Preoperative MRI characteristics and short-term postoperative outcomes of microvascular decompression in trigeminal neuralgia with no vascular compression

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.

Download Full-text

Endoscopic-Assisted Microvascular Decompression

Effective Techniques for Managing Trigeminal Neuralgia - Advances in Medical Diagnosis, Treatment, and Care ◽

10.4018/978-1-5225-5349-6.ch007 ◽

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.

Download Full-text

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

Operative Neurosurgery ◽

10.1227/01.neu.0000381769.15291.4c ◽

2010 ◽

Vol 67 (3) ◽

pp. onsE309-onsE310 ◽

Cited By ~ 8

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.

Download Full-text

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

Acta biomedica scientifica ◽

10.29413/abs.2021-6.4.11 ◽

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.

Download Full-text

Microvascular decompression for trigeminal neuralgia caused by vertebrobasilar compression

Journal of Neurosurgery ◽

10.3171/jns.1994.81.1.0001 ◽

1994 ◽

Vol 81 (1) ◽

pp. 1-9 ◽

Cited By ~ 75

Author(s):

Mark E. Linskey ◽

Hae Dong Jho ◽

Peter J. Jannetta

Keyword(s):

Hearing Loss ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Microvascular Decompression ◽

Sensory Loss ◽

Vascular Compression ◽

Content Type ◽

Root Section ◽

Vascular Decompression ◽

Fine Print

✓ Thirty-one (2%) of 1404 consecutive patients with typical trigeminal neuralgia who underwent microvascular decompression between 1972 and 1993 were found to have vascular compression by the vertebral artery (VA) or the basilar artery (BA). Compared to the remaining 1373 patients, this subgroup was older (mean age 62 vs. 55 years, p < 0.001), was predominantly male (68% vs. 39%, p < 0.002), demonstrated left-sided predominance (65% vs. 39%, p < 0.002), was more likely to be hypertensive (65% vs. 18%, p < 0.001), and was more likely to have ipsilateral hemifacial spasm (16% vs. 0.6%, p < 0.001). The trigeminal nerve was compressed by the VA in 18 cases (the VA alone in three and the VA plus other vessels in 15), the BA in 12 cases (the BA alone in four and the BA plus other vessels in eight), and the vertebrobasilar junction in one case. Twenty-nine of the 31 patients underwent vascular decompression of the trigeminal nerve, one had a complete trigeminal root section, and one underwent partial root section with vascular decompression of the remaining nerve. All 31 patients were pain-free, off medication immediately after surgery, and this pain-free, medication-free status was maintained at 1 year after surgery in 96% of cases, at 3 years in 92%, and at 10 years in 86%, based on life-table analysis. Minor trigeminal hypesthesia/hypalgesia was present preoperatively in 52%. New or worsened minor hypesthesia/hypalgesia developed in 41% of patients, while transient diplopia as well as hearing loss developed in 23% and 13% in the overall series, respectively. No patient developed major trigeminal sensory loss or masseter weakness after vascular decompression alone. There was no operative mortality. Vascular decompression is an effective treatment for patients with trigeminal neuralgia who have vertebrobasilar compression of the trigeminal nerve. Patients should be warned that decompression of a tortuous vertebrobasilar system carries a higher risk of mild trigeminal dysfunction, diplopia, and hearing loss than standard microvascular decompression.

Download Full-text

219 A Clinical Analysis on Microvascular Decompression Surgery for Treatment of Hemifacial Spasm: 2500 Cases Review in a Single Institute

Neurosurgery ◽

10.1093/neuros/nyx417.219 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 259-260

Author(s):

Myeongki Yeo ◽

Bong Jin Park ◽

Hridayesh Pratap Malla ◽

Bong Arm Rhee ◽

Young Jin Lim

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Clinical Analysis ◽

Postoperative Outcomes ◽

Cerebrospinal Fluid Leakage ◽

Subdural Hemorrhage ◽

Decompression Surgery ◽

Vascular Compression ◽

Root Exit Zone ◽

Microvascular Decompression Surgery

Abstract INTRODUCTION Hemifacial spasm (HFS) is caused by vascular compression of the facial nerve at its root exit zone from the brainstem. Microvascular decompression (MVD) is the only treatment option that offers the prospect of a definitive cure for HFS. However, this surgery can be risky and the postoperative outcomes might not be good enough sometimes. In order to refine that, we investigated our result of MVDs. METHODS Among 2500 consecutive cases of MVDs have been performed in our institute between January 2000 and December 2015, 2196 patients were enrolled in the current study. They were retrospectively analyzed with emphasis on postoperative outcomes and complications. RESULTS >Postoperatively, the spasm complete cease occurred immediately in 73.4%. The symptoms improved at some degree in 22.7%. The spasm not improved at all in 3.9%. However, the symptom free rate was 88.3% at 6 months after surgery. Eventually, the successful rate was increased by 93.1% at 1 year after MVD. Major complications included permanent hearing disturbance (1.13%), permanent facial palsy (0.4%), vertebral artery injury (0.2%), subdural hemorrhage (0.2%), and epidural hemorrhage (0.1%). Minor complications included transient cerebrospinal fluid leakage (1.3%), infection (0.6%). CONCLUSION MVD is a safe and effective treatment for HFS. A precise recognition of the neurovascular conflict site lead to a successful MVD.

Download Full-text

Partial sensory trigeminal rhizotomy at the pons for trigeminal neuralgia

Journal of Neurosurgery ◽

10.3171/jns.1993.79.5.0680 ◽

1993 ◽

Vol 79 (5) ◽

pp. 680-687 ◽

Cited By ~ 42

Author(s):

Jacob N. Young ◽

Robert H. Wilkins

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Microvascular Decompression ◽

Vascular Compression ◽

Neurovascular Compression ◽

Recurrent Pain ◽

Preoperative Pain ◽

Content Type ◽

Additional Surgery

✓ Microvascular decompression is preferred among open procedures for the treatment of trigeminal neuralgia. However, in some cases the decompression cannot be performed, either because no significant vascular compression of the trigeminal nerve is found at surgery or because a patient's vascular anatomy makes it unsafe. Partial sensory rhizotomy is a commonly used alternative in these instances. The outcome after partial sensory rhizotomy was reviewed retrospectively in 83 patients with an average follow-up period of 72 months. Sixty-four (77%) of these patients had no evidence of vascular contact at operation. The remaining 19 patients (23%) had vascular structures in proximity to the trigeminal nerve but still underwent partial sensory rhizotomy in place of or in addition to microvascular decompression either because the offending vessel could not be moved adequately (11 cases) or because the vascular contact was considered insignificant (eight cases). Outcome was classified as: excellent if there was no trigeminal neuralgia postoperatively; good if pain persisted or recurred but was less severe than preoperatively; and poor if persistent or recurrent pain was equal to or greater than the preoperative pain in severity and was refractory to medication, or was severe enough to require additional surgery. The outcome was excellent in 40 patients (48%), good in 18 (22%), and poor in 25 (30%); follow-up durations were similar for the three outcome categories. The failure rate was 17% for the 1st year and averaged 2.6% each year thereafter. Two variables were predictive of a poor outcome: prior surgery and lack of preoperative involvement of the third trigeminal division. Major complications occurred in 4% of cases and minor complications in 11%. The authors conclude that partial sensory rhizotomy is a safe and effective alternative to microvascular decompression when neurovascular compression is not identified at operation or when microvascular decompression cannot be performed for technical reasons.

Download Full-text

Microvascular transposition using Teflon sling technique

Neurosurgical Focus: Video ◽

10.3171/2020.6.focvid2040 ◽

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

Download Full-text

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

Neurosurgical FOCUS ◽

10.3171/2018.4.focus18122 ◽

2018 ◽

Vol 45 (1) ◽

pp. E2 ◽

Cited By ~ 10

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.

Download Full-text

Image diagnosis of Trigeminal Neuralgia caused by Vascular Compression

Bangladesh Journal of Neurosurgery ◽

10.3329/bjns.v10i1.49155 ◽

2020 ◽

Vol 10 (1) ◽

pp. 3-8

Author(s):

Moududul Haque ◽

AKM Tarikul Islam ◽

Asifur Rahman ◽

Sudipta Kumar Mukharjee ◽

ATM Mosharef Hossain

Keyword(s):

Blood Vessel ◽

Trigeminal Neuralgia ◽

Blood Vessels ◽

Microvascular Decompression ◽

Facial Pain ◽

Brain Mri ◽

Specific Treatment ◽

Vascular Compression ◽

Mr Images ◽

Cerebellar Artery

Trigeminal Neuralgia (TGN) is a disease frequently encountered by the neurologists and neurosurgeons. The typical pain of TGN is lancinating in nature in one side of face along the distribution of Trigeminal nerve. Pain is sharp shooting and periodic in nature, aggravated by various factors, like eating, talking, laughing. A typical trigeminal neuralgia is caused by compression to the Root exit zone (REZ) by superior cerebellar artery (SCA), aberrant loop of Antero inferior cerebellar artery (AICA), dolichobasilar artery or a large sized vein. However facial pain mimicking TGN may occur by a tumor, plaque of Multiple sclerosis or may be idiopathic. So this is very important to know the cause of TGN/ facial pain for planning of specific treatment. Most of the patients remain pain free by medical management by using Carbamazepine, oxycarbazepine, Pregabalin, Gabapentin, Clonazepam etc. But medically refractory TGN can be treated by Microvascular decompression (MVD) with significantly satisfactory results if the cause is by vascular compression. However during MVD no significant blood vessels are seen and surgery become failed. Clinical examination and evaluation is very important, however to become confirmed about the pathogenesis needs imaging of brain. MRI of brain can differentiate any tumor or Plaque of MS. But conventional MRI images can not show us clearly the blood vessel causing TGN. Conventional MRA could show the blood vessels, which might be causing compression to REZ but does not confirm the fact. Constructive interference in steady state (CISS) MR images were evaluated in our 15 cases to find neurovascular relationship at the REZ. In 11 cases CISS images showed excellent visualization of fifth nerve and blood vessels causing compression to REZ in all case of TGN who underwent Microvascular decompression (MVD) with excellent result. In 2 patients we depended on clinical findings and T2 MR Images. In one of them we could find Offending vessels who were also improved clinically. In one case we did not find any significant offending vessel except a small vein and this patient did not show any improvement. In rest two cases, in one patient CISS showed a tiny vessel and after MVD the patient did not improve. In one patient no significant vessels were not seen in CISS images. We did not go for MVD for this case. So the pre-operative CISS MR images are more precise to show the neurovascular relationship and determine the offending blood vessel causing TGN. Thus we can avoid an unnecessary MVD. Bang. J Neurosurgery 2020; 10(1): 3-8

Download Full-text