here, we describe our preliminary experience with this procedure for MVD.Methods. A retrospective review of our two-year experience from 2011 to 2012, transitioning from using conventional microscopic techniques to endoscope-assisted microsurgery to fully endoscopic MVD, is provided. We also reviewed our preliminary outcomes during this transition.Results. There was no difference in the surgical duration of these three procedures. In addition, the majority of procedures performed in 2012 were fully endoscopic, suggesting the ease of incorporating this solo tool into practice. Pain outcomes of fully endoscopic MVD appear to be very similar to those of both conventional and endoscope-assisted MVDs. Complications occurred in all groups at equally low rates.Conclusion. Fully endoscopic MVD is both safe and effective. By enhancing visualization of structures within the cerebellopontine angle, endoscopy may prove to be a valuable adjunct or alternative to conventional microscopic approaches.

scholarly journals Microvascular decompression for typical trigeminal neuralgia: Personal experience with intraoperative neuromonitoring with level-specific-CE-Chirp® brainstem auditory evoked potentials in preventing possible hearing loss

2020 ◽  
Vol 11 ◽  
pp. 388
Author(s):  
Luciano Mastronardi ◽  
Franco Caputi ◽  
Guglielmo Cacciotti ◽  
Carlo Giacobbo Scavo ◽  
Raffaelino Roperto ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Trigeminal Neuralgia ◽  
Evoked Potentials ◽  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Auditory Evoked Potentials ◽  
Intraoperative Neuromonitoring ◽  
Brainstem Auditory Evoked Potentials ◽  
Group A ◽  
Group B

Background: Permanent hearing loss after posterior fossa microvascular decompression (MVD) for typical trigeminal neuralgia (TTN) is one of the possible complications of this procedure. Intraoperative brainstem auditory evoked potentials (BAEPs) are used for monitoring the function of cochlear nerve during cerebellopontine angle (CPA) microsurgery. Level-specific (LS)-CE-Chirp® BAEPs are the most recent evolution of classical click BAEP, performed both in clinical studies and during intraoperative neuromonitoring (IONM) of acoustic pathways during several neurosurgical procedures. Methods: Since February 2016, we routinely use LS-CE-Chirp® BAEPs for monitoring the function of cochlear nerve during CPA surgery, including MVD for trigeminal neuralgia. From September 2011 to December 2018, 71 MVDs for TTN were performed in our department, 47 without IONM of acoustic pathways (Group A), and, from February 2016, 24 with LS-CE-Chirp BAEP (Group B). Results: Two patients of Group A developed a permanent ipsilateral anacusia after MVD. In Group B, we did not observe any permanent acoustic deficit after surgery. In one case of Group B, during arachnoid dissection, intraoperative LS-CE-Chirp BAEP showed a temporary lag of V wave, resolved in 5 min after application of intracisternal diluted papaverine (0.3% solution without excipients). Conclusion: MVD is widely considered a definitive surgical procedure in the management of TTN. Even though posterior fossa MVD is a safe procedure, serious complications might occur. In particular, the use of IONM of acoustic pathways during MVD for TTN might contribute to prevention of postoperative hearing loss.

Patient Reports of Satisfaction after Microvascular Decompression and Partial Sensory Rhizotomy for Trigeminal Neuralgia

Neurosurgery ◽  
2005 ◽  
Vol 56 (6) ◽  
pp. 1304-1312 ◽  
Author(s):  
Joanna M. Zakrzewska ◽  
Benjamin C. Lopez ◽  
Sung Eun Kim ◽  
Hugh B. Coakham
Keyword(s):  
Patient Satisfaction ◽  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Primary Group ◽  
Posterior Fossa Surgery ◽  
Ablative Surgery ◽  
Significant Difference ◽  
Primary Procedure

Abstract OBJECTIVE: There are no reports of patient satisfaction surveys after either a microvascular decompression (MVD) or a partial sensory rhizotomy (PSR) for trigeminal neuralgia. This study compares patient satisfaction after these two types of posterior fossa surgery for trigeminal neuralgia, because it is postulated that recurrences, complications, and previous surgical experience reduce satisfaction. METHODS: All patients who had undergone their first posterior fossa surgery at one center were sent a self-complete questionnaire by an independent physician. Among the 44 questions on four standardized questionnaires were 5 questions that related to patient satisfaction and experience of obtaining care. Patients were divided into those having their first surgical procedure (primary) and those who had had previous ablative surgery (nonprimary). RESULTS: Response rates were 90% (220 of 245) of MVD and 88% (53 of 60) of PSR patients. Groups were comparable with respect to age, sex, duration of symptoms, mean duration of follow-up, and recurrence rates. Overall satisfaction with their current situation was 89% in MVD and 72% in PSR patients. Unsatisfied with the outcome were 4% of MVD and 20% of PSR patients, and this is a significant difference (P &lt; 0.01). Satisfaction with outcome was higher in those undergoing this as a primary procedure. In the primary group, satisfaction was dependent on recurrence and complication/side effects status (each P &lt; 0.01), but this was not the case in the nonprimary group. Patients expressed a desire for earlier posterior fossa surgery in 73% of MVD and 58% of PSR patients, and this was highest in the primary group. The final outcome was considered to be better than expected in 80% of MVD and 54% of PSR patients, but 22% of the PSR group (P &lt; 0.01) thought they were worse off. CONCLUSION: Patients undergoing posterior fossa surgery as a primary procedure are most satisfied and PSR patients are least satisfied, partly because of a higher rate of side effects.

Transposition of Vessels for Microvascular Decompression of Posterior Fossa Cranial Nerves: Review of Literature and Intraoperative Decision-Making Scheme

2021 ◽  
Vol 145 ◽  
pp. 64-72
Author(s):  
Samer S. Hoz ◽  
Zahraa F. Al-Sharshahi ◽  
Ali Adnan Dolachee ◽  
Silky Chotai ◽  
Hayder Salih ◽  
...  
Keyword(s):  
Decision Making ◽  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Cranial Nerves ◽  
Review Of Literature

Treatment of Tic Douloureux and Hemifacial Spasm by Posterior Fossa Exploration: Therapeutic Implications of Various Neurovascular Relationships

Neurosurgery ◽  
1984 ◽  
Vol 14 (4) ◽  
pp. 462-471 ◽  
Author(s):  
H. Piatt Joseph ◽  
H. Wilkins Robert
Keyword(s):  
Posterior Fossa ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Symptomatic Relief ◽  
Effective Alternative ◽  
Neurovascular Compression ◽  
Entry Zone ◽  
Therapeutic Implications ◽  
Tic Douloureux

Abstract A series of 152 posterior fossa explorations for tic douloureux and hemifacial spasm has been reviewed with assessment of outcome at the last follow-up examination. Among 103 cases of tic followed for an average of 48.3 months. 79 patients (77%) obtained good or excellent symptomatic relief, and there were 24 failures or recurrences (23%). Of 48 cases of hemifacial spasm followed for an average of 42.1 months, there were good or excellent results in 42 cases (87.5%); only 6 patients (12.5%) experienced failure or recurrence. Patients noted to have arterial contact at the 5th nerve entry zone responded significantly better to microvascular decompression than did patients with no arterial contact. Further, patients noted to have anatomical distortion of the 5th nerve by an artery or wedging of an artery into the crevice between the nerve and the pons had significantly better outcomes after microvascular decompression than did patients with other kinds of arterial contact. Partial sensory rhizotomy proved to be a highly effective alternative to microvascular decompression in cases of doubtful neurovascular compression. It was not possible to define similar neuroanatomical criteria predictive of response to microvascular decompression in patients with hemifacial spasm.

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