Results Of Treatment Of Trigeminal Neuralgia By Microvascular Decompression Of The Vth Nerve At Its Root Entry Zone

✓ 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.

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

Operative Neurosurgery ◽

10.1227/01.neu.0000232768.47615.82 ◽

2006 ◽

Vol 59 (suppl_4) ◽

pp. ONS-E489-ONS-E490 ◽

Cited By ~ 11

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.

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

Journal of Neurosurgery ◽

10.3171/jns.1997.87.3.0454 ◽

1997 ◽

Vol 87 (3) ◽

pp. 454-457 ◽

Cited By ~ 43

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.

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PREOPERATIVE SIMULATION FOR MICROVASCULAR DECOMPRESSION IN PATIENTS WITH IDIOPATHIC TRIGEMINAL NEURALGIA

Neurosurgery ◽

10.1227/01.neu.0000249213.34838.c9 ◽

2007 ◽

Vol 60 (1) ◽

pp. 104-114 ◽

Cited By ~ 37

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.

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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

Neurosurgical Focus: Video ◽

10.3171/2020.7.focvid2032 ◽

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

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

Journal of Neurosurgery ◽

10.3171/2014.12.jns142086 ◽

2015 ◽

Vol 123 (6) ◽

pp. 1512-1518 ◽

Cited By ~ 10

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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The Effect of Microvascular Decompression in Patients With Multiple Sclerosis and Trigeminal Neuralgia

Neurosurgery ◽

10.1227/01.neu.0000375491.81803.5d ◽

2010 ◽

Vol 67 (3) ◽

pp. 749-754 ◽

Cited By ~ 33

Author(s):

Tiril Sandell ◽

Per Kristian Eide

Keyword(s):

Multiple Sclerosis ◽

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Senior Author ◽

Preoperative Pain ◽

Entry Zone ◽

Root Entry Zone ◽

Constant Pain ◽

First Time

Abstract BACKGROUND Trigeminal neuralgia (TN) in patients with multiple sclerosis (MS) is thought to be caused by demyelinating plaques within the nerve root entry zone, the trigeminal nucleus, or the trigeminal tracts. OBJECTIVE To review our experience of microvascular decompression (MVD) in patients with MS and symptomatic TN. METHODS All first-time MVDs for symptomatic trigeminal neuralgia in patients with MS performed by the senior author during an 8-year period (1999–2007) in this department were reviewed. The preoperative pain components were differentiated as being 100% episodic pain, > 50% episodic pain, or > 50% constant pain. At follow-up, pain relief was assessed with a standard mail questionnaire; those still having residual pain were further examined in the outpatient clinic or interviewed by phone. RESULTS Of the 19 MS patients, 15 were available for follow-up. The median observation period was 55 months (range, 17–99 months). At follow-up, 7 of 15 patients (47%) were completely free of their episodic pain, and an additional 4 (27%) had significant relief of episodic pain (ie, worst pain marked as 0 to 3 cm on a 10-cm visual analog scale). Among the subgroup of 8 patients with a constant pain component, all were free of their constant pain, and 4 (50%) were free of their episodic pain. CONCLUSION In our 8-year experience of doing MVD in MS patients with TN, we found complete and significant relief of episodic TN in a large proportion of patients. Even those with a constant pain component before MVD were completely relieved of their constant pain. Thus, in patients with TN (with or without a constant pain component), the presence of MS should not prevent patients from being offered MVD.

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Pathophysiology of trigeminal neuralgia: new evidence from a trigeminal ganglion intraoperative microneurographic recording

Journal of Neurosurgery ◽

10.3171/jns.2004.101.5.0872 ◽

2004 ◽

Vol 101 (5) ◽

pp. 872-873 ◽

Cited By ~ 23

Author(s):

Kim J. Burchiel ◽

Thomas K. Baumann

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Ganglion ◽

Physiological Mechanism ◽

Vascular Compression ◽

Entry Zone ◽

Content Type ◽

Root Entry Zone ◽

Trigeminal Ganglion Neurons ◽

Ganglion Neurons ◽

New Evidence

✓ The origin of trigeminal neuralgia (TN) appears to be vascular compression of the trigeminal nerve at the root entry zone; however, the physiological mechanism of this disorder remains uncertain. The authors obtained intraoperative microneurographic recordings from trigeminal ganglion neurons in a patient with TN immediately before percutaneous radiofrequency-induced gangliolysis. Their findings are consistent with the idea that the pain of TN is generated, at least in part, by an abnormal discharge within the peripheral nervous system.

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