Adjunctive Use of Endoscopy during Posterior Fossa Surgery to Treat Cranial Neuropathies

Neurosurgery ◽  
2001 ◽  
Vol 49 (1) ◽  
pp. 108-116 ◽  
Author(s):  
Wesley A. King ◽  
Phillip A. Wackym ◽  
Chandranath Sen ◽  
Glenn A. Meyer ◽  
John Shiau ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Vascular Compression ◽  
Posterior Fossa Surgery ◽  
Suboccipital Craniotomy ◽  
Neoplastic Processes ◽  
Rigid Endoscope ◽  
Cranial Neuropathies

Abstract OBJECTIVE The objective of this study was to determine the utility and safety of rigid endoscopy as an adjunct during posterior fossa surgery to treat cranial neuropathies. METHODS A suboccipital craniotomy was performed for 19 patients with non-neoplastic processes involving the Vth, VIIth, and/or VIIIth cranial nerves. Ten patients with trigeminal neuralgia (n = 8), hemifacial spasm (n = 1), or intractable tinnitus (n = 1) underwent primarily microvascular decompression procedures. One patient with geniculate neuralgia underwent nervus intermedius sectioning combined with microvascular decompression. Eight patients underwent unilateral vestibular nerve neurectomies for treatment of Ménière's disease. A 0- or 30-degree rigid endoscope was used in conjunction with the standard microscopic approach for all procedures. RESULTS All patients experienced resolution or significant improvement of their preoperative symptoms after posterior fossa surgery. The endoscope allowed improved definition of anatomic neurovascular relationships without the need for significant cerebellar or brainstem retraction. Cleavage planes between the cochlear and vestibular nerves entering the internal auditory canal and sites of vascular compression could not be microscopically observed for several patients; however, endoscopic identification was possible for all patients. There were no complications related to the use of the endoscope. CONCLUSION The rigid endoscope can be used safely during posterior fossa surgery to treat cranial neuropathies, and it allows improved observation of the cranial nerves, nerve cleavage planes, and vascular anatomic features without significant cerebellar or brainstem retraction.

Demonstration of neurovascular compression in trigeminal neuralgia with magnetic resonance imaging

1995 ◽  
Vol 83 (5) ◽  
pp. 799-805 ◽  
Author(s):  
James F. M. Meaney ◽  
Paul R. Eldridge ◽  
Lawrence T. Dunn ◽  
Thomas E. Nixon ◽  
Graham H. Whitehouse ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Posterior Fossa Surgery ◽  
Content Type ◽  
Fine Print

✓ Until recently, the inability to demonstrate neurovascular compression of the trigeminal nerve preoperatively resulted in surgery being offered only in cases of severe trigeminal neuralgia (TGN), frequently after a prolonged trial of medical treatment and following less invasive procedures, despite the fact that posterior fossa microvascular decompression gives long-term pain relief in 80% to 90% of cases. To assess whether vascular compression of the nerve could be demonstrated preoperatively, high definition magnetic resonance tomographic angiography (MRTA) was performed in 50 consecutive patients, five of whom had bilateral TGN, prior to posterior fossa surgery. The imaging results were compared with the operative findings in all patients, including two patients who underwent bilateral exploration. Vascular compression of the trigeminal nerve was identified in 42 of 45 patients with unilateral symptoms and on both sides in four patients with bilateral TGN. In the last patient with bilateral TGN, neurovascular compression was identified on one side, and on the other side the compressing superior cerebellar artery was separated from the nerve by a sponge placed during previous surgery. There was full agreement regarding the presence or absence of neurovascular compression demonstrated by MRTA in 50 of 52 explorations, but MRTA misclassified four vessels compressing the trigeminal nerve as arteries rather than veins. In two cases, there was disagreement between the surgical and MRTA findings. In the first of these cases, surgery revealed distortion of the nerve at the pons by a vein that MRTA had predicted to lie 6 mm remote from this point. In the second patient, venous compression was missed; however, this patient was investigated early in the series and did not have gadolinium-enhanced imaging. In nine cases, MRTA correctly identified neurovascular compression of the trigeminal nerve by two arteries. Moreover, MRTA successfully guided surgical reexploration in one patient in whom a compressing vessel was missed during earlier surgery and also prompted exploration of the posterior fossa in two patients with multiple sclerosis and one patient with Charcot-Marie-Tooth syndrome, in whom neurovascular compression was identified preoperatively. It is concluded that MRTA is an extremely sensitive and specific method for demonstrating vascular compression in TGN. As a result, open surgical procedures can be recommended with confidence, and microvascular decompression is now the treatment of choice for TGN at the authors' unit. They propose MRTA as the definitive investigation in such patients in whom surgery is contemplated.

Endoscopic-Assisted Microvascular Decompression

2018 ◽  
pp. 139-154
Author(s):  
M. Yashar S. Kalani ◽  
Michael R. Levitt ◽  
Celene B. Mulholland ◽  
Charles Teo ◽  
Peter Nakaji
Keyword(s):  
Trigeminal Neuralgia ◽  
Minimally Invasive ◽  
Effective Treatment ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Patient Population ◽  
Surgical Intervention ◽  
Cranial Nerves ◽  
Vascular Compression ◽  
Ephaptic Transmission

Diseases of ephaptic transmission are commonly caused by vascular compression of cranial nerves. The advent of microvascular decompression has allowed for surgical intervention for this patient population. This chapter highlights the technique of endoscopic-assisted microvascular decompression for trigeminal neuralgia and hemifacial spasm. Endoscopy and keyhole techniques have resulted in a minimally invasive and effective treatment of symptoms for patients with neuralgia.

Adjunctive Use of Endoscopy during Posterior Fossa Surgery to Treat Cranial Neuropathies

Neurosurgery ◽  
2001 ◽  
Vol 49 (1) ◽  
pp. 108-116 ◽  
Author(s):  
Wesley A. King ◽  
Phillip A. Wackym ◽  
Chandranath Sen ◽  
Glenn A. Meyer ◽  
John Shiau ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Posterior Fossa Surgery ◽  
Cranial Neuropathies

Microvascular decompression for hemifacial spasm

1991 ◽  
Vol 75 (3) ◽  
pp. 388-392 ◽  
Author(s):  
Shinji Nagahiro ◽  
Akira Takada ◽  
Yasuhiko Matsukado ◽  
Yukitaka Ushio
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Anterior Inferior Cerebellar Artery ◽  
Vascular Compression ◽  
Content Type ◽  
Seventh Cranial Nerve ◽  
Cerebellar Artery

✓ To determine the causative factors of unsuccessful microvascular decompression for hemifacial spasm, the follow-up results in 53 patients were assessed retrospectively. The mean follow-up period was 36 months. There were 32 patients who had compression of the seventh cranial nerve ventrocaudally by an anterior inferior cerebellar artery (AICA) or a posterior inferior cerebellar artery. Of these 32 patients, 30 (94%) had excellent postoperative results. Of 14 patients with more severe compression by the vertebral artery, nine (64%) had excellent results, three (21%) had good results, and two (14%) had poor results; in this group, three patients with excellent results experienced transient spasm recurrence. There were seven patients in whom the meatal branch of the AICA coursed between the seventh and eighth cranial nerves and compressed the dorsal aspect of the seventh nerve; this was usually associated with another artery compressing the ventral aspect of the nerve (“sandwich-type” compression). Of these seven patients, five (71%) had poor results including operative failure in one and recurrence of spasm in four. The authors conclude that the clinical outcome was closely related to the patterns of vascular compression.

Microvascular Decompression in Patient With Atypical Features of Hemifacial Spasm Secondary to Compression by a Tortuous Vertebrobasilar System

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. E1212-E1212 ◽  
Author(s):  
David H. Perlmutter ◽  
Anthony L. Petraglia ◽  
Richard Barbano ◽  
Jason M. Schwalb
Keyword(s):  
Hearing Loss ◽  
Botulinum Toxin ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cranial Nerves ◽  
Vascular Compression ◽  
Vertebrobasilar System ◽  
The Face ◽  
Grade 3 ◽  
The Right

Abstract OBJECTIVE We report a case of hemifacial spasm in a patient who had associated hearing loss, numbness throughout the face, tinnitus, and vertigo, all of which occurred when turning his head to the left. To our knowledge, these symptoms have not occurred in this pattern and with a single trigger. CLINICAL PRESENTATION A 45-year-old man presented with a 3-year history of right-sided hemifacial spasm initially treated with botulinum toxin. One month before presentation, he had an episode of acute hearing loss in the right ear when turning his head to the left, followed by multiple episodes of transient hearing loss in his right ear, numbness in his right face in all distributions of the trigeminal nerve, tinnitus, and vertigo. He was found to have decreased sensation in nerves V1 to V3 and House-Brackmann grade 3/6 weakness in his right face, despite not having botulinum toxin injections in more than a year. Magnetic resonance imaging/angiography showed an ectatic vertebrobasilar system causing compression of the fifth, seventh, and eighth cranial nerves. INTERVENTION The patient underwent a retromastoid craniotomy and microvascular decompression. Postoperatively, he had complete resolution of his symptoms except for his facial weakness. The benefit has been long-lasting. CONCLUSION Multiple, simultaneous cranial neuropathies from vascular compression are rare, but this case is an example of safe and effective treatment with microvascular decompression with durable results.

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 < 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 < 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 < 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.

Intraoperative three-dimensional visualization in microvascular decompression

2007 ◽  
Vol 107 (6) ◽  
pp. 1137-1143 ◽  
Author(s):  
Levent Tanrikulu ◽  
Peter Hastreiter ◽  
Regina Troescher-Weber ◽  
Michael Buchfelder ◽  
Ramin Naraghi
Keyword(s):  
Mr Imaging ◽  
Microvascular Decompression ◽  
3D Visualization ◽  
Cranial Nerves ◽  
Preoperative Imaging ◽  
Neurosurgical Procedures ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Imaging Data ◽  
Neurovascular Structures

Object The authors systematically analyzed 3D visualization of neurovascular compression (NVC) syndromes in the operating room (OR) during microvascular decompression (MVD). Methods A total of 50 patients (26 women and 24 men) with trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GN) were examined and underwent MVD. Preoperative imaging of the neurovascular structures was performed using constructive interference in the steady state magnetic resonance (CISS MR) imaging, which consisted of 2D image slices. The 3D visualization of the neurovascular anatomy is generated after segmentaion of the CISS MR imaging in combination with direct volume rendering (DVR). The 3D representations were stored on a personal computer (PC) that was mounted on a mobile unit and transferred to the OR. During surgery, 3D visualization was applied by the surgeon with remotely controlled plasma-sterilized devices such as a wireless mouse and keyboard. The position of the 3D visualized neurovascular structures at the PC monitor was determined according to the intraoperative findings observed through the operating microscope. Results The system was stable during all neurosurgical procedures, and there were no operative or technical complications. Interactive adjustment of the 3D visualization guided by the view through the microscope permitted observation of the neurovascular relationships at the brainstem. Vessels covered by the cranial nerves could be noninvasively viewed by intraoperative 3D visualization. Postoperatively, the patients with TN and GN experienced pain relief, and the patients with HFS attained resolution of their facial tics. Vascular compression of nerves was explored in all 50 patients during MVD. Intraoperative 3D visualization delineated the compressing vessels and respective cranial nerves in 49 (98%) of 50 patients. Conclusions Interactive 3D visualization by DVR of high-resolution MR imaging data offered the opportunity for noninvasive virtual exploration of the neurovascular structures during surgery. An extended global survey of the neurovascular relationships was provided during MVD in each case. The presented method proved to be extremely advantageous for optimizing microneurosurgical procedures, supporting superior safety and improving the operative results when compared with the conventional strategy. This modality proved to be a very valuable teaching instrument and ensured the improvement of neurosurgical quality.

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

Mutism after posterior fossa surgery in children

1990 ◽  
Vol 72 (6) ◽  
pp. 959-963 ◽  
Author(s):  
Luigi Ferrante ◽  
Luciano Mastronardi ◽  
Michele Acqui ◽  
Aldo Fortuna
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Cranial Nerves ◽  
Speech Disorder ◽  
Posterior Fossa Surgery ◽  
Content Type ◽  
Disturbance Of Consciousness ◽  
Lower Cranial Nerves ◽  
Fine Print

✓ Three patients aged 5½ to 9 years old with mutism after posterior fossa surgery are presented. The entity is discussed with a review of 15 additional previously reported cases in children aged 2 to 11 years. In all 18 patients, a large midline tumor of the posterior fossa (medulloblastoma in nine cases, astrocytoma in five, and ependymoma in four), often attached to one or both lateral recesses of the fourth ventricle, was removed. Mutism developed 18 to 72 hours after the operation (mean 41.5 hours) in patients with no disturbance of consciousness and no deficits of the lower cranial nerves or of the organs of phonation. All of these children had spoken in the first hours after surgery. The disorder lasted from 3 to 16 weeks (mean 7.9 weeks). Speech was regained after a period of dysarthria in six of the 10 cases for whom this information was available. The various hypotheses advanced to explain the pathogenesis of this speech disorder are analyzed.

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