Arteriovenous Micromalformation of the Trigeminal Root: Intraoperative Diagnosis With Indocyanine Green Videoangiography: Case Report

2010 ◽  
Vol 67 (3) ◽  
pp. onsE309-onsE310 ◽  
Author(s):  
Paolo Ferroli ◽  
Francesco Acerbi ◽  
Morgan Broggi ◽  
Giovanni Broggi
Keyword(s):  
Trigeminal Neuralgia ◽  
Indocyanine Green ◽  
Microvascular Decompression ◽  
Single Case ◽  
Preoperative Evaluation ◽  
Vascular Compression ◽  
Contrast Administration ◽  
Intraoperative Diagnosis ◽  
Petrosal Vein ◽  
Trigeminal Root

Abstract BACKGROUND AND IMPORTANCE: To report on a single case of arteriovenous micromalformation (micro-AVM) of the trigeminal root that was diagnosed during microvascular decompression for trigeminal neuralgia with the use of indocyanine green (ICG) videoangiography. CLINICAL PRESENTATION: A 52-year-old woman with drug-resistant trigeminal neuralgia underwent a key hole suboccipital cerebellopontine angle exploration after the usual magnetic resonance imaging (MRI) screening had raised the suspicion of a vascular compression. In surgery, the petrosal vein was found to be bigger than usual and arterialized; the trigeminal root was embedded in a tangle of abnormal arterialized vessels. Intraoperative ICG videoangiography showed that the direction of flow in the arterialized petrosal vein was anterograde, thus allowing for the differential diagnosis between micro-AVM and tentorial dural fistula. It was possible to achieve only a partial nerve decompression because of the intimate relationship between the trigeminal root and the pathological vessels. Postoperative angiography and MRI with contrast administration confirmed the intraoperative diagnosis of micro-AVM. The patient was discharged neurologically intact on postoperative day 4. One month after surgery, she remains pain-free despite a 50% reduction in antiepileptic drugs. CONCLUSION: Surgeons performing microvascular decompression should be aware that a diagnosis of vascular compression based on MRI without contrast administration could not exclude the presence of a pontine micro-AVM. ICG videoangiography provides an elegant means of showing the flow dynamics of these pathological vessels. An MRI protocol that is suitable to avoid this kind of intraoperative drawback should be defined and systematically used in the preoperative evaluation of all such surgical candidates.

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.

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.

Mechanism of trigeminal neuralgia: an ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery

2002 ◽  
Vol 96 (3) ◽  
pp. 532-543 ◽  
Author(s):  
Marshall Devor ◽  
Ruth Govrin-Lippmann ◽  
Z. Harry Rappaport
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Negative Symptoms ◽  
Ultrastructural Level ◽  
Nerve Fibers ◽  
Decompression Surgery ◽  
Content Type ◽  
Trigeminal Root ◽  
Microvascular Decompression Surgery ◽  
Fine Print

Object. Recent progress in the understanding of abnormal electrical behavior in injured sensory neurons motivated an examination, at the ultrastructural level, of trigeminal roots of patients with trigeminal neuralgia (TN). Methods. In 12 patients biopsy specimens of trigeminal root were obtained during surgery for microvascular decompression. Pathological changes in tissue included axonopathy and axonal loss, demyelination, a range of less severe myelin abnormalities (dysmyelination), residual myelin debris, and the presence of excess collagen, including condensed collagen masses in two cases. Within zones of demyelination, groups of axons were often closely apposed without an intervening glial process. Pathological characteristics of nerve fibers were clearly graded with the degrees of root compression noted at operation. Pain also occurred, however, in some patients who did not appear to have a severe compressive injury. Conclusions. Findings were consistent with the ignition hypothesis of TN. This model can be used to explain the major positive and negative symptoms of TN by axonopathy-induced changes in the electrical excitability of afferent axons in the trigeminal root and of neuronal somata in the trigeminal ganglion. The key pathophysiological changes include ectopic impulse discharge, spontaneous and triggered afterdischarge, and crossexcitation among neighboring afferents.

Preoperative evaluation of neurovascular relationships for microvascular decompression in the cerebellopontine angle in a virtual reality environment

2010 ◽  
Vol 113 (3) ◽  
pp. 479-485 ◽  
Author(s):  
Zhuo-Ying Du ◽  
Xiang Gao ◽  
Xiao-Luo Zhang ◽  
Zhi-Qiu Wang ◽  
Wei-Jun Tang
Keyword(s):  
Virtual Reality ◽  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cerebellopontine Angle ◽  
Surgical Simulation ◽  
Preoperative Evaluation ◽  
Spatial Understanding ◽  
Idiopathic Trigeminal Neuralgia ◽  
And Training

Object In this paper the authors' goal was to evaluate the feasibility and efficacy of a virtual reality (VR) system in preoperative planning for microvascular decompression (MVD) procedures treating idiopathic trigeminal neuralgia and hemifacial spasm. The system's role in surgical simulation and training was also assessed. Methods Between May 2008 and April 2009, the authors used the Dextroscope system to visualize the neurovascular complex and simulate MVD in the cerebellopontine angle in a VR environment in 16 patients (6 patients had trigeminal neuralgia and 10 had hemifacial spasm). Reconstructions were carried out 2–3 days before MVD. Images were printed in a red-blue stereoscopic format for teaching and discussion and were brought into the operating room to be compared with real-time intraoperative findings. Results The VR environment was a powerful aid for spatial understanding of the neurovascular relationship in MVD for operating surgeons and trainees. Through an initial series of comparison/confirmation experiences, the senior neurosurgeon became accustomed to the system. He could predict intraoperative problems and simulate surgical maneuvering, which increased his confidence in performing the procedure. Conclusions The Dextroscope system is an easy and rapid method to create a stereoscopic neurovascular model for MVD that is highly concordant with intraoperative findings. It effectively shortens the learning curve and adds to the surgeon's confidence.

scholarly journals MICROVASCULAR DECOMPRESSION IN THE TREATMENT OF PATIENTS WITH TRIGEMINAL NEURALGIA

2019 ◽  
Vol 19 (1-2) ◽  
pp. 101-106
Author(s):  
D. M Lazarchuk ◽  
G. N Alekseev ◽  
O. O Kamadey ◽  
S. N Chemidronov
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Nerve Root ◽  
Treatment Method ◽  
Neurovascular Conflict ◽  
Neurosurgical Department ◽  
Trigeminal Nerve Root ◽  
Trigeminal Root ◽  
Cranial Fossa

This work highlights the main variant treatment of patients with trigeminal neuralgia, with a proven neurovascular conflict, microvascular decompression of the trigeminal root. Microvascular decompression is the main radical treatment method which allows to relieve hyperfunctional syndrome manifested by prosopalgia. In the course of this study, the variant anatomy of the neurovascular conflict in patients with trigeminal neuralgia was described in detail. The group of patients whose clinical diagnosis at the stage of selection was based on a neurological examination and taking into account the progression of symptoms as well as the performed instrumental examination (CT angiography). The results are described in the article. Atrophic changes of the root of the trigeminal nerve are visualized and described. The nature of its blood supply is classified according to the type of the origin of the artery or arterial branches of the trigeminal nerve root. The main types of neurovascular conflict classified according to the type of blood vessel are presented. Variant neuroanatomy of the trigeminal nerve root as well as the interaction with the arteries of the vertebrobasilar basin and the veins of the posterior cranial fossa are described. The course of microvascular decompression of the trigeminal nerve root, used in the neurosurgical department of Samara Regional Clinical Hospital n.a. V.D. Seredavin is described

scholarly journals Historical aspects of the problem of treatment of trigeminal neuralgia and the role of neurosurgical methods in its solution (literature review)

2021 ◽  
Vol 6 (4) ◽  
pp. 123-136
Author(s):  
A. N. Zhurkin ◽  
A. V. Semenov ◽  
V. A. Sorokovikov ◽  
N. V. Bartul
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Surgical Techniques ◽  
Pain Syndrome ◽  
World Health ◽  
Vascular Compression ◽  
Neurogenic Pain ◽  
Surgical Methods ◽  
The Face

The trigeminal nerve is a mixed fifth cranial nerve, consisting of motor and sensory components. The sensitive component receives somesthetic information from the skin and mucous membranes of the face into the central nervous system, and the motor component is responsible for the innervation of chewing muscles. One of the manifestations of the pathology of the trigeminal nerve is pain syndrome. Trigeminal neuralgia occupies the main place among neurogenic pain syndrome in the face, is characterized by а severe course and the absence of sufficiently effective methods of treatment. According to the World Health Organization (WHO), the prevalence of trigeminal neuralgia in different countries is 2–5 cases per 100 thousand people per year. Trigeminal neuralgia is classified into 3 etiologic categories. Idiopathic trigeminal neuralgia occurs without apparent cause. Classical trigeminal neuralgia is caused by vascular compression of the trigeminal nerve root. Secondary trigeminal neuralgia is the consequence of a major neurologic disease, e. g., a tumor of the cеrеbеllоpоntine angle or multiple sclerosis. Today, there are many different options for the surgical treatment of trigeminal neuralgia. microvascular decompression of the root, radiosurgical destruction of the Gasser’s node, radiofrequency destruction, glycerol rhizotomy, balloon microcompression are considered the main effective and proven surgical methods for treating trigeminal neuralgia. But the questions of diagnosing the cause of the disease and choosing an adequate surgical method for treating therapeutically resistant trigeminal neuralgia for a particular patient remain open. The development of surgical methods begins from ancient times to the present day. The main stages in the development of neurosurgical treatment methods are presented. The following surgical techniques are described: open method – microvascular decompression, and closed percutaneous destructive methods – radiofrequency destruction, glycerol rhizotomy, balloon compression, radiosurgery, cryodestruction, laser destruction, botulinum toxin injections.

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