scholarly journals The role of neurovascular conflict in the pathogenesis of classical trigeminal neuralgia and the dynamics of approaches to its visualization

2021 ◽  
Vol 2 (1) ◽  
pp. 24-31
Author(s):  
E. V. Baliazina ◽  
O. M. Evusyak ◽  
V. A. Baliazin ◽  
N. G. Kadyan
Keyword(s):  
Trigeminal Neuralgia ◽  
Superior Cerebellar Artery ◽  
Neurovascular Conflict ◽  
Classical Trigeminal Neuralgia ◽  
Cerebellar Artery ◽  
X Ray Computed ◽  
Thematic Review ◽  
Points Of View ◽  
Diagnostic Capabilities

The thematic review discusses various points of view on the topographic and atomic features of the location of the root of the trigeminal nerve and the superior cerebellar artery that serve as the foundation for the development of classical trigeminal neuralgia. The diagnostic capabilities of magnetic resonance imaging in the recognition of neurovascular conflict as the pathogenetic basis of the disease are considered. The search for diagnostic criteria that distinguish neurovascular conflict from neurovascular contact by improving both the performance of MRI and the new technical possibilities of its interpretation is highlighted in the chronological aspect. The possibilities of multispiral X-ray computed angiography in 3D mode as an alternative method for diagnosing neurovascular conflict are described.

Diagnosis of classic trigeminal neuralgy

2010 ◽  
Vol 9 (4) ◽  
pp. 94-99
Author(s):  
Ye. V. Balyazina
Keyword(s):  
Trigeminal Neuralgia ◽  
Ct Angiography ◽  
Spiral Ct ◽  
Superior Cerebellar Artery ◽  
Neurovascular Conflict ◽  
Pathogenic Role ◽  
Classical Trigeminal Neuralgia ◽  
Cerebellar Artery ◽  
Spiral Ct Angiography

Spiral CT angiography was used for identify position the top of the loop of the superior cerebellar artery (SCA) in 23 patients classical trigeminal neuralgia (TN). The author describes the defining point, expressed as the position of the loop of the SCA in relation to the root of the trigeminal nerve (RTN) projection. In all 23 observed cases of patients with classical TN the apex of the loop of SCA was located lower of the RTN projection, which confirmed pathogenic role of neurovascular conflict in TN.

scholarly journals Microvascular Decompression by Interposition Method for Treatment of Trigeminal Neuralgia Due to Vertebrobasilar Dolichoectasia: A Retrospective Single-Center Study

2021 ◽  
Author(s):  
Feng Yu ◽  
Jia Yin ◽  
Pei-gang Lu ◽  
Zhen-yu Zhao ◽  
Yong-qiang Zhang ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Long Term Results ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Symptom Duration ◽  
Free Survival ◽  
Kaplan Meier ◽  
Vertebrobasilar Dolichoectasia ◽  
Cerebellar Artery

Abstract Trigeminal neuralgia (TN) due to vertebrobasilar dolichoectasia (VBD) is a rare disease that can be challenging to treat. The objectives of this study are to investigate the characteristics of patients with TN due to VBD and to analyze the efficacy of microvascular decompression (MVD) by the interposition method for treatment of the condition. From 2010 till 2020, the data of 30 patients with TN due to VBD who were treated with MVD by the interposition method were analyzed retrospectively. The characteristics of the patients were compared with those of patients with non-VBD TN (n = 815). Kaplan–Meier survival analysis was performed to determine pain-free survival. The 30 patients (21 males, 9 females; mean age, 63.03 years) accounted for 3.55% of all patients with TN during the study period. In 30 patients, the offending vessel was the basilar artery (BA) in 1 patient, the vertebral artery (VA) in 6 patients, the VA plus the superior cerebellar artery (SCA) in 6 patients, the VA plus the anterior inferior cerebellar artery (AICA) in 12 patients, and the VA+SCA+AICA in 5 patients. Compared to non-VBD TN patients, those with TN due to VBD were significantly more likely to be male, to have TN of the left side, and to have hypertension (all P < 0.001). Mean age at surgery (P = 0.057) and symptom duration (P = 0.308) were comparable between the two groups. All 30 patients had immediate relief of facial pain after MVD and could stop medication. There were no postoperative complications. Over mean follow-up of 76.67 months, 3 patients had recurrence. The mean duration of pain-free survival was 70.77 months. In conclusions, TN due to VBD appears to be more likely in males, in those with hypertension, and to involve the left side. The interposition method performed by experienced and skilled neurosurgeons is a safe and effective treatment for TN due to VBD. Further studies are needed to analyze the associated long-term results and the pain recurrence rate among this special population.

scholarly journals Microvascular Decompression for Trigeminal Neuralgia: Our Experiences at Bir Hospital

2017 ◽  
Vol 14 (2) ◽  
pp. 3-7
Author(s):  
Gopal R Sharma ◽  
Rajiv Jha ◽  
Prakash Poudel ◽  
Dhrub R Adhikari ◽  
Prakash Bista
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Treatment Options ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Recurrent Pain ◽  
Cerebellar Artery

Trigeminal neuralgia (TGN) is a very peculiar disease, mostly characterized by unilateral paroxysmal facial pain, often described by patient as ‘one of the worst pain in my life’. This condition is also known as ‘Tic Douloureus’. The annual incidence of TN is about 4.7/100000 population, male and female are equally affected. The diagnosis is usually made by history, clinical fi ndings and cranial imaging is required to rule out compressing vascular loop, organic lesions and Multiple Sclerosis (MS) at Trigeminal nerve (TN). Treatment of TGN ranged from medical to surgical intervention. Between September 2007 and April 2015, 20 patients underwent micro vascular decompression (MVD) of TN for TGN who were refractory to medical treatment at department of Neurosurgery, Bir Hospital. All decompressions were performed using operating microscope. Follow up period ranged from 22 months to 8 years.There were 9 males and 11 females and age ranged from 30-70 years. The neuralgic pain was localized on right side in 13 patients and left on 7 patients. Pain distribution was on V3 (mandibular branch) dermatome in 11, V2( Maxillary branch ) in 4, V2-3 in 2 and V1- 2-3 in 3 patients respectively. On intraoperative fi ndings TN was compressed by superior cerebellar artery ( SCA ) in 8, tumors in 4, unidentifi ed vessels in 3, veins in 2, anterior inferior cerebellar artery ( AICA ) in 1 and no cause was found in 2 patients. 7 patients suffered postoperative complications which included hyposthesia in 3, pseudomeningocele in 3 and meningitis in 1. There was no mortality in this series. 20 patients felt pain relief immediately after procedure and 1 patients came after 3 years with recurrent pain requiring second surgery. In conclusion, MVD for TGN in younger patients who are refractory to medical treatment is one of the best treatment options which is safe and long term pain relief is achieved in majority of cases.Nepal Journal of Neuroscience, Vol. 14, No. 2,  2017 Page:11-15

Vascular Transposition of the Superior Cerebellar Artery Using a Fenestrated Clip and Fibrin Glue in Trigeminal Neuralgia: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (1) ◽  
pp. E50-E51 ◽  
Author(s):  
Karl R Abi-Aad ◽  
Evelyn Turcotte ◽  
Devi P Patra ◽  
Matthew E Welz ◽  
Tanmoy Maiti ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Fibrin Glue ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Superior Cerebellar Artery ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Trigeminal Nerve Root ◽  
Made In

Abstract This is the case of an 86-yr-old gentleman who presented with left facial pain exacerbated by eating, drinking, chewing, and shaving (distribution: V2, V3). The patient was diagnosed with trigeminal neuralgia and was refractory to medications. Imaging showed a superior cerebellar artery (SCA) loop adjacent to the trigeminal nerve root entry zone and a decision to perform a microvascular decompression of the fifth nerve was presented to the patient. After patient informed consent was obtained, a standard 3 cm × 3 cm retrosigmoid craniotomy was performed with the patient in a supine head turned position and in reverse Trendelenburg. The arachnoid bands tethering the SCA to the trigeminal nerve were sharply divided. A slit was then made in the tentorium and a 3 mm fenestrated clip was then used to secure the transposed SCA away from the trigeminal nerve. The SCA proximal to this was slightly patulous in its course so a small amount of a fibrin glue was also used to secure the more proximal SCA to the tentorium. The patient was symptom-free postoperatively and no longer required medical therapy. Additionally, imaging was consistent with adequate separation of the nerve from adjacent vessels.1-5

scholarly journals Revascularization of the upper posterior circulation with the anterior temporal artery: an anatomical feasibility study

2018 ◽  
Vol 129 (1) ◽  
pp. 121-127 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Michael T. Lawton ◽  
Dylan Griswold ◽  
Pooneh Mokhtari ◽  
Andre Payman ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Posterior Cerebral Artery ◽  
Temporal Artery ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Middle Temporal ◽  
Cerebellar Artery ◽  
Orbitozygomatic Approach ◽  
Basal Cisterns

OBJECTIVEIn various disease processes, including unclippable aneurysms, a bypass to the upper posterior circulation (UPC) including the superior cerebellar artery (SCA) and posterior cerebral artery (PCA) may be needed. Various revascularization options exist, but the role of intracranial (IC) donors has not been scrutinized. The objective of this study was to evaluate the anatomical feasibility of utilizing the anterior temporal artery (ATA) for revascularization of the UPC.METHODSATA-SCA and ATA-PCA bypasses were performed on 14 cadaver specimens. After performing an orbitozygomatic craniotomy and opening the basal cisterns, the ATA was divided at the M3-M4 junction and mobilized to the crural cistern to complete an end-to-side bypass to the SCA and PCA. The length of the recipient artery between the anastomosis and origin was measured.RESULTSSeventeen ATAs were found. Successful anastomosis was performed in 14 (82%) of the ATAs. The anastomosis point on the PCA was 14.2 mm from its origin on the basilar artery. The SCA anastomosis point was 10.1 mm from its origin. Three ATAs did not reach the UPC region due to a common opercular origin with the middle temporal artery. The ATA-SCA bypass was also applied to the management of an incompletely coiled SCA aneurysm.CONCLUSIONSThe ATA is a promising IC donor for UPC revascularization. The ATA is exposed en route to the proximal SCA and PCA through the pterional-orbitozygomatic approach. Also, the end-to-side anastomosis provides an efficient and straightforward bypass without the need to harvest a graft or perform multiple or difficult anastomoses.

The Microsurgical Anatomy of the Infratentorial Lateral Supracerebellar Approach to the Trigeminal Nerve for Tic Douloureux

Neurosurgery ◽  
1989 ◽  
Vol 24 (6) ◽  
pp. 890-895 ◽  
Author(s):  
Toshio Matsushima ◽  
Masashi Fukui ◽  
Satoshi Suzuki ◽  
Albert L. Rhoton
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Cerebellar Hemisphere ◽  
Superior Cerebellar Artery ◽  
Microsurgical Anatomy ◽  
Medial Side ◽  
Microsurgical Decompression ◽  
Cerebellar Artery ◽  
Relationship Of ◽  
Anatomical Information

ABSTRACT The increasing use of microsurgical decompression for trigeminal neuralgia has created a need for more detailed anatomical information about the approach. To define better this anatomy, 10 cerebellar specimens obtained at autopsy were examined, and intraoperative findings in 30 patients with trigeminal neuralgia were analyzed. Since the infratentorial subdural space on the tentorial cerebellar surface is exposed to explore the trigeminal nerve in the infratentorial lateral supracerebellar approach, attention was directed to the following: the anterolateral margin of the cerebellar hemisphere, bridging veins on the tentorial surface, superior petrosal veins, and relationships between blood vessels and the trigeminal nerve. The lateral mesencephalic segment of the superior cerebellar artery at or near the bifurcation often compressed the nerve laterally at more than one point. With this approach, the relationship of the superior cerebellar artery to the nerve could be observed from the medial side of the tentorial surface. The infratentorial lateral supracerebellar approach is discussed and compared to Dandy's cerebellar route.

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