Microvascular decompression as a treatment for cranial nerve hyperactive dysfunction ? a critical view

Object. Microvascular decompression has become an accepted surgical technique for the treatment of trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and other cranial nerve rhizopathies. The senior author (P.J.J.) began performing this procedure in 1969 and has performed more than 4400 operations. The purpose of this article is to review some of the nuances of the technical aspects of this procedure.Methods. A review of 4415 operations shows that numerous modifications to the technique of microvascular decompression have occurred during the last 29 years. Of the 2420 operations performed for trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia before 1990, cerebellar injury occurred in 21 cases (0.87%), hearing loss in 48 (1.98%), and cerebrospinal fluid (CSF) leakage in 59 cases (2.44%). Of the 1995 operations performed since 1990, cerebellar injuries declined to nine cases (0.45%), hearing loss to 16 (0.8%), and CSF leakage to 37 (1.85% p < 0.01, test for equality of distributions). The authors describe slight variations made to maximize surgical exposure and minimize potential complications in each of the six principal steps of this operation. These modifications have led to decreasing complication rates in recent years.Conclusions. Using the techniques described in this report, microvascular decompression is an extremely safe and effective treatment for many cranial nerve rhizopathies.

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Treatment of Trigeminal Neuralgia with “Microvascular Decompression Plus” Technique

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1710520 ◽

2020 ◽

Author(s):

Ming-Xing Liu ◽

Jun Zhong ◽

Lei Xia ◽

Ning-Ning Dou ◽

Juanhong Shi

Keyword(s):

Retrospective Study ◽

Trigeminal Neuralgia ◽

Effective Treatment ◽

Microvascular Decompression ◽

Cranial Nerve ◽

Surgical Procedure ◽

Postoperative Outcome ◽

High Rate ◽

Facial Numbness ◽

Over Time

Abstract Objectives Although microvascular decompression (MVD) has been widely accepted as an effective treatment of trigeminal neuralgia (TN), some patients have not been cured. To improve the postoperative outcome, the surgical procedure should be further refined. Design This is a retrospective study. Setting Present study conducted at a cranial nerve disorder center. Participants: Clinical data were collected from patients with TN who had undergone surgery in our center, including 685 who had undergone traditional MVD and 576 who had undergone the “MVD plus” procedure, in which any vessel attached to the trigeminal nerve was freed away (“nerve-combing”), which was followed by intraoperative neurolysis. Main Outcome Measures Postoperative outcomes and complications in the two groups were compared. Results Among patients who underwent traditional MVD, the rates of immediate relief and 1-year relief were 89.9 and 86.9%, respectively; among patients who underwent MVD plus group, these rates were 95.1 and 94.6%, respectively (p = 0.05). Patients who underwent MVD plus initially exhibited a higher rate of facial numbness (p < 0.05), but this finding decreased over time and reached the same level as that in the traditional MVD group within 3 months (p > 0.05). Conclusion Sufficient MVD with nerve-combing for the treatment of TN may produce a high rate of cure with less recurrence.

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Vertebral artery pexy for microvascular decompression of the facial nerve in the treatment of hemifacial spasm

Journal of Neurosurgery ◽

10.3171/2010.12.jns10891 ◽

2011 ◽

Vol 114 (6) ◽

pp. 1800-1804 ◽

Cited By ~ 20

Author(s):

Manuel Ferreira ◽

Brian P. Walcott ◽

Brian V. Nahed ◽

Laligam N. Sekhar

Keyword(s):

Facial Nerve ◽

Vertebral Artery ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Cranial Nerve ◽

Anterior Inferior Cerebellar Artery ◽

Careful Study ◽

Venous Compression ◽

Select Group ◽

Far Lateral Approach

Object Hemifacial spasm (HFS) is caused by arterial or venous compression of cranial nerve VII at its root exit zone. Traditionally, microvascular decompression of the facial nerve has been an effective treatment for posterior inferior and anterior inferior cerebellar artery as well as venous compression. The traditional technique involves Teflon felt or another construct to cushion the offending vessel from the facial nerve, or cautery and division of the offending vein. However, using this technique for severe vertebral artery (VA) compression can be ineffective and fraught with complications. The authors report the use of a new technique of VA pexy to the petrous or clival dura mater in patients with HFS attributed to a severely ectatic and tortuous VA, and detail the results in a series of patients. Methods Six patients with HFS due to VA compression underwent a retrosigmoid craniotomy, combined with a far-lateral approach in some patients. On identification of the site of VA compression, the vessel was mobilized adequately for the decompression. Great care was taken to avoid kinking the perforating vessels arising from the VA. Two 8-0 nylon sutures were passed through to the wall of the VA and then through the clival or petrous dura, and then tied to alleviate compression on cranial nerve VII. Results Patients were followed for at least 1 year postoperatively (mean 2.7 years, range 1–4 years). All 6 patients had complete resolution of their HFS. Facial function was tested postoperatively, and was stable when compared with the preoperative baseline. Two of the 3 patients with preoperative tinnitus had resolution of this symptom after the procedure. Postoperative imaging demonstrated VA decompression of the facial nerve and no evidence of stroke in all patients. One patient suffered from hearing loss, another developed a postoperative transient unilateral vocal cord paralysis, and a third patient developed a pseudomeningocele that resolved with the placement of a lumbar drain. Conclusions Hemifacial spasm and other neurovascular syndromes are effectively treated by repositioning the compressing artery. Careful study of the preoperative MR images may identify a select group of patients with HFS due to an ectatic VA. Rather than traditional decompression with only pledget placement, these patients may benefit from a VA pexy to provide an effective, safe, and durable resolution of their symptoms while minimizing surgical complications.

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Microvascular Decompression of the VII/VIII Cranial Nerve Complex for the Treatment of Intermediate Nerve Neuralgia: A Retrospective Case Series

Operative Neurosurgery ◽

10.1093/ons/opy056 ◽

2018 ◽

Vol 14 (5) ◽

pp. 600-600

Keyword(s):

Microvascular Decompression ◽

Cranial Nerve ◽

Case Series ◽

Retrospective Case ◽

Retrospective Case Series

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Microvascular decompression for elderly patients with trigeminal neuralgia: a prospective study and systematic review with meta-analysis

Journal of Neurosurgery ◽

10.3171/2010.6.jns10142 ◽

2011 ◽

Vol 114 (1) ◽

pp. 172-179 ◽

Cited By ~ 67

Author(s):

Raymond F. Sekula ◽

Andrew M. Frederickson ◽

Peter J. Jannetta ◽

Matthew R. Quigley ◽

Khaled M. Aziz ◽

...

Keyword(s):

Systematic Review ◽

Trigeminal Neuralgia ◽

Elderly Patients ◽

Prospective Study ◽

Microvascular Decompression ◽

Cranial Nerve ◽

Meta Analysis ◽

Complication Rates ◽

Significant Difference

Object Because the incidence of trigeminal neuralgia (TN) increases with age, neurosurgeons frequently encounter elderly patients with this disorder. Although microvascular decompression (MVD) is the only etiological therapy for TN with the highest initial efficacy and durability of all treatments, it is nonetheless associated with special risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the commonly performed ablative procedures. Thus, the safety of MVD in the elderly remains a concern. This prospective study and systematic review with meta-analysis was conducted to determine whether MVD is a safe and effective treatment in elderly patients with TN. Methods In this prospectively conducted analysis, 36 elderly patients (mean age 73.0 ± 5.9 years) and 53 nonelderly patients (mean age 52.9 ± 8.8 years) underwent MVD over the study period. Outcome and complication data were recorded. The authors also conducted a systematic review of the English literature published before December 2009 and providing outcomes and complications of MVD in patients with TN above the age of 60 years. Pooled complication rates of stroke, death, cerebellar hematoma, and permanent cranial nerve deficits were analyzed. Results Thirty-one elderly patients (86.1%) reported an excellent outcome after MVD (mean follow-up 20.0 ± 7.0 months). Twenty-five elderly patients with Type 1 TN were compared with 26 nonelderly patients with Type 1 TN, and no significant difference in outcomes was found (p = 0.046). Three elderly patients with Type 2a TN were compared with 12 nonelderly patients with Type 2a TN, and no significant difference in outcomes was noted (p = 1.0). Eight elderly patients with Type 2b TN were compared with 15 nonelderly patients with Type 2b TN, and no significant difference in outcomes was noted (p = 0.086). The median length of stay between cohorts was compared, and no significant difference was noted (2 days for each cohort, p = 0.33). There were no CSF leaks, no cerebellar hematomas, no strokes, and no deaths. Eight studies (1334 patients) met the inclusion criteria for the meta-analysis. For none of the complications was the incidence significantly more frequent in elderly patients than in the nonelderly. Conclusions Although patient selection remains important, the authors' experience and the results of this systematic review with meta-analysis suggest that the majority of elderly patients with TN can safely undergo MVD.

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