Cranial nerve vascular compression syndromes

2019 ◽  
pp. 909-928
Author(s):  
Marc Sindou ◽  
George Georgoulis
Keyword(s):  
High Resolution ◽  
Trigeminal Neuralgia ◽  
Cranial Nerve ◽  
Clinical Manifestations ◽  
Ventrolateral Medulla ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Mri Imaging ◽  
Neurovascular Conflict ◽  
Vestibulocochlear Nerve

Hyperactive cranial nerve syndromes originate in a large number of cases from chronic neurovascular conflict. Classical trigeminal neuralgia is the most frequent syndrome, followed by primary hemifacial spasm. Vago-glossopharyngeal neuralgia is rare, but still underestimated. Vascular compression of the vestibulocochlear nerve may be at the origin of tinnitus and positional disabling vertigo. Vascular compression of the ventrolateral medulla can be a possible cause of neurogenic essential blood hypertension. Chronic pulsatile neurovascular compression would generate ectopic stimuli that are transmitted to neighbouring fibres through focal zones of demyelination, which provokes an ephaptic mechanism between fibres. Also, chronic pulsatile compression would induce hyperactivity of the corresponding cranial nerve nuclei. In trigeminal neuralgia this hyperactivity is expressed by epileptic-like clinical manifestations that respond to anticonvulsants. MRI imaging with high-resolution protocol, and the three following sequences—3D T2 high-resolution, TOF MR-angiography, and T1 with gadolinium—permit to depict the neurovascular conflict and predict the degree of compression. First option of the treatment is microvascular decompression.

Sensitivity of high-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled-gradient recalled imaging in the prediction of neurovascular compression in patients with hemifacial spasm

2009 ◽  
Vol 111 (4) ◽  
pp. 733-736 ◽  
Author(s):  
Ahmed M. Raslan ◽  
Reynaldo DeJesus ◽  
Caglar Berk ◽  
Andrew Zacest ◽  
Jim C. Anderson ◽  
...  
Keyword(s):  
High Resolution ◽  
Trigeminal Neuralgia ◽  
Blood Vessels ◽  
Hemifacial Spasm ◽  
Predictive Value ◽  
Mr Angiography ◽  
Three Dimensional ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Predictive Values

Object Hemifacial spasm is a clinical syndrome caused by vascular compression of the facial nerve in the cerebellopontine angle, which can be relieved by surgical intervention. Advances in medical imaging technology allow for direct visualization of the offending blood vessels in hemifacial spasm and similar conditions (such as trigeminal neuralgia). The utility of high resolution 3D MR angiography and 3D spoiled-gradient recalled (SPGR) imaging sequences for surgical decision-making in hemifacial spasm, as measured by sensitivity, specificity, and positive and negative predictive values, has not been previously determined. Methods A retrospective review was undertaken of 23 patients with hemifacial spasm who underwent operations between January 2001 and December 2006 at Oregon Health & Science University. All patients underwent preoperative high-resolution 3D MR angiography and 3D SPGR imaging. The sensitivity of the SPGR imaging/MR angiography interpretation of neurovascular compression (NVC) by both a neurosurgeon and 2 neuroradiologists was determined in relation to the presence of actual NVC during surgery. Results All patients were found to have NVC at surgery. After review by a neurosurgeon and 2 neuroradiologists, imaging data from 19 of the 23 patients were evaluated. The neurosurgeon's interpretation had a sensitivity of 79% and a positive predictive value (PPV) of 100%. The first neuroradiologist's interpretation had a sensitivity of 21% with a PPV of 100%. Further interpretation by a blinded second neuroradiologist with expertise in MR imaging of hemifacial spasm and trigeminal neuralgia was conducted, and sensitivity was 59% and PPV was 100%. Specificity was not determined because there were no true negative cases. The negative predictive value was 0% for both the neurosurgeon's and neuroradiologists' evaluations. Conclusions Although high-resolution 3D MR angiography and 3D SPGR imaging was helpful in providing information about the anatomical relationship of cranial nerve VII and surrounding blood vessels, the authors determined that in the case of hemifacial spasm these types of imaging did not influence preoperative surgical decisionmaking.

Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study

1992 ◽  
Vol 76 (6) ◽  
pp. 948-954 ◽  
Author(s):  
Peter J. Hamlyn ◽  
Thomas T. King
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Nerve ◽  
Operative Procedure ◽  
Anatomical Study ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Content Type ◽  
Simple Contact ◽  
Neurovascular Decompression ◽  
Fine Print

✓ Neurovascular decompression is a widely practiced tec hnique for the treatment of trigeminal neuralgia, and yet there is still debate as to whether the beneficial effect results from relieving the nerve of compression by an anatomically abnormal vessel or from the manipulation and trauma the nerve undergoes during the procedure. The development of this operation has been hampered by the lack of adequate anatomical studies in normal controls. The authors present a combined study of clinical and anatomical material employing standardized definitions of the neurovascular relationships in both groups. Detailed simulations of the operative procedure were carried out on fresh cadavers matched for age, sex, and side, and a technique of in situ blood vessel perfusion was developed that enabled the normal neurovascular arrangement to be observed post mortem at physiological pressures. Neurovascular compression, typified by a large vessel distorting and creating a groove in the fifth cranial nerve, was found in 37 of the 41 cases of trigeminal neuralgia; recurrence of pain did not relate to the site of compression. A follow-up study was carried out for a median of 53 months (range 12 to 103 months). No distortion was found in a total of 50 normal cadaveric dissections; however, on perfusion to physiological pressures, the percentage of nerves with vessels adjacent or in simple contact increased from 16% to 40%. This study using this new technique confirms that vascular compression of the fifth cranial nerve is an anatomical abnormality specific to trigeminal neuralgia.

Targeting the cranial nerve: microradiosurgery for trigeminal neuralgia with CISS and 3D-Flash MR imaging sequences

2005 ◽  
Vol 102 ◽  
pp. 107-110 ◽  
Author(s):  
Vasilios A. Zerris ◽  
Georg C. Noren ◽  
William A. Shucart ◽  
Jeff Rogg ◽  
Gerhard M. Friehs
Keyword(s):  
Mr Imaging ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Cranial Nerve ◽  
Fusion Imaging ◽  
Vascular Compression ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object.The authors undertook a study to identify magnetic resonance (MR) imaging techniques that can be used reliably during gamma knife surgery (GKS) to identify the trigeminal nerve, surrounding vasculature, and areas of compression.Methods.Preoperative visualization of the trigeminal nerve and surrounding vasculature as well as targeting the area of vascular compression may increase the effectiveness of GKS for trigeminal neuralgia. During the past years our gamma knife centers have researched different MR imaging sequences with regard to their ability to visualize cranial nerves and vascular structures. Constructive interference in steady-state (CISS) fusion imaging with three-dimensional gradient echo sequences (3D-Flash) was found to be of greatest value in the authors' 25 most recent patients.In 24 (96%) out of the 25 patients, the fifth cranial nerve, surrounding vessels, and areas of compression could be reliably identified using CISS/3D-Flash. The MR images were acceptable despite patients' history of microvascular decompression, radiofrequency (RF) ablation, or concomitant disease. In one of 25 patients with a history of multiple RF lesions, the visualization was inadequate due to severe trigeminal nerve atrophy.Conclusions.The CISS/3D-Flash fusion imaging has become the preferred imaging method at the authors' institutions during GKS for trigeminal neuralgia. It affords the best visualization of the trigeminal nerve, surrounding vasculature, and the precise location of vascular compression.

TRIGEMINAL NEURALGIA AND VASCULAR COMPRESSION IN PATIENTS WITH TRIGEMINAL SCHWANNOMAS

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. E974-E975 ◽  
Author(s):  
Jonathan P. Miller ◽  
Feridun Acar ◽  
Kim J. Burchiel
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Gamma Knife Radiosurgery ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Intracranial Tumors ◽  
Resonance Imaging

Abstract OBJECTIVE Trigeminal neuralgia (TN) is often associated with neurovascular compression. However, intracranial tumors are occasionally observed, particularly when symptoms are atypical. We describe three patients with Type-1 TN and trigeminal schwannoma diagnosed by magnetic resonance imaging, with concomitant arterial compression of the trigeminal nerve. CLINICAL PRESENTATION All three patients had Type-1 TN with spontaneous onset, paroxysm-triggered pain, and response to antiepileptic medication. Contrast-enhanced T1-weighted magnetic resonance imaging scans demonstrated an ipsilateral enhancing perineural mass consistent with a schwannoma. Two of the three patients had previously undergone gamma knife radiosurgery without improvement. Subsequent high-resolution magnetic resonance imaging in all three patients revealed obvious compression of the trigeminal nerve by an arterial structure. INTERVENTION Two patients underwent retrosigmoid craniectomy followed by microvascular decompression and remain pain-free. One patient elected not to pursue surgical intervention. CONCLUSION Although intracranial tumors are occasionally observed in patients with TN, neurovascular compression must still be considered as an etiology, especially if typical TN symptoms are reported.

scholarly journals To be or not to be a neurovascular conflict: importance of the preoperative identification of the neurovascular conflict in the trigeminal neuralgia

2016 ◽  
Vol 30 (3) ◽  
pp. 336-344
Author(s):  
Dana Mihaela Turliuc ◽  
B. Dobrovăţ ◽  
A. I. Cucu ◽  
Ş. Turliuc ◽  
Daniela Trandafir ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Surgical Approach ◽  
Neurovascular Compression ◽  
Neurovascular Conflict

Abstract The trigeminal neuralgia caused by neurovascular compression is a neurosurgical pathology requiring the preoperative identification as exact as possible of the neurovascular conflict. In this case, neuroimaging is very useful, as it allows not only the determination of the neurovascular conflict of the trigeminal nerve, but also the correct indication of an adequate surgical approach.

scholarly journals Hypertension of neurogenic origin: effect of microvascular decompression of the CN IX-X root entry/exit zone and ventrolateral medulla on blood pressure in a prospective series of 48 patients with hemifacial spasm associated with essential hypertension

2015 ◽  
Vol 123 (6) ◽  
pp. 1405-1413 ◽  
Author(s):  
Marc Sindou ◽  
Mohamed Mahmoudi ◽  
Andrei Brînzeu
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
High Resolution ◽  
Medical Treatment ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Ventrolateral Medulla ◽  
Vascular Compression ◽  
Who Grade

OBJECT In spite of solid anatomical and physiological arguments and the promising results of Jannetta in the 1970s, treating essential hypertension by microvascular decompression (MVD) of the brainstem has not gained acceptance as a mainstream technique. The main reason has been a lack of established selection criteria. Because of this, the authors' attempts have been limited to patients referred for MVD for hemifacial spasm (HFS) who also had hypertension likely to be related to neurovascular compression (NVC). METHODS Of 201 patients referred for HFS, 48 (23.8%) had associated hypertension. All had high-resolution MR images that demonstrated NVC. All underwent MVD of the root exit/entry zone (REZ) of the ninth and tenth cranial nerves (CN IX-X) and adjacent ventrolateral medulla in addition to the CN VII REZ. Effects on hypertension, graded using the WHO classification, were studied up to the latest follow-up, which was 2–16 years from the time of surgery, 7 years on average. Also, effects of MVD on blood pressure (BP) according to the side of vascular compression were evaluated. RESULTS Preoperatively, hypertension was severe in all but 1 of the patients; in spite of medical treatment, 47 patients still had WHO Grade 1 or 2 hypertension, and 18 still had unstable BP. After MVD, at latest follow-up, BP had returned to normal (i.e., systolic pressure < 140 mm Hg) in 28 patients; 14 of these patients (29.10% of the whole series) were able to maintain normal BP without any antihypertensive treatment; the other 14 still required some medication to maintain their BP below 140 mm Hg (p < 0.0001). Also, at latest follow-up, BP remained unstable in only 8 of the 18 patients with instability prior to MVD (p < 0.02). Analysis according to side of compression showed that of the 30 patients with left-sided compression, 17 had their BP normalized (without medication in 11 cases), and of the 18 patients with right-sided compression, 11 had their BP normalized (without medication in 3 cases). The difference between sides was not significant. CONCLUSIONS These results argue for considering MVD for the treatment of hypertension likely to be due to NVC at the CN IX-X REZ and adjacent ventrolateral medulla. Criteria for selecting patients with hypertension alone still need to be established and could include the following indications: apparently essential hypertension, likely to be neurogenic, in patients in whom high-resolution MRI shows clear-cut images of NVC at the CN IX-X REZ and adjacent ventrolateral medulla and in whom BP cannot be controlled by medical treatment.

scholarly journals Prevalence of elevated intracranial pressure in patients with classical trigeminal neuralgia with overweight and obesity

2020 ◽  
Vol 25 (3) ◽  
pp. 6-13
Author(s):  
Betzaida Saraí Oseguera-Zavala ◽  
Aarón Giovanni Munguía-Rodríguez ◽  
Octavio Carranza-Rentería ◽  
María Dolores Flores-Solís ◽  
Mauro Alberto Segura-Lozano
Keyword(s):  
Intracranial Pressure ◽  
Trigeminal Neuralgia ◽  
Intracranial Hypertension ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
Case Series ◽  
Abducens Nerve ◽  
Overweight And Obesity ◽  
Vascular Compression ◽  
Related Disorder

Background: There is a clear association between obesity and Idiopathic Intracranial Hypertension (IIH), a syndrome characterized by increased Intracranial Pressure (ICP). The clinical manifestations of IHH include headache and visual/oculomotor disorders due to the involvement of abducens nerve. Thus far, it has not been widely studied whether affectations by ICP elevation could involve other cranial nerves such as the trigeminal nerve.Objective: The aim of this study is to analyze the prevalence of elevated ICP in patients with BMI ≥ 25 that suffer vascular compression of the trigeminal nerve. Methods: A case series including 19 patients evaluated during a period of 8 months with BMI ≥ 25 and a clinical diagnosis of classic trigeminal neuralgia (TN) who underwent Microvascular Decompression (MVD) surgery is reported. Patients with TN presenting another cause of intracranial hypertension were excluded. The ICP was determined just before MVD surgery by introducing an enteral tube through a 2 mm incision in the dura and measuring the level reached by the CSF. Results: In our series, 42.1% of patients suffered overweight (n = 8), 47.3% grade I obesity (n = 9) and 10.5% grade II obesity (n = 2). The ICP was elevated in 47.4% of patients. Conclusion: IHH is an obesity-related disorder. Patients with BMI ≥ 25 and TN show a high prevalence of ICP. It is important to consider that an obese patient may present high ICP during and after MVD surger

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

2014 ◽  
Vol 120 (6) ◽  
pp. 1484-1495 ◽  
Author(s):  
Paulo Roberto Lacerda Leal ◽  
Charlotte Barbier ◽  
Marc Hermier ◽  
Miguel Angelo Souza ◽  
Gerardo Cristino-Filho ◽  
...  
Keyword(s):  
High Resolution ◽  
Trigeminal Neuralgia ◽  
Clinical Outcomes ◽  
Pearson Correlation ◽  
P Value ◽  
Neurovascular Compression ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Trigeminal Nerves ◽  
Grade Iii

Object The aim of this study was to prospectively evaluate atrophic changes in trigeminal nerves (TGNs) using measurements of volume (V) and cross-sectional area (CSA) from high-resolution 3-T MR images obtained in patients with unilateral trigeminal neuralgia (TN), and to correlate these data with patient and neurovascular compression (NVC) characteristics and with clinical outcomes. Methods Anatomical TGN parameters (V and CSA) were obtained in 50 patients (30 women and 20 men; mean age 56.42 years, range 22–79 years) with classic TN before treatment with microvascular decompression (MVD). Parameters were compared between the symptomatic (ipsilateralTN) and asymptomatic (contralateralTN) sides of the face. Twenty normal control subjects were also included. Two independent observers blinded to the side of pain separately analyzed the images. Measurements of V (from the pons to the entrance of the nerve into Meckel's cave) and CSA (at 5 mm from the entry of the TGN into the pons) for each TGN were performed using imaging software and axial and coronal projections, respectively. These data were correlated with patient characteristics (age, duration of symptoms before MVD, side of pain, sex, and area of pain distribution), NVC characteristics (type of vessel involved in NVC, location of compression along the nerve, site of compression around the circumference of the root, and degree of compression), and clinical outcomes at the 2-year follow-up after surgery. Comparisons were made using Bonferroni's test. Interobserver variability was assessed using the Pearson correlation coefficient. Results The mean V of the TGN on the ipsilateralTN (60.35 ± 21.74 mm3) was significantly smaller (p < 0.05) than those for the contralateralTN and controls (78.62 ± 24.62 mm3 and 89.09 ± 14.72 mm3, respectively). The mean CSA of the TGN on the ipsilateralTN (4.17 ± 1.74 mm2) was significantly smaller than those for the contralateralTN and controls (5.41 ± 1.89 mm2 and 5.64 ± 0.85 mm2, respectively). The ipsilateralTN with NVC Grade III (marked indentation) had a significantly smaller mean V than the ipsilateralTN with NVC Grade I (mere contact), although it was not significantly smaller than that of the ipsilateralTN with NVC Grade II (displacement or distortion of root). The ipsilateralTN with NVC Grade III had a significantly smaller mean CSA than the ipsilateralTN with NVC Grades I and II (p < 0.05). The TGN on the ipsilateralTN in cured patients had a smaller mean CSA than that on the ipsilateralTN of patients with partial pain relief or treatment failure (p < 0.05). The same finding was almost found in relation to measurements of V, but the p value was slightly higher at 0.05. Conclusions Results showed that TGN atrophy in patients with TN can be demonstrated by high-resolution imaging. These data suggest that atrophic changes in TGNs, which significantly correlated with the severity of compression and clinical outcomes, may help to predict long-term prognosis after vascular decompression.

Hemifacial spasm caused by vascular compression of the distal portion of the facial nerve

1998 ◽  
Vol 88 (3) ◽  
pp. 605-609 ◽  
Author(s):  
Hiroshi Ryu ◽  
Seiji Yamamoto ◽  
Kenji Sugiyama ◽  
Kenichi Uemura ◽  
Tsunehiko Miyamoto
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Cranial Nerve ◽  
Distal Portion ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Content Type ◽  
Seventh Cranial Nerve ◽  
Neurovascular Decompression ◽  
Fine Print

✓ It is generally accepted that hemifacial spasm (HFS) and trigeminal neuralgia are caused by compression of the facial nerve (seventh cranial nerve) or the trigeminal nerve (fifth cranial nerve) at the nerve's root exit (or entry) zone (REZ); thus, neurosurgeons generally perform neurovascular decompression at the REZ. Neurosurgeons tend to ignore vascular compression at distal portions of the seventh cranial nerve, even when found incidentally while performing neurovascular decompression at the REZ of that nerve, because compression of distal portions of the seventh cranial nerve has not been regarded as a cause of HFS. Recently the authors treated seven cases of HFS in which compression of the distal portion of the seventh cranial nerve produced symptoms. The anterior inferior cerebellar artery (AICA) was the offending vessel in five of these cases. Great care must be taken not to stretch the internal auditory arteries during manipulation of the AICA because these small arteries are quite vulnerable to surgical manipulation and the patient may experience hearing loss postoperatively. It must be kept in mind that compression of distal portions of the seventh cranial nerve may be responsible for HFS in cases in which neurovascular compression at the REZ is not confirmed intraoperatively and in cases in which neurovascular decompression at the nerve's REZ does not cure HFS. Surgical procedures for decompression of the distal portion of the seventh cranial nerve as well as decompression at the REZ should be performed when a deep vascular groove is noticed at the distal site of compression of the nerve.

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