Enlightening the Cerebellopontine Angle: Intraoperative Indocyanine Green Angiography in Microvascular Decompression for Trigeminal Neuralgia

2016 ◽  
Vol 78 (02) ◽  
pp. 161-166 ◽  
Author(s):  
Dorothee Mielke ◽  
Reza Akhavan-Sigari ◽  
Veit Rohde ◽  
Kajetan von Eckardstein
Keyword(s):  
Trigeminal Neuralgia ◽  
Indocyanine Green ◽  
Microvascular Decompression ◽  
Cerebellopontine Angle ◽  
Indocyanine Green Angiography

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

2010 ◽  
Vol 67 (3) ◽  
pp. onsE309-onsE310 ◽  
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.

Preoperative evaluation of neurovascular relationships for microvascular decompression in the cerebellopontine angle in a virtual reality environment

2010 ◽  
Vol 113 (3) ◽  
pp. 479-485 ◽  
Author(s):  
Zhuo-Ying Du ◽  
Xiang Gao ◽  
Xiao-Luo Zhang ◽  
Zhi-Qiu Wang ◽  
Wei-Jun Tang
Keyword(s):  
Virtual Reality ◽  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cerebellopontine Angle ◽  
Surgical Simulation ◽  
Preoperative Evaluation ◽  
Spatial Understanding ◽  
Idiopathic Trigeminal Neuralgia ◽  
And Training

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.

scholarly journals Microsurgical resection of previously embolized recurrent cerebellopontine angle AVM

2021 ◽  
Vol 4 (1) ◽  
pp. V2
Author(s):  
Ehsan Dowlati ◽  
Kelsi Chesney ◽  
Vikram V. Nayar
Keyword(s):  
Arteriovenous Malformation ◽  
Indocyanine Green ◽  
Endovascular Treatment ◽  
Cerebellopontine Angle ◽  
Indocyanine Green Angiography ◽  
Transverse Sinus ◽  
Grade Ii ◽  
Microsurgical Resection ◽  
Martin Grade

This is the case of a ruptured Spetzler-Martin grade II arteriovenous malformation (AVM) located in the cerebellopontine angle and draining into the transverse sinus. The AVM was initially treated with staged embolization using Onyx (ev3 Neurovascular). However, recurrence was noted and treatment with microsurgical resection was undertaken. The authors present technical nuances of the approach and strategies for microsurgical resection of a previously embolized recurrent AVM with the aid of intraoperative indocyanine green angiography. Follow-up after endovascular treatment is critical, and curative treatment with microsurgical resection can be achieved with low morbidity in such AVMs as demonstrated by this case.The video can be found here: https://youtu.be/LMpz_YTFC0g

scholarly journals Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery

2017 ◽  
Vol 126 (5) ◽  
pp. 1676-1684 ◽  
Author(s):  
John Y. K. Lee ◽  
John T. Pierce ◽  
Sukhmeet K. Sandhu ◽  
Dmitriy Petrov ◽  
Andrew I. Yang
Keyword(s):  
Trigeminal Neuralgia ◽  
Pain Intensity ◽  
Endoscopic Surgery ◽  
Microvascular Decompression ◽  
Cerebellopontine Angle ◽  
Group Versus ◽  
Complication Rates ◽  
Internal Neurolysis ◽  
Pain Outcomes

OBJECTIVEEndoscopic surgery has revolutionized surgery of the ventral skull base but has not yet been widely adopted for use in the cerebellopontine angle. Given the relatively normal anatomy of the cerebellopontine angle in patients with trigeminal neuralgia (TN), the authors hypothesized that a fully endoscopic microvascular decompression (E-MVD) might provide pain outcomes equivalent to those of microscopic MVD (M-MVD) but with fewer complications.METHODSThe authors conducted a single-institution, single-surgeon retrospective study with patients treated in the period of 2006–2013. Before surgery, all patients completed a questionnaire that included a validated multidimensional pain-outcome tool, the Penn Facial Pain Scale (PFPS, formerly known as Brief Pain Inventory–Facial), an 11-point scale that measures pain intensity, interference with general activities of daily living (ADLs), and facial-specific ADLs. Using a standardized script, independent research assistants conducted follow-up telephone interviews.RESULTSIn total, 167 patients were available for follow-ups (66.5% female; 93 patients underwent M-MVD and 74 underwent E-MVD). Preoperative characteristics (i.e., TN classification, PFPS components, and medication use) were similar for the 2 surgical groups except for 2 variables. Patients in the M-MVD group had slightly higher incidence of V3 pain, and the 2 groups differed in the date of surgery and hence in the length of follow-up (2.4 years for the M-MVD group and 1.3 years for the E-MVD group, p < 0.05). There was a trend toward not finding neurovascular conflict at the time of surgery more frequently in the M-MVD than in the E-MVD group (11% vs 7%, p = 0.052). Internal neurolysis was more often performed in the E-MVD group (26% vs 7%, p = 0.001). The 2 groups did not significantly differ in the length of the MVD procedure (approximately 2 hours). Self-reported headaches at 1 month postoperatively were present in 21% of the patients in the M-MVD group versus 7% in the E-MVD group (p = 0.01). Pain outcomes at the most recent followup were equivalent, with patients reporting a 5- to 6-point (70%–80%) improvement in pain intensity, a 5-point (85%) improvement in pain interference with ADLs, and a 6-point (85%) improvement in interference with facial-specific ADLs. Actuarial freedom from pain recurrence was equivalent in the 2 groups, with 80% pain control at 3 years.CONCLUSIONSBoth the fully endoscopic MVD and the conventional M-MVD appear to provide patients with equivalent pain outcomes. Complication rates were also similar between the groups, with the exception of the rate of headaches, which was significantly lower in the E-MVD group 1 month postoperatively.

Use of the Arachnoid Membrane of the Cerebellopontine Angle to Transpose the Superior Cerebellar Artery in Microvascular Decompression for Trigeminal Neuralgia: Technical Note

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-88-ons-91 ◽  
Author(s):  
Miran Skrap ◽  
Francesco Tuniz
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Cerebellopontine Angle ◽  
Technical Note ◽  
Superior Cerebellar Artery ◽  
Arachnoid Membrane ◽  
Recurrent Pain ◽  
Cerebellar Artery

Abstract Background: Microvascular decompression is an accepted, safe, and useful surgical technique for the treatment of trigeminal neuralgia. Autologous muscle or implant materials such as shredded Teflon are used to separate the vessel from the nerve but may occasionally be inadequate, become displaced or create adhesions and recurrent pain. Objective: The authors evaluated the use of arachnoid membrane of the cerebellopontine angle to maintain the transposition of vessels from the trigeminal nerve. Methods: The authors conducted a retrospective review of microvascular decompression operations in which the offending vessel was transposed and then retained by the arachnoid membrane of the cerebellopontine cistern, specifically by the lateral pontomesenchepalic membrane. Results: This technique was used in 30 patients of the most recently operated series. Postoperatively, complete pain relief was achieved in 90% of the patients without any observed surgical complications. Conclusion: To the authors’ knowledge this is the first report in which the arachnoid membrane is used in the microvascular decompression of the trigeminal nerve. While this technique can be used only for selected cases, the majority of the vascular compressions on the trigeminal nerve are due to the SCA, so this sling transposition technique can be useful and effective.

Technique of microvascular decompression

2005 ◽  
Vol 18 (5) ◽  
pp. 1-5 ◽  
Author(s):  
Peter J. Jannetta ◽  
Mark R. Mclaughlin ◽  
Kenneth F. Casey
Keyword(s):  
Surgical Technique ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Cerebellopontine Angle ◽  
Wound Closure ◽  
Primary Source ◽  
Vascular Compression ◽  
Pathological Features ◽  
The Third

Vascular compression of the trigeminal nerve in the cerebellopontine angle is now generally accepted as the primary source or “trigger” causing trigeminal neuralgia. A clear clinicopathological association exists in the neurovascular relationship. In general, pain in the third division of the trigeminal nerve is caused by rostral compression, pain in the second division is caused by medial or more distant compression, and pain in the first division is caused by caudal compression. This discussion of the surgical technique includes details on patient position, placement of the incision and craniectomy, microsurgical exposure of the supralateral cerebellopontine angle, visualization of the trigeminal nerve and vascular pathological features, microvascular decompression, and wound closure. Nuances of the technique are best learned in the company of a surgeon who has a longer experience with this procedure.

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