Trigeminal neuralgia and hemifacial spasm associated with vertebrobasilar artery tortuosity

2016 ◽  
Vol 80 (1) ◽  
pp. 44 ◽  
Author(s):  
Yu. A. Grigoryan ◽  
A. R. Sitnikov ◽  
G. Yu. Grigoryan
Keyword(s):  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Vertebrobasilar Artery

Microvascular Decompression in the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Ectasia

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 330-337 ◽  
Author(s):  
Nasser M.F. El-Ghandour
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Nerve Compression ◽  
Resonance Imaging ◽  
Duration Of Symptoms ◽  
Vertebrobasilar Artery ◽  
The Mean

Abstract BACKGROUND Vertebrobasilar ectasia (VBE) is a rare cause of trigeminal neuralgia (TN). It occurs in about 2% of all patients. OBJECTIVE This study reviewed the clinical features, radiological concomitants, and surgical findings of VBE and evaluate the microsurgical decompression procedure as a surgical line of treatment of the associated TN. METHODS Ten patients with TN caused by VBE and treated by microvascular decompression are the subject of this study. The study consisted of 6 men and 4 women with a mean age of 54 years. The mean duration of symptoms was 4.5 years. TN was the only symptom in 6 patients; it was associated with hemifacial spasm in 4. Arterial hypertension was present in 6 patients. Multiplanar high-resolution magnetic resonance imaging showed the accurate location and course of the ectatic vessel. Magnetic resonance angiography and digital subtraction angiography confirmed the diagnosis. Surgery demonstrated fifth nerve compression by an ectatic and tortuous vertebrobasilar artery in all cases and seventh nerve compression in 4 cases. Teflon felt was placed between the ectatic artery and compressed nerves. RESULTS There was complete resolution of TN in 8 patients (80%) and hemifacial spasm in 3 (75%) without medication. Four of 6 hypertensive patients (66.7%) achieved normotension without medication. There was no recurrence of symptoms in the mean follow-up period of 7.8 years. CONCLUSION Microvascular decompression is recommended for the treatment of TN caused by VBE if medical treatment has failed, if the patient is suitable for general anesthesia, and if there is evidence of vascular compression of the trigeminal nerve on magnetic resonance imaging.

Macrovascular Decompression of Facial Nerve With Anteromedial Transposition of a Dolichoectatic Vertebral Artery: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. E4-E4
Author(s):  
Halima Tabani ◽  
Sonia Yousef ◽  
Jan-Karl Burkhardt ◽  
Sirin Gandhi ◽  
Arnau Benet ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Cranial Nerve ◽  
Nerve Compression ◽  
Large Artery ◽  
Nerve Compression Syndromes ◽  
Vertebrobasilar Artery ◽  
Patient Consent ◽  
Compression Syndromes

Abstract Most cranial nerve compression syndromes (ie, trigeminal neuralgia and hemifacial spasm) are caused by small arteries impinging on a nerve and are relieved by microvascular decompression. Rarely, cranial nerve compression syndromes can be caused by large artery impingement and can be relieved by macrovascular decompression. When present, this compression often occurs in association with degenerative atherosclerosis in the vertebral arteries (VA) and basilar artery. Conservative treatment is recommended for mild forms, but surgical transposition of the VA away from the root entry zone (REZ) can be considered. This video demonstrates macrovascular decompression of a dolichoectatic VA in a 74-yr-old female with refractory left hemifacial spasm. After obtaining IRB approval, patient consent was sought for the procedure. With the patient in three-quarter-prone position, a far-lateral craniotomy was performed. The dentate ligament was cut to free the VA, and the suprahypoglossal portion of the vagoaccessory triangle was widened. VA compressed the REZ of the facial nerve, but was mobilized anteromedially off the REZ. A muslin sling was wrapped around the VA and its tail brought down to the clival dura, which was punctured with a 19-gauge needle and enlarged with a dissector. The sling was pulled anteromedially to this puncture site and secured to the dura with an aneurysm clip, relieving the REZ of all compression. The patient tolerated the procedure with mild, transient hoarseness and her hemifacial spasm resolved completely. This case demonstrates the macrovascular decompression technique with anteromedial transposition of the vertebrobasilar artery, which can also be used for trigeminal neuralgia.

Trigeminal neuralgia plus hemifacial spasm caused by a dilated artery: a case of painful tic convulsif syndrome

The Lancet ◽  
2019 ◽  
Vol 394 (10211) ◽  
pp. e36 ◽  
Author(s):  
Gabriel Crevier-Sorbo ◽  
Andrea Brock ◽  
John D Rolston
Keyword(s):  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Painful Tic Convulsif

Microvascular Compressicaude by Slinging a Tortuous Vertebrobasilar Artery to the Petrous Dura in Hemifacial Spasm: Technical Note

2018 ◽  
Vol 37 (04) ◽  
pp. 352-361
Author(s):  
Forhad Chowdhury ◽  
Mohammod Haque ◽  
Jalal Rumi ◽  
Monir Reza
Keyword(s):  
Vertebral Artery ◽  
Free Flap ◽  
Hemifacial Spasm ◽  
Technical Note ◽  
Taxi Driver ◽  
Treatment Technique ◽  
Entry Zone ◽  
Temporal Fascia ◽  
Vertebrobasilar Artery ◽  
The Brain

Objective In cases of hemifacial spasm caused by a tortuous vertebrobasilar artery (TVBA), the traditional treatment technique involves Teflon (polytetrafluoroethylene), which can be ineffective and fraught with recurrence and neurological complications. In such cases, there are various techniques of arteriopexy using adhesive compositions, ‘suspending loops’ made of synthetic materials, dural or fascial flaps, surgical sutures passed around or through the vascular adventitia, as well as fenestrated aneurysmal clips. In the present paper, we describe a new technique of slinging the vertebral artery (VA) to the petrous dura for microvascular decompression (MVD) in a patient with hemifacial spasm caused by a TVBA. Method A 50-year-old taxi driver presented with a left-sided severe hemifacial spasm. A magnetic resonance imaging (MRI) scan of the brain showed a large tortuous left-sided vertebral artery impinging and compressing the exit/entry zone of the 7th and 8th nerve complex. After a craniotomy, a TVBA was found impinging and compressing the entry zone of the 7th and 8th nerve complex. Arachnoid bands attaching the artery to the nerve complex and the pons were released by sharp microdissection. Through the upper part of the incision, a 2.5 × 1 cm temporal fascia free flap was harvested. After the fixation of the free flap, a 6–0 prolene suture was passed through its length several times using the traditional Bengali sewing and stitching techniques to make embroidered quilts called Nakshi katha. The ‘prolenated’ fascia was passed around the compressing portion of the VA. Both ends of the fascia were brought together and stitched to the posterior petrous dura to keep the TVBA away from the 7th and 8th nerves and the pons. Result The patient had no hemifacial spasm immediately after the recovery from the anesthesia. A postoperative MRI of the brain showed that the VA was away from the entry zone of the 7th and 8th nerves. Conclusion The ‘prolenated’ temporal fascia slinging technique may be a very good option of MVD in cases in which the causative vessel is a TVBA.

scholarly journals Microvascular Decompression for Patient With Coexistent of Trigeminal Neuralgia, Hemifacial Spasm and Glossopharyngeal Neuralgia- a Case Report

2021 ◽  
Author(s):  
Tao Sun ◽  
Wentao Wang ◽  
Longshuang He ◽  
Yu Su ◽  
Ning Li ◽  
...  
Keyword(s):  
Nervous System ◽  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Treatment Strategies ◽  
Glossopharyngeal Neuralgia ◽  
Case Presentation ◽  
Involuntary Contraction ◽  
History Of ◽  
Primary Trigeminal Neuralgia

Abstract Background: Primary trigeminal neuralgia (TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GN) are common diseases of nervous system, with similar pathogenesis and treatment strategies. Coexistent of such disease, especially coexistent of TN-HFS-GN simultaneously, is very rare. To date, only nine cases have been reported.Case Presentation: A 70-year-old male with a history of hypertension and diabetes complained of severe involuntary contraction for about 10 years, knife-like and lighting-like pain, which was restricted to the distribution of the second and third branches of trigeminal nerve and pharynx and root of tongue, for about 2 years. Coexistent of TN HFS and GN was diagnosed and MVD was carried out. After MVD, the patient completely free from symptoms and no recurrence and hypoesthesia were recorded in 18 months follow up.Conclusion: Here we report the tenth and oldest male patient with coexistent of TN-HFS-GN. Despite limited reports, MVD is the preferred choice for such diseases which can free patients from spasm and neuralgia.

TRIGEMINAL NEURALGIA—HEMIFACIAL SPASM—PAGET'S DISEASE

Brain ◽  
1966 ◽  
Vol 89 (3) ◽  
pp. 555-562 ◽  
Author(s):  
W. JAMES GARDNER ◽  
DONALD F. DOHN
Keyword(s):  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Paget’S Disease ◽  
Paget's Disease

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 P.022 Hemifacial Spasm due to dolichoectatic vertebrobasilar artery compression

2018 ◽  
Vol 45 (s2) ◽  
pp. S21-S21
Author(s):  
CM Honey ◽  
A Almojuela ◽  
M Hasen ◽  
AM Kaufmann
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Symptom Relief ◽  
Retrospective Chart Review ◽  
Senior Author ◽  
High Rate ◽  
Case Volume ◽  
Vertebrobasilar Artery ◽  
Final Followup

Background: Hemifacial Spasm (HFS) is rarely caused by a dolichoectatic vertebrobasilar artery (eVB) compression of the Facial Nerve. This can pose a surgical challenge when performing microvascular decompression as vessel mobilization is often difficult due to atherosclerosis, tethering from brainstem perforators, and large size. These patients are often not considered for surgery. Methods: A retrospective chart review of patients who were surgically treated by the senior author between 2003 and 2017 with an admitting diagnosis of HFS was performed. Patients with preoperative neuroimaging demonstrating eVB compression of their facial nerve/root were included. Results: During the 15-year review, 315 patients underwent microvascular decompression for HFS and 21 (6.7%) had dolichoectactic vertebrobasilar compressions. At final followup (>3 months) 19 patients (90.4%) experienced reduction in symptoms with 15 (71.4%) having complete resolution. One patient required re-operation and benefitted from subsequent symptom relief. The majority of culprit compression was found proximally on the pontine surface. Mobilization of the culprit vessel was achieved successfully in the majority of cases with Teflon pledgets. There were no perioperative strokes or death. Complications are presented Conclusions: Microvascular Decompression for Hemifacial Spasm caused by dolichoectatic vertebrobasilar artery compression can be performed with a high rate of safety and success in the setting of a high case volume centre.

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