VASCULAR COMPRESSION OF LOWER CRANIAL NERVES: OBSERVATIONS USING MICROSURGERY, WITH PARTICULAR REFERENCE TO TRIGEMINAL NEURALGIA

1977 ◽  
Vol 47 (3) ◽  
pp. 314-320 ◽  
Author(s):  
Peter G. Petty ◽  
Robert Southby
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Nerves ◽  
Vascular Compression ◽  
Lower Cranial Nerves

scholarly journals Disease of lower cranial nerves caused by vascular compression

2008 ◽  
Vol 55 (2) ◽  
pp. 27-31 ◽  
Author(s):  
B.D. Antic ◽  
P. Peric ◽  
S.Lj. Stefanovic
Keyword(s):  
Surgical Treatment ◽  
Cranial Nerves ◽  
Postoperative Outcome ◽  
Glossopharyngeal Neuralgia ◽  
Statistic Analysis ◽  
Vascular Compression ◽  
Excellent Outcome ◽  
Surgical Options ◽  
Lower Cranial Nerves ◽  
Surgical Option

Between April 1989 and September 2007, 181 patients with disease of lower cranial nerves (DLCN) underwent posterior fossa exploration. As a cause of DLCN, vascular compression (VC) was present in 89 patients with trigeminal neuralgia (TN), in 6 with hemifacial spasm (HFS), in 1 with glossopharyngeal neuralgia, in 1 with Meniere?s disease, and in 5 with multiple DLCN. Depending on intraoperative findings, different surgical options were used: microvascular decompression (MVD), MVD with partial sensory rhizotomy (PSR) or total sensory rhizotomy (TSR). Statistic analysis was made using the Fisher?s exact 2-side test. In patients with TN, excellent outcome was archived in 83 patients and good in 6. Postoperative outcome was better (p = 0.007) in cases with severe VC, but without significant correlation between used surgical option and outcome (p = 0.402). Frequency rate of relapses did not depend on severity of VC (p = 0.502) and used surgical option (p = 0.175). In 6 patients with HFS, excellent outcome was archived in 5 with arterial compression and poor in 1 with venous contact. In patients with Meniere?s disease and glossopharyngeal neuralgia, MVD result with excellent outcome. In 5 patients with multiple DLCN, excellent outcome was archived in 3 and good in 2. MVD is method of choice in surgical treatment of DLCN caused by VC. Overall outcome is better with severity of VC.

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.

Endoscope-assisted Microsurgery for Microvascular Compression Syndromes

Neurosurgery ◽  
2004 ◽  
Vol 54 (4) ◽  
pp. 876-883 ◽  
Author(s):  
Ramin Rak ◽  
Laligam N. Sekhar ◽  
Dinko Stimac ◽  
Peter Hechl
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Nerves ◽  
Vascular Compression ◽  
Primary Role ◽  
Multiple Sources ◽  
Root Exit Zone ◽  
Venous Compression ◽  
Microsurgical Approach ◽  
Grade Ii ◽  
Neural Anatomy

Abstract OBJECTIVE To discuss the results of endoscope-assisted surgery in microvascular decompression (MVD) of Cranial Nerves (CNs) V, VII, and VIII. METHODS Neuroendoscopy was used as an adjunct to the surgical microscope in the MVD of the trigeminal (17 patients), facial (10 patients), and vestibulocochlear (1 patient) nerves in a series of 28 consecutive patients. After a standard microsurgical approach to CNs V, VII, and VIII, the endoscope was used to inspect all aspects of neural anatomy, to assess vascular compression, and to check the results of the decompression. Endoscope use was graded in four categories: Grade I, used but no definite role; Grade II, visualization assisted; Grade III, procedure assisted; and Grade IV, primary role. The usefulness of the endoscope was evaluated in each case. RESULTS The endoscope was useful in visualizing the anatomy in all cases. It was especially useful in establishing trigeminal vein compression of CN V in Meckel's cave; observing multiple sources of vascular compression; ensuring adequate decompression after cauterization of vein, insertion of the Teflon felt, or a pexy procedure; and permitting observation of the compression of CN VII at the root exit zone by small arteries and veins. In six patients with trigeminal neuralgia, the trigeminal vein was cauterized and divided by using endoscopic vision only because the venous compression was not completely visualized with the microscope. During a follow-up period of 6 to 52 months (mean, 29 mo; median, 40 mo), all patients were asymptomatic and receiving no medication. CONCLUSION The endoscope is a useful adjunct to MVD in the treatment of trigeminal neuralgia, hemifacial spasm, and disabling positional vertigo or tinnitus.

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

scholarly journals Trigeminal Neuralgia due to Vertebrobasilar Dolichoectasia

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Wuilker Knoner Campos ◽  
André Accioly Guasti ◽  
Benjamin Franklin da Silva ◽  
José Antonio Guasti
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Nerves ◽  
Rare Condition ◽  
Vascular Compression ◽  
Drug Resistant ◽  
Neurovascular Conflict ◽  
Vertebrobasilar Dolichoectasia ◽  
Intracranial Arteries

We presented a case of drug-resistant trigeminal neuralgia attributed to vertebrobasilar dolichoectasia, a rare condition characterized by enlargement, tortuosity, or elongation of intracranial arteries. Dolichoectatic vessels can cause dysfunction of cranial nerves through direct vascular compression. The relationships of vertebrobasilar dolichoectasia with the particularities of neurovascular conflict and images findings are discussed.

scholarly journals Microvascular transposition using Teflon sling technique

2020 ◽  
Vol 3 (2) ◽  
pp. V2
Author(s):  
Mitchell W. Couldwell ◽  
Vance Mortimer, AS ◽  
William T. Couldwell
Keyword(s):  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Vascular Compression ◽  
Link Type ◽  
Pain Syndromes ◽  
Established Technique

Microvascular decompression is a well-established technique used to relieve abnormal vascular compression of cranial nerves and associated pain. Here the authors describe three cases in which a sling technique was used in the treatment of cranial nerve pain syndromes: trigeminal neuralgia with predominant V2 distribution, hemifacial spasm, and geniculate neuralgia and right-sided ear pain. In each case, the artery was mobilized from the nerve and tethered with a sling. All three patients had reduction of symptoms within 6 weeks.The video can be found here: https://youtu.be/iM7gukvPz6E

scholarly journals Right medium-sized vestibular schwannoma with trigeminal neuralgia post-fractionated radiotherapy

2021 ◽  
Vol 5 (2) ◽  
pp. V10
Author(s):  
Kunal Vakharia ◽  
Anthony L. Mikula ◽  
Ashley M. Nassiri ◽  
Colin L. W. Driscoll ◽  
Michael J. Link
Keyword(s):  
Trigeminal Neuralgia ◽  
Vestibular Schwannoma ◽  
Cranial Nerves ◽  
Motor Branch ◽  
Entry Zone ◽  
Fractionated Radiotherapy ◽  
Root Entry Zone ◽  
Trigeminal Nerve Root ◽  
Microsurgical Resection ◽  
Lower Cranial Nerves

A patient with trigeminal neuralgia secondary to a vestibular schwannoma underwent fractionated radiotherapy without relief of her pain. She was then effectively treated with microsurgical resection of her tumor. Early identification of the lower cranial nerves and the origin of the facial and vestibulocochlear nerves is key to determining the operative corridors for vestibular schwannoma resection. To effectively treat trigeminal neuralgia, the trigeminal nerve root entry zone and motor branch are clearly identified and decompressed. Fractioned radiotherapy does not effectively treat trigeminal neuralgia secondary to vestibular schwannoma compression. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21112

scholarly journals Combined hyperactive dysfunctional cranial nerve syndrome: trigeminal neuralgia, facial hemispasm, and glossopharyngeal neuralgia

1999 ◽  
Vol XXXI (1-4) ◽  
pp. 94-94
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Glossopharyngeal Neuralgia ◽  
Vascular Compression ◽  
Pathological Conditions

Pathological conditions resulting from vascular compression of the input or output zone of the cranial nerves cause the so-called hyperactive dysfunctional cranial nerve syndrome (HDS).

scholarly journals Neuralgies of the lower cranial nerves: Microsurgical posterior fossa exploration

2004 ◽  
Vol 51 (4) ◽  
pp. 39-43 ◽  
Author(s):  
Branislav Antic ◽  
Predrag Peric ◽  
S. Ivanovic ◽  
M. Spaic
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Facial Nerve ◽  
Posterior Fossa ◽  
Trigeminal Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cranial Nerves ◽  
Relief Rate ◽  
Lower Cranial Nerves

Neuralgias of the lower cranial nerves are trigeminal neuralgia (TN), glossopharingeal neuralgia (GphN), and geniculate neuralgia (GN). Microsurgical posterior fossa exploration with its variations microvascular decompression (MVD), partial sensory rhisotomy (PSR), and total sensory rhisotomy (TSR) is one of the most efficient ways of treating these neuralgias. It was performed 130 operations in 125 patients with TN, 3 in GphN patients, 1 in GN patient, 1 in GN/TN patients, 1 in GphN/GN patient, and 2 in GN/hemifacial spasm patients. Of total of 125 patients with TN, MVD was performed in 63, PSR in 18, and MVD+PSR in 44 cases. In 5 patients with recidivate TN PSR was performed. Of total 3 patients with GphN MVD was performed in 2 cases, and extirpation of a small meningeoma in 1 case (it was not seen on CT). In the patients with GN TSR of intermediate nerve was performed, in GN/TN patients TSR of intermediate nerve and PSR of trigeminal nerve was performed, in the GN/GphN patients MVD of glossopharingeal and TSR of intermediate nerve were performed, and in the GN/hemifacial spasm patients TSR of intermediate and MVD of facial nerve were performed. The results of TN patients are: excellent in 82,4%, good in 12%, and poor in 5,6% of patients. There is no difference in complete pain relief, rate of recurrence, and complications between MVD, MVD+PSR and PSR operative groups (p>0,05). Among patients with other neuralgias the following results are noted: excellent in 4, good in 3, and poor in 1 patient. Microsurgical posterior fossa exploration is the method of choice in the treatment of the neuralgias of the lower cranial nerves.

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