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.

Comparison of Clinical Symptoms and Magnetic Resonance Angiographic (MRA) Results in Patients with Trigeminal Neuralgia and Persistent Idiopathic Facial Pain. Medium-Term Outcome after Microvascular Decompression of Cases with Positive MRA Findings

Cephalalgia ◽  
2006 ◽  
Vol 26 (3) ◽  
pp. 266-276 ◽  
Author(s):  
A Kuncz ◽  
E Vörös ◽  
P Barzó ◽  
J Tajti ◽  
P Milassin ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Facial Pain ◽  
Clinical Symptoms ◽  
Vascular Compression ◽  
Term Outcome ◽  
Persistent Idiopathic Facial Pain ◽  
Venous Compression ◽  
Imaging Results

To evaluate whether NC could be demonstrated preoperatively, high-resolution magnetic resonance angiography (MRA) was performed in 287 consecutive patients with TN and persistent idiopathic facial pain (PIFP) on a 0.5-T and a 1-T MR unit. Depending on the clinical symptoms, the TN cases were divided into typical TN and trigeminal neuralgia with non-neuralgic interparoxysmal pain (TNWIP) groups. Microvascular decompression (MVD) was performed in 103 of the MRA-positive cases. The patients were followed up postoperatively for from 1 to 10 years. The clinical symptoms were compared with the imaging results. The value of MRA was assessed on the basis of the clinical symptoms and surgical findings. The outcome of MVD was graded as excellent, good or poor. The clinical symptoms were compared with the type of vascular compression and the outcome of MVD. The MRA image was positive in 161 (56%) of the 287 cases. There were significant differences between the clinical groups: 66.5% of the typical TN group, 47.5% of the TNWIP group and 3.4% of the PIFP group were positive. The quality of the MR unit significantly determined the ratio of positive/negative MRA results. The surgical findings corresponded with the MRA images. Six patients from the MRA-negative group were operated on for selective rhizotomy and no NC was found. Venous compression of the trigeminal nerve was observed in a significantly higher proportion in the background of TNWIP than in that of typical TN on MRA imaging (24.1% and 0.8%, respectively) and also during MVD (31.2% and 1.2%, respectively). Four years following the MVD, 69% of the patients gave an excellent, 23% a good and 8% a poor result. The rate of some kind of recurrence of pain was 20% in the typical TN and 44% in TNWIP group. The rate of recurrence was 57% when pure venous compression was present. The only patient who was operated on from the PIFP group did not react to the MVD. The clinical symptoms and preoperative MRA performed by at least a 1-T MR unit furnish considerable information, which can play a role in the planning of the treatment of TN.

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.

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 Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

2018 ◽  
Vol 45 (1) ◽  
pp. E2 ◽  
Author(s):  
Hiroki Toda ◽  
Koichi Iwasaki ◽  
Naoya Yoshimoto ◽  
Yoshihito Miki ◽  
Hirokuni Hashikata ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Decompression Surgery ◽  
Vascular Compression ◽  
Petrosal Vein ◽  
Venous Compression ◽  
Bridging Veins ◽  
Superior Petrosal Vein ◽  
Microvascular Decompression Surgery

OBJECTIVEIn microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm, the bridging veins are dissected to provide the surgical corridors, and the veins of the brainstem may be mobilized in cases of venous compression. Strategy and technique in dissecting these veins may affect the surgical outcome. The authors investigated solutions for minimizing venous complications and reviewed the outcome for venous decompression.METHODSThe authors retrospectively reviewed their surgical series of microvascular decompression for trigeminal neuralgia and hemifacial spasm in patients treated between 2005 and 2017. Surgical strategies included preservation of the superior petrosal vein and its tributaries, thorough dissection of the arachnoid sleeve that enveloped these veins, cutting of the inferior petrosal vein over the lower cranial nerves, and mobilization or cutting of the veins of the brainstem that compressed the nerve roots. The authors summarized the patient characteristics, operative findings, and postoperative outcomes according to the vascular compression types as follows: artery alone, artery and vein, and vein alone. They analyzed the data using chi-square and 1-way ANOVA tests.RESULTSThe cohort was composed of 121 patients with trigeminal neuralgia and 205 patients with hemifacial spasm. The superior petrosal vein and its tributaries were preserved with no serious complications in all patients with trigeminal neuralgia. Venous compression alone and arterial and venous compressions were observed in 4% and 22%, respectively, of the patients with trigeminal neuralgia, and in 1% and 2%, respectively, of those with hemifacial spasm (p < 0.0001). In patients with trigeminal neuralgia, 35% of those with artery and venous compressions and 80% of those with venous compression alone had atypical neuralgia (p = 0.015). The surgical cure and recurrence rates of trigeminal neuralgias with venous compression were 60% and 20%, respectively, and with arterial and venous compressions the rates were 92% and 12%, respectively (p < 0.0001, p = 0.04). In patients with hemifacial spasm who had arterial and venous compressions, their recurrence rate was 60%, and that was significantly higher compared to other compression types (p = 0.0008).CONCLUSIONSDissection of the arachnoid sleeve that envelops the superior petrosal vein may help to reduce venous complications in surgery for trigeminal neuralgia. Venous compression may correlate with worse prognosis even with thorough decompression, in both trigeminal neuralgia and hemifacial spasm.

scholarly journals Neurovascular Decompression for Trigeminal Neuralgia in 17-year-old Girl

2018 ◽  
Vol 24 (4) ◽  
pp. 349-352
Author(s):  
Gustavo Simiano Jung ◽  
Leonardo Gilmone Ruschell ◽  
Luis Fernando Moura Da Silva Junior ◽  
Erasmo Barros Da Silva Jr. ◽  
Jerônimo Buzetti Milano ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Complete Resolution ◽  
Pediatric Patients ◽  
The Elderly ◽  
Vascular Compression ◽  
Venous Compression ◽  
Neurovascular Decompression

Trigeminal neuralgia in general is a disease of the elderly. Rarely, the disease presents during childhood. Therefore we sought to explore the role of vascular compression in pediatric patients with medically refractory trigeminal neuralgia. A case of venous compression related to trigeminal neuralgia is presented in a 17-year-old girl. Upper petrous vein was found to be related to aneurovascular conflict with unusual response to neurovascular decompression with complete resolution of symptoms in postoperativeperiod. 

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).

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