Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia

2014 ◽  
Vol 121 (4) ◽  
pp. 936-939 ◽  
Author(s):  
Nicolaas A. Bakker ◽  
J. Marc C. Van Dijk ◽  
Steven Immenga ◽  
Michiel Wagemakers ◽  
Jan D. M. Metzemaekers
Keyword(s):  
Risk Factors ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Therapeutic Option ◽  
Significant Risk ◽  
Case Series ◽  
Binary Logistic Regression Analysis ◽  
Complication Rates ◽  
Idiopathic Trigeminal Neuralgia ◽  
Facial Numbness

Object Microvascular decompression (MVD) is considered the method of choice to treat idiopathic trigeminal neuralgia (TN) refractory to medical treatment. However, repeat MVD for recurrent TN is not well established. In this paper, the authors describe a large case series in which patients underwent repeat MVD for recurrent TN, focusing on outcome, risk factors, and complication rates. Methods Between 1990 and 2012, a total of 33 consecutive patients underwent repeat MVD for recurrent TN at the University Medical Center Groningen. The authors performed a retrospective chart review and telephone interviews. Risk factors were analyzed by binary logistic regression analysis. Results After 12 months of follow-up, 22 (67%) operations were successful, of which 19 patients were completely free of pain without medication. With multivariate analysis significant risk factors for success were older age (OR 1.11, p < 0.01) and direct absence of pain after repeat MVD (OR 25.2, p < 0.01). Previous neurodestructive procedures did not influence success rates. Facial numbness occurred in 9 patients (27%), while other morbidity was minimal. There was no mortality. Conclusions This study demonstrates that repeat MVD is a feasible therapeutic option with good chances of success, even in patients who have undergone neurodestructive procedures. Complication rates, particularly facial numbness, can be avoided if only a limited neurolysis is performed.

The Risk Factors for Facial Numbness After Microvascular Decompression in Patients With Trigeminal Neuralgia

2019 ◽  
Vol 30 (8) ◽  
pp. e710-e713 ◽  
Author(s):  
Wen-Bo Zhang ◽  
Qiu-Yang Sun ◽  
Ling-Zhao Min ◽  
Bang-Bao Tao ◽  
Xiao-Qiang Wang
Keyword(s):  
Risk Factors ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Facial Numbness

A Novel Technical Refinement of Microvascular Decompression: Pain Relief and Complication Rate in a Consecutive Series of Patients With Trigeminal Neuralgia

2020 ◽  
Vol 19 (3) ◽  
pp. 226-233 ◽  
Author(s):  
Francesco Tomasello ◽  
Antonino Germanò ◽  
Angelo Lavano ◽  
Alberto Romano ◽  
Daniele Cafarella ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Complication Rate ◽  
Csf Leak ◽  
Complication Rates ◽  
Patient Reported ◽  
Facial Numbness

Abstract BACKGROUND Microvascular decompression (MVD) represents a milestone for the treatment of trigeminal neuralgia (TN). Nevertheless, several complications still occur and may negatively affect the outcome. We recently proposed some technical nuances for complication avoidance related to MVD. OBJECTIVE To verify the efficacy of the proposed refinement of the standard MVD technique in terms of resolution of the pain and reduction of complication rates. METHODS We analyzed surgical and outcome data of patients with TN using a novel surgical refinement to MVD, over the last 4 yr. Outcome variables included pain relief, facial numbness, muscular atrophy, local cutaneous occipital and temporal pain or numbness, cerebellar injury, hearing loss, cranial nerve deficits, wound infection, and cerebrospinal fluid (CSF) leak. Overall complication rate was defined as the occurrence of any of the aforementioned items. RESULTS A total of 72 consecutive patients were enrolled in the study. Pain relief was achieved in 91.6% and 88.8% of patients at 1- and 4-yr follow-up, respectively. No patient reported postoperative facial numbness during the entire follow-up period. The incidence of CSF leak was 1.4%. One patient developed a complete hearing loss and another a minor cerebellar ischemia. There was no mortality. The overall complication rate was 5.6%, but only 1.4% of patients experienced permanent sequelae. CONCLUSION The proposed refinement of the standard MVD technique has proved effective in maintaining excellent results in terms of pain relief while minimizing the overall complication rate associated with this surgical approach.

Risk factors for post-polypectomy bleeding; a retrospective case-control study of a high-volume colonoscopy center

2021 ◽  
Author(s):  
Dimitrios Eleftheriadis ◽  
Christina Imalis ◽  
Guido Gerken ◽  
Heiner Wedemeyer ◽  
Jan Duerig
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Ileocecal Valve ◽  
Binary Logistic Regression ◽  
High Volume ◽  
Binary Logistic Regression Analysis ◽  
Care Hospital ◽  
Retrospective Case ◽  
Polyp Size ◽  
Epinephrine Injection

Abstract Background and aim Post-polypectomy bleeding (PPB) remains an uncommon although serious complication of colonoscopy. The aim of this study is to determine the PPB-prevalence in a secondary care hospital and its associated risk factors. Patients and methods We collected data from 581 patients, with the removal of 1593 polyps between August 2017 and August 2019. A univariate binary logistic regression analysis was conducted retrospectively. Results PPB occurred in only 10 cases, representing 1.7% of patients: immediate in 1.2% and delayed in 0.5%. The number of removed polyps per patient [4.5 (SD 2.59) for hemorrhagic vs. 2.74 (SD 1.98) for non-hemorrhagic group] and the propofol dose [232 mg (SD 93.07) for hemorrhagic vs. 133 mg (SD 57.28) for non-hemorrhagic group] were relevant patient-related risk factors. The polyp-based analysis showed the polyp size [18.4 mm (SD 10.44) for hemorrhagic vs. 4.42 mm (SD 4.29) for non-hemorrhagic group], the morphology [wide-based: OR 24.83 (95 % CI 2.76 – 223.44), pedunculated: OR 56.67 (95 % CI 5.03 – 638.29)], the location at ileocecal valve [OR 20.48, 95 % CI 1.81 – 231.97)], and the polypectomy method [hot snare piecemeal with epinephrine injection: OR 75.38 (95 % CI 7.67 – 741.21)] as significant risk factors for PPB, too. Conclusions The low rate of PPB confirms the safety of the procedure in non-tertiary, high-volume colonoscopy centers. The number of polyps removed per patient, the polyp size, morphology and location, as well as the sedation dose and the method of polypectomy were shown as relevant risk factors.

scholarly journals Comparison of Microvascular Decompression and Two Isocenters Gamma Knife for the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Dolichoectasia

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhen Zhao ◽  
SongShan Chai ◽  
JiaJing Wang ◽  
XiaoBing Jiang ◽  
ChuanSheng Nie ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Treatment Outcomes ◽  
Gamma Knife ◽  
Microvascular Decompression ◽  
Gamma Knife Radiosurgery ◽  
Therapeutic Effects ◽  
Imaging Data ◽  
Vertebrobasilar Dolichoectasia ◽  
Surgical Methods ◽  
Facial Numbness

Background: Vertebrobasilar dolichoectasia (VBD) is one of the rare causes of trigeminal neuralgia (TN). The common surgical treatments for patients with TN caused by VBD (VBD-TN) are microvascular decompression (MVD) and Gamma Knife radiosurgery (GKRS). However, the therapeutic effects of the two methods have not been clinically compared, so this study was performed to evaluate the treatment outcomes of MVD and GKRS for patients with VBD-TN.Methods: The retrospective study was performed from March 2011 to March 2019 in Wuhan Union Hospital. A total of 80 patients diagnosed with VBD-TN were included in this study, and they were divided into the MVD group (n = 46) and GKRS group (n = 34) according to the surgical methods. The imaging data, intraoperative findings, treatment outcomes, and complications of the two groups were analyzed and compared. Meanwhile, the influencing factors of the treatment effect are also explored on the two groups.Results: Patients who underwent MVD were younger than patients who underwent GKRS (median ages were 61.1 and 65.4 years old, respectively, p = 0.03). The median follow-up was 61.1 months for the MVD group and 56.8 months for the GKRS group. The favorable outcomes [Barrow Neurological Institute (BNI) pain score, BNI scores I–II] occurred in 97.8% of patients treated with MVD and in 78.9% of patients treated with GKRS (p = 0.009). The favorable outcomes in the percentage of patients after MVD 1, 3, 5, and 7 years were 95.7, 85.1, 74.2, and 74.2%, respectively, whereas the corresponding percentages after GKRS were 76.5, 66.2, 56.6, and 47.2%, respectively (p = 0.031). The postoperative complications (except facial numbness) in the MVD group were higher than those in the GKRS group (p = 0.036), but the incidence of new and worsening facial numbness was lower in the GKRS group (p &lt; 0.001).Conclusions: MVD is superior to GKRS in obtaining and maintaining favorable outcomes for patients with VBD-TN, but it also comes with more complications other than facial numbness. Thus, the treatment program can be tailored to a patient's unique condition and wishes.

scholarly journals Prognostic Nutritional Index Is a Better Predictor of Perioperative Adverse Outcomes in Patients With Femoral Fractures: a Retrospective Study

2021 ◽  
Author(s):  
Miao He ◽  
Qinghong Fan ◽  
Yuhang Zhu ◽  
Dexing Liu ◽  
Xingxing Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nutritional Assessment ◽  
Femoral Fractures ◽  
Prognostic Nutritional Index ◽  
Adverse Outcomes ◽  
Major Influence ◽  
Binary Logistic Regression Analysis ◽  
Complication Rates ◽  
Nutritional Index ◽  
Independent Risk Factors

Abstract Background: Surgery is usually the best treatment for patients with femoral fractures. However, the incidence of perioperative adverse outcomes in such cases is quite high. Nutrition has a major influence on fracture healing, and malnutrition is associated with higher complication rates, higher mortality rates, and longer hospitalisation periods. In this study, we aimed to identify independent risk factors and assess the predictive value of the prognostic nutritional index (PNI) for perioperative adverse outcomes in patients with femoral fractures. Methods: This retrospective observational study included 343 patients who underwent surgery for a single femur fracture at the Affiliated Hospital of Zunyi Medical University in 2018. Binary logistic regression analysis was applied to identify significant independent risk factors. The discriminatory ability of independent predictors was assessed using the receiver operating characteristic curve analysis, and DeLong's test was used to compare the area under the curve (AUC). Results: In total, 159 patients (46.4%) had perioperative adverse outcomes. PNI (OR: 0.819, 95% CI: 0.754–0.889, P < 0.001), age (OR: 1.042, 95% CI: 1.020–1.066, P < 0.001), time to admission (OR: 1.404, 95% CI: 1.117–1.765, P = 0.004), hypertension (OR: 1.912, 95% CI: 1.049–3.488, P = 0.034), combined injures (OR: 2.739, 95% CI: 1.338–5.607, P = 0.006), and operation types (OR: 3.696, 95% CI: 1.913–7.138, P < 0.001) were independent factors for perioperative adverse outcomes. Based on the AUC (PNI: 0.772, 95% CI: 0.723–0.821, P < 0.001; age: 0.678, 95% CI: 0.622–0.734, P < 0.001; time to admission: 0.585, 95% CI: 0.525–0.646, P = 0.006), the PNI had the optimal discrimination ability, indicating its superiority over other independent predictors (age vs. PNI, P = 0.002; time to admission vs. PNI, P < 0.001). Conclusions: This study showed that the PNI was a better and effective independent predictor of perioperative adverse outcomes in patients with femoral fractures. Our findings suggest that nutritional assessment at admission and appropriate intervention strategies are necessary for patients with femoral fractures.

Microvascular decompression of cranial nerves: lessons learned after 4400 operations

1999 ◽  
Vol 90 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Mark R. McLaughlin ◽  
Peter J. Jannetta ◽  
Brent L. Clyde ◽  
Brian R. Subach ◽  
Christopher H. Comey ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Glossopharyngeal Neuralgia ◽  
Complication Rates ◽  
Content Type ◽  
Csf Leakage ◽  
Fine Print

Object. Microvascular decompression has become an accepted surgical technique for the treatment of trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and other cranial nerve rhizopathies. The senior author (P.J.J.) began performing this procedure in 1969 and has performed more than 4400 operations. The purpose of this article is to review some of the nuances of the technical aspects of this procedure.Methods. A review of 4415 operations shows that numerous modifications to the technique of microvascular decompression have occurred during the last 29 years. Of the 2420 operations performed for trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia before 1990, cerebellar injury occurred in 21 cases (0.87%), hearing loss in 48 (1.98%), and cerebrospinal fluid (CSF) leakage in 59 cases (2.44%). Of the 1995 operations performed since 1990, cerebellar injuries declined to nine cases (0.45%), hearing loss to 16 (0.8%), and CSF leakage to 37 (1.85% p < 0.01, test for equality of distributions). The authors describe slight variations made to maximize surgical exposure and minimize potential complications in each of the six principal steps of this operation. These modifications have led to decreasing complication rates in recent years.Conclusions. Using the techniques described in this report, microvascular decompression is an extremely safe and effective treatment for many cranial nerve rhizopathies.

Trigeminal Neuralgia Caused by Venous Compression

Neurosurgery ◽  
2004 ◽  
Vol 55 (2) ◽  
pp. 334-339 ◽  
Author(s):  
Toshio Matsushima ◽  
Phuong Huynh-Le ◽  
Masayuki Miyazono
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Complete Relief ◽  
Surgical Results ◽  
Meckel’S Cave ◽  
Trigeminal Pain ◽  
Venous Compression ◽  
Facial Numbness ◽  
Meckel's Cave

Abstract OBJECTIVE: The purpose of this study is to clarify whether venous compression on the trigeminal nerve really causes trigeminal neuralgia or not, and to identify which veins are the offending veins. METHODS: We used microvascular decompression in operations on 121 patients with typical trigeminal neuralgia. We analyzed the intraoperative findings and surgical results in these 121 cases. RESULTS: In 7 of the 121 cases, only the vein was identified as a compressive factor on the trigeminal nerve. In 6 of these 7 cases, single venous compression was found, whereas the remaining case had two offending veins. The transverse pontine vein was most frequently found as the offending vein near Meckel's cave. All patients showed complete relief of trigeminal pain after decompression of the veins, but four of them developed facial numbness after surgery, which tended to be slight and did not require any treatment. CONCLUSION: Our surgical experiences showed that venous compression could cause trigeminal neuralgia by itself and that the transverse pontine vein should be carefully observed because it is most frequently the offending vein.

Incidence and Risk Factors for Pin Site Infection of Exposed Kirschner Wires Following Elective Forefoot Surgery

2019 ◽  
Vol 40 (10) ◽  
pp. 1154-1159 ◽  
Author(s):  
James C. McKenzie ◽  
Ryan G. Rogero ◽  
Sultan Khawam ◽  
Elizabeth L. McDonald ◽  
Kristen Nicholson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Case Series ◽  
Current Smoker ◽  
Site Infection ◽  
Kirschner Wires ◽  
Forefoot Surgery ◽  
Pin Site ◽  
Male Sex ◽  
K Wires

Background: Kirschner wires (K-wires) are commonly utilized for temporary metatarsal and phalangeal fixation following forefoot procedures. K-wires can remain in place for up to 6 weeks postoperatively and are at risk for complications. This study investigated the incidence of infectious complications of exposed K-wires after forefoot surgery and identifies risk factors for these complications. Methods: A single-surgeon retrospective chart review of forefoot surgeries from 2007 to 2017 was undertaken. Inclusion criteria were adult patients (≥18 years) undergoing elective forefoot surgery with the use of exposed K-wires. Incidence of pin site infectious complication, defined as cellulitis, or pin site drainage and/or migration/loosening of the pin was noted. Patient demographic and perioperative data were analyzed, along with the number of K-wires placed per procedure. Mann-Whitney U and chi-square tests were performed to determine predictive factors related to pin site infection rates, with a multivariable model with significant factors subsequently performed. Two-thousand seventeen K-wires in 1237 patients were analyzed. Results: There were 35 pin site infections for a rate of 1.74%. Combined forefoot procedures (507 pins in 229 patients) had a pin site infection rate of 4.93% (N = 25), followed by lesser metatarsal osteotomies (667 pins in 446 patients) at 1.05% (N = 7), then hammertoe corrections (694 pins in 421 patients) at 0.43% (N = 3), and no pin site infections with chevron osteotomies (149 pins in 141 patients). Male sex, body mass index (BMI), current smoker, and number of pins were significant risk factors ( P ≤ .05). Additionally, there were 23 non–infection-related K-wire complications. No long-term sequelae were encountered based on any complications. Conclusion: K-wires are commonly used for temporary immobilization of the smaller bones of the forefoot following deformity correction. Male sex, BMI, current smoker, and number of pins were significant risk factors for pin site infection, with a higher rate of infection with 2 or more pins placed. Level of Evidence: Level IV, case series.

scholarly journals Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia

2017 ◽  
Vol 126 (5) ◽  
pp. 1691-1697 ◽  
Author(s):  
Debebe Theodros ◽  
C. Rory Goodwin ◽  
Matthew T. Bender ◽  
Xin Zhou ◽  
Tomas Garzon-Muvdi ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Pain Control ◽  
Surgical Intervention ◽  
Patient Records ◽  
Duration Of Symptoms ◽  
Facial Numbness ◽  
Lancinating Pain

OBJECTIVETrigeminal neuralgia (TN) is characterized by intermittent, paroxysmal, and lancinating pain along the distribution of the trigeminal nerve. Microvascular decompression (MVD) directly addresses compression of the trigeminal nerve. The purpose of this study was to determine whether patients undergoing MVD as their first surgical intervention experience greater pain control than patients who undergo subsequent MVD.METHODSA retrospective review of patient records from 1998 to 2015 identified a total of 942 patients with TN and 500 patients who underwent MVD. After excluding several cases, 306 patients underwent MVD as their first surgical intervention and 175 patients underwent subsequent MVD. Demographics and clinicopathological data and outcomes were obtained for analysis.RESULTSIn patients who underwent subsequent MVD, surgical intervention was performed at an older age (55.22 vs 49.98 years old, p < 0.0001) and the duration of symptoms was greater (7.22 vs 4.45 years, p < 0.0001) than for patients in whom MVD was their first surgical intervention. Patients who underwent initial MVD had improved pain relief and no improvement in pain rates compared with those who had subsequent MVD (95.8% and 4.2% vs 90.3% and 9.7%, respectively, p = 0.0041). Patients who underwent initial MVD had significantly lower rates of facial numbness in the pre- and postoperative periods compared with patients who underwent subsequent MVD (p < 0.0001). The number of complications in both groups was similar (p = 0.4572).CONCLUSIONSThe results demonstrate that patients who underwent other procedures prior to MVD had less pain relief and a higher incidence of facial numbness despite rates of complications similar to patients who underwent MVD as their first surgical intervention.

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