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Vanloon M, Verbraeken B, Remacle T, Menovsky T. Fenestrated Aneurysm Clip Trigeminal Decompression after CyberKnife Treatment Failure. J Neurol Surg B Skull Base 2025; 86:370-372. [PMID: 40351884 PMCID: PMC12064295 DOI: 10.1055/s-0044-1786737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2025] Open
Affiliation(s)
- Maarten Vanloon
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Barbara Verbraeken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Pathology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Thibault Remacle
- Departement of Neurosurgery, Regional Hospital Center Citadelle, Liège, Belgium
| | - Tomas Menovsky
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Neurosurgery, Antwerp University Hospital (UZA), Edegem, Belgium
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2
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Ansari S, Mu BH, Basappa ER, Akyuz M, Jhaveri MD, Gaddikeri S. Comparison of sagittal angle of trigeminal nerve at porus trigeminus between responders and non-responders to microvascular decompression surgery in patients with trigeminal neuralgia. Curr Probl Diagn Radiol 2025:S0363-0188(25)00093-3. [PMID: 40382220 DOI: 10.1067/j.cpradiol.2025.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 05/09/2025] [Accepted: 05/10/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND AND PURPOSE The sagittal angle of the trigeminal nerve at the porus trigeminus (SATNaPT) has been described as abnormally hyperacute in a subset of patients with trigeminal neuralgia and proposed as a potential marker for the likelihood of poor microvascular decompression (MVD) outcomes. The purpose of this study is to replicate these results and evaluate this hypothesized association by comparing the SATNaPT between MVD responders and non-responders. MATERIALS AND METHODS At a single institution, 80 patients with a clinical diagnosis of trigeminal neuralgia, surgical intervention with MVD, and available adequate high-resolution T2 imaging were identified. SATNaPT was measured between the cisternal segment of the trigeminal nerve and its uppermost branch in the Meckel cave by a blinded observer. These data were evaluated for normality of distribution and compared between responders and non-responders to MVD as well as between affected and unaffected sides. Non-response to MVD was defined as persistent pain requiring continuous medication postoperatively or progression to secondary interventions. RESULTS There were 43 (52.5 %) responders and 39 (47.5 %) non-responders to MVD. Two patients had bilateral disease for 82 affected sides and 78 unaffected sides. The mean SATNaPT among responders was 150.5° (SD: ±10.6°), which was not significantly different (p = 0.21) from the 153.1° (SD: ±8.0°) mean angle in non-responders. Mean SATNaPT was not significantly different (p = 0.10) between the affected (mean: 151.7°, SD: ±9.5°) and the unaffected (mean: 153.1°, SD: ±10.0°) sides. CONCLUSIONS Our study did not replicate the bimodal distribution of the SATNaPT in cTN patients. No statistically significant difference was noted in the SATNaPT between responders and non-responders to MVD or between symptomatic and asymptomatic sides.
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Affiliation(s)
- Shehbaz Ansari
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653W Congress Parkway, Chicago, IL 60612, USA.
| | - Brian H Mu
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653W Congress Parkway, Chicago, IL 60612, USA.
| | - Eric R Basappa
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653W Congress Parkway, Chicago, IL 60612, USA
| | - Melih Akyuz
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653W Congress Parkway, Chicago, IL 60612, USA
| | - Miral D Jhaveri
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653W Congress Parkway, Chicago, IL 60612, USA.
| | - Santhosh Gaddikeri
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653W Congress Parkway, Chicago, IL 60612, USA.
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Iwasaki K, Uezato M, Nishida N, Yoshimoto N, Kitamura K, Gomi M, Hashikata H, Sasaki I, Toda H. Surgical Nuances and Predictors of Requirement for Suprameatal Tubercle Removal in Microvascular Decompression for Trigeminal Neuralgia. J Neurol Surg B Skull Base 2024; 85:e38-e45. [PMID: 39444768 PMCID: PMC11495899 DOI: 10.1055/a-2198-8279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2024] Open
Abstract
Objective Suprameatal tubercle (SMT), a bony prominence located above the internal acoustic meatus, is reported to impede the microscopic view during microvascular decompression (MVD) for trigeminal neuralgia (TN). For an enlarged SMT, removal of the SMT may be required in addition to the routine MVD to precisely localize the offending vessels. The objective of this study is to investigate the predictive factors influencing the requirement of SMT removal during trigeminal MVD. Methods We retrospectively reviewed 197 patients who underwent MVD for TN, and analyzed the correlation of the SMT height and other clinicosurgical data with the necessity to remove the SMT during MVD. The parameters evaluated in the statistical analyses included maximum SMT height, patient's clinical characteristics, surgical data including the type and number of offending vessels, and surgical outcomes. Results SMT removal was required for 20 patients among a total of enrolled 197 patients. In the univariate analysis, maximum SMT height, patient's age, and number (≥ 2) of offending vessels were associated with the requirement for SMT removal. Multivariate analysis with binary logistic regression revealed that the maximum SMT height and number (≥ 2) of offending vessels were significant factors influencing the necessity for SMT removal. A receiver operating characteristic curve analysis revealed that an SMT height ≥ 4.8 mm was the optimal cutoff value for predicting the need for SMT removal. Conclusion Large SMTs and the presence of multiple offending vessels are helpful in predicting the technical difficulty of trigeminal MVD associated with the necessity of SMT removal.
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Affiliation(s)
- Koichi Iwasaki
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
- Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan
| | - Minami Uezato
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Namiko Nishida
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Naoya Yoshimoto
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Kazushi Kitamura
- Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan
| | - Masanori Gomi
- Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan
| | - Hirokuni Hashikata
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Isao Sasaki
- Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan
| | - Hiroki Toda
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
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Yokoyama K, Ikeda N, Tanaka H, Ito Y, Sugie A, Yamada M, Wanibuchi M, Kawanishi M. Microvascular Decompression for Trigeminal Neuralgia with Complicated Offending Vessel Involving Trigeminocerebellar Artery: 2-Dimensional Operative Video. World Neurosurg 2024; 186:97. [PMID: 38522789 DOI: 10.1016/j.wneu.2024.03.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/17/2024] [Indexed: 03/26/2024]
Abstract
Microvascular decompression (MVD) is a well-established and definitive treatment option for trigeminal neuralgia (TN).1 However, complex vascular geometry and numerous offending vessels make it difficult to perform nerve decompression in certain cases.2 The trigeminocerebellar artery (TCA) is a unique branch of the basilar artery. The vessel is named the TCA because it supplies both the trigeminal nerve root and the cerebellar hemisphere.3 This anatomical variant may increase the risk of neurovascular compression in the trigeminal nerve. We present the case of a 74-year-old man with left TN in whom a TCA was one of the responsible compression vessels. Preoperative images revealed the ipsilateral anterior inferior cerebellar artery, well-developed TCA, and superior cerebellar artery, wherein these branches were all suspected to be involved in trigeminal nerve compression. In MVD, 3 arteries were suspected to compress the trigeminal nerve in 5 sites, and all of them needed to be meticulously dissected from the nerve root and decompressed. Moreover, 2 of them branched many short perforators to the brainstem. Three decompression procedures (transposition to the dura, transposition to the brain, and interposition) were performed to decompress the trigeminal nerve. Postoperatively, TN was completely resolved immediately. MVD for TN could be difficult to perform in cases with TCA, as in the present case, and rigorous procedures were required intraoperatively.
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Affiliation(s)
- Kunio Yokoyama
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan.
| | - Naokado Ikeda
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Hidekazu Tanaka
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Yutaka Ito
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Akira Sugie
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Makoto Yamada
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Graffeo CS, Scherschinski L, Ibrahim S, Baranoski JF, Srinivasan VM, Lawton MT. Fenestrated Aneurysm Clip Trigeminal Decompression after CyberKnife Treatment Failure. J Neurol Surg B Skull Base 2024; 85:106-108. [PMID: 38274478 PMCID: PMC10807953 DOI: 10.1055/s-0042-1760295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/23/2022] [Indexed: 01/18/2023] Open
Abstract
Objective This article describes a novel technique for trigeminal nerve decompression in the setting of refractory trigeminal neuralgia (TN). Design Technical note with an illustrative case example and operative video. Setting Outpatient, inpatient, and operating room of a quaternary neurosurgical referral center. Participant A woman in her early 70s who had previously undergone linear accelerator-based stereotactic radiotherapy (i.e., CyberKnife) and achieved 2 years of partial pain relief. However, facial pain, numbness, and parasympathetic dysfunction returned and became unbearable. Main Outcome Measure Durable relief of TN. Results Microvascular decompression was recommended for refractory TN. Intraoperatively, the trigeminal nerve was markedly attenuated from previous irradiation, with the superior cerebellar artery (SCA) loop embedded in the nerve at its root entry zone. The arterial loop was mobilized into a new position superior to the nerve, thus liberating it from the impingement. The tentorium was incised, and a fenestrated aneurysm clip was positioned such that the SCA loop was transmitted via the fenestration. The clip was applied across the tentorium, thus suspending the artery in a kink-free orientation that made no contact with the nerve. Conclusion This procedure provided excellent neurovascular decompression without placing mechanical strain on the nerve, relieving the patient's persistent postirradiation TN. The technique could have broader applications for other challenging or atypical microvascular decompression procedures.
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Affiliation(s)
- Christopher S. Graffeo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Lea Scherschinski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Sufyan Ibrahim
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Jacob F. Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Visish M. Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
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Karadag A, Mirkhasilova M, Turkis OF, Yuncu ME, Grande AW, Lopez GG, Roser F, Tatagiba M. Endoscope Assisted Microvascular Decompression for Trigeminal Neuralgia: Surgical Safety and Efficacy. ACTA MEDICA (HRADEC KRALOVE) 2024; 67:12-20. [PMID: 39288441 DOI: 10.14712/18059694.2024.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
BACKGROUND The cranial nerve (CN) V and adjacent neurovascular structures are crucial landmarks in microvascular decompression (MVD). MVD of CN V is the most effective treatment for patients with drug-resistant trigeminal neuralgia (TN) diagnosis. The endoscope-assisted retrosigmoid approach (RSA) provides better exposure and less cerebellar retraction in the corridor towards the cerebellopontine angle (CPA). METHODS Five adult cadaver heads (10 sides) underwent dissection of the MVD in park bench position. MVD was simulated using microsurgical RSA, and the anatomical landmarks were defined. Microsurgical dissections were additionally performed along the endoscopic surgical path. Additionally, we present an illustrative case with TN caused by anterior inferior cerebellar artery (AICA) compression. The CN V and its close relationships were demonstrated. Endoscopic and microscopic three-dimensional pictures were obtained. RESULTS This study increases the anatomical and surgical orientation for CN V and surrounding structures. The CN V arises from the lateral part of the pons and runs obliquely upward toward the petrous apex. It has motor roots that leave from pons antero-supero-medial direction to the sensory root. The endoscopic instruments provide perfect visualization with minimal cerebellar retraction during MVD. CONCLUSION MVD surgically targets the offending vessel(s) leading to TN and aims to create a disconnected area. The combination of preoperative radiographic assessment with and anatomical correlation provides safe and effective application while facilitating selection of the most appropriate approach. The RSA allows satisfactory visualization for CN V. Endoscope-assisted microsurgery through the CPA is a challenge, it should be performed with advanced anatomical knowledge.
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Affiliation(s)
- Ali Karadag
- Izmir City Hospital, Department of Neurosurgery, Izmir, Turkey.
- University of Health Sciences, Izmir Faculty of Medicine, Department of Neurosurgery, Izmir, Turkey.
| | - Muyassar Mirkhasilova
- University of Minnesota, Department of Neurosurgery Neuroanatomy Laboratory, Minnesota, USA
| | - Omer Furkan Turkis
- Antalya Ataturk State Hospital, Department of Neurosurgery, Antalya, Turkey
| | - Mustafa Eren Yuncu
- Elbistan State Hospital, Department of Neurosurgery, Kahramanmaras, Turkey
| | - Andrew W Grande
- University of Minnesota, Department of Neurosurgery Neuroanatomy Laboratory, Minnesota, USA
| | | | - Florian Roser
- Cleveland Clinic Abu Dhabi, Neurological Institute, Department of Neurosurgery, Abu Dhabi, UAE
| | - Marcos Tatagiba
- Eberhard Karls University of Tübingen, Department of Neurosurgery, Tubingen, Germany
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Toda H, Hashikata H, Ishibashi R. Exoscopic microvascular decompression for hemifacial spasm and trigeminal neuralgia. NEUROSURGICAL FOCUS: VIDEO 2024; 10:V12. [PMID: 38288291 PMCID: PMC10823421 DOI: 10.3171/2023.10.focvid23122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/20/2023] [Indexed: 01/31/2024]
Abstract
The 4K 3D exoscope system is becoming increasingly used in neurosurgery. Its 3D ultra-high-definition image is valuable in identifying and dissecting the delicate neural and vascular structures during microvascular decompression. In this video, the authors describe several nuances and details to perform the exoscopic microvascular decompression, including the exoscope layout and the modified supine position. Several illustrative case presentations highlight the benefits of exoscopic surgery. The authors' exoscopic microvascular decompression series of 159 patients showed noninferior surgical outcomes compared to the operative microscope with no significant increase in surgical risk. In conclusion, an exoscope can be a practical alternative to performing microvascular decompression. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23122.
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Affiliation(s)
- Hiroki Toda
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Osaka, Japan
| | - Hirokuni Hashikata
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Osaka, Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Osaka, Japan
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Zhu C, Chong Y, Jiang C, Xu W, Wang J, Jiang C, Liang W, Wang B. Surgical anatomy of sigmoid sinus with evaluation of its venous dominance for advances in preoperative planning. Front Neurosci 2023; 17:1161179. [PMID: 37179552 PMCID: PMC10174243 DOI: 10.3389/fnins.2023.1161179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/04/2023] [Indexed: 05/15/2023] Open
Abstract
Microvascular decompression (MVD) is a widely adopted neurosurgery in treating cranial nerve diseases providing long-term pain relief. Improving surgical techniques has been a focus of recent studies. Venous structures such as the sigmoid sinus are essential to protect, and whose risk of destruction during surgery increases with size. The medical records of patients who went through MRI ahead of MVD surgery between Dec 2020 and Dec 2021 were reviewed. Section area of sigmoid sinus calculated from the MRI plane of auditory nerve showed a right dominance of the sinus. The improved method concerning the relationship between affected side and the dominant sigmoid sinus offered a better bone window and surgical field by planning the operation incision in advance. Intraoperative adjustment of the bone flap was avoided, and the risk of destructing the sigmoid sinus was reduced.
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Affiliation(s)
- Chunran Zhu
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
- Affliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yulong Chong
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chenjun Jiang
- Department of Physics, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Wu Xu
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jing Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chengrong Jiang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Weibang Liang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Weibang Liang,
| | - Bei Wang
- Department of Nursing, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Bei Wang,
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Yoshizaki W, Fujikawa Y, Torikoshi S, Katayama T, Iwasaki K, Toda H. Effects of microvascular decompression on quality-of-life in trigeminal neuralgia patients aged 70 years and older. Surg Neurol Int 2023; 14:41. [PMID: 36895226 PMCID: PMC9990813 DOI: 10.25259/sni_997_2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
Background Trigeminal neuralgia (TN) occasionally affects older adults, frequently worsens, and becomes refractory to medication. Older adult patients with TN may consider microvascular decompression (MVD) for their treatment. No study examines MVD effects on older adult TN patients' health-related quality of life (HRQoL). The present study evaluates the HRQoL of TN patients aged 70 years and older before and after MVD. Methods Adult TN patients who underwent MVD evaluated their HRQoL using the 36-Item Short-form (SF-36) Health Survey before and 6 months after MVD. The patients were divided into four groups according to their decade of age. The clinical parameters and operative outcomes were analyzed statistically. The SF-36 physical, mental, and role social component summary scores and eight domain scale scores were analyzed using a twoway repeated-measures analysis of variance (ANOVA) to compare the effects of age group and preoperative and postoperative time points. Results Among 57 adult patients (34 women, 23 men; mean age, 69 years; range, 30-89 years), 21 patients were in their seventies, and 11 were in their eighties. The SF-36 scores of patients in all age groups improved after MVD. Two-way repeated-measures ANOVA demonstrated a significant age group effect on the physical component summary and its physical functioning domain. A time point effect was significant on all component summaries and domains. There was a significant interaction between age group and time point effects on the bodily pain domain. These results suggested that patients 70 years and older had significant postoperative HRQoL improvement, but their improvement of physical-related HRQoL and multiple physical pain issues were limited. Conclusion Impaired HRQoL in TN patients aged 70 years and older can improve after MVD. Careful management of multiple comorbidities and surgical risks enables MVD to be an appropriate treatment for older adult patients with refractory TN.
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Affiliation(s)
- Wataru Yoshizaki
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka
| | - Yoshiki Fujikawa
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka
| | | | - Toshiro Katayama
- Department of Health Science, Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Koichi Iwasaki
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka
| | - Hiroki Toda
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka
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Fayed ZY, Afify H. Long-term follow-up of microvascular decompression for management of trigeminal neuralgia. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00171-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Trigeminal neuralgia (TN) is mostly caused by neurovascular compression of the trigeminal nerve and the root entry zone at the brain stem. Microvascular decompression (MVD) has been established as a standard treatment for trigeminal neuralgia in patients not adequately controlled by medications.
Objectives
Reporting the long-term outcome of MVD in our group of patients with follow-up period equal to or more than five years.
Patients and methods
Twenty-one patients operated by MVD for TN were followed up for at least five years, they were evaluated describing the patient criteria and operative findings, complications, and the long-term clinical outcome.
Results
Sixteen of the twenty-one patients had complete pain relief maintained for up to five years and three of them up to eight years. Two patients had significant improvement but with mild occasional pain not requiring medications only one of them had his occasional pain maintained till five years, three patients experienced persistent pain which was still there after five years one of them showed mild improvement in his pain after one year of follow-up. Complications were mild and/or transient most frequent were headache nausea and dizziness.
Conclusion
In the long-term follow-up, microvascular decompression still maintains its clinical benefit with most patients still pain free after at least five years and up to eight years. It is safe procedures and should be considered in every patient with failed medical treatment.
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Zhu G, Fu Z, Su S, Tang Y, Liu F, Yu W. Global Trends and Hotspots in Trigeminal Neuralgia Research From 2001 to 2021: A Bibliometric Analysis. Front Neurol 2022; 13:894006. [PMID: 35620788 PMCID: PMC9127545 DOI: 10.3389/fneur.2022.894006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/08/2022] [Indexed: 01/03/2023] Open
Abstract
BackgroundIn recent years, there have been an increasing number of studies on trigeminal neuralgia (TN). However, a scientific and comprehensive study of the current situation and trends in the field of TN research is lacking. The purpose of this study is to summarize and visualize the development, research hotspots, and future trends in TN based on a bibliometric approach.MethodsStudies on TN published from 2001 to 2021 were obtained from the Web of Science Core Collection (WoSCC). Bibliometrics, CiteSpace, and VOSviewer tools were used for bibliometric analysis and visualization.ResultsIn total, 4,112 documents were searched. The number of research articles in the field is generally on an upward trend, with the fastest growth in the number of articles from 2017 to 2020. Shanghai Jiao Tong University, Pittsburgh University, and Mayo Clinic are the three institutions with the most publications. Shiting Li and Zakrzewska JM are the most prolific author and top co-cited authors, respectively. The Journal of Neurosurgery is the most influential journal. The top 5 keywords in that time frame are TN, microvascular decompression, facial pain, stereotactic radiosurgery, and neuropathic pain.ConclusionThis is the first comprehensive scientific bibliometric analysis of the global research field on TN over the past 21 years, providing a meaningful reference for further exploration of topical issues and research trends in the field.
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Affiliation(s)
- Ganggui Zhu
- Department of Neurosurgery, Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zaixiang Fu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Sheng Su
- Department of Neurosurgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Yajuan Tang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fuyi Liu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Fuyi Liu
| | - Wenhua Yu
- Department of Neurosurgery, Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Wenhua Yu
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Microvascular decompression for pediatric onset trigeminal neuralgia: patterns and variation. Childs Nerv Syst 2022; 38:767-772. [PMID: 35034138 DOI: 10.1007/s00381-021-05432-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/03/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Pediatric trigeminal neuralgia has been rarely reported in the literature, which were only 28 cases. Although microvascular decompression (MVD) has been widely accepted as effective therapy for trigeminal neuralgia, the etiology and surgical treatment of pediatric ones are seldom addressed. We report our experience with MVD for pediatric trigeminal neuralgia patients with emphasis on the vascular conflict patterns and surgical skills. METHODS This retrospective report included 11 pediatric TN patients, who underwent MVD and were followed for 3-86 months. The data were retrospectively analyzed with emphasis on the clinical features. RESULTS This series included 4 boys and 7 girls with average age of 13 ± 3.4 years old, their onset age were from 7 to 18 years old. The singular vein and combined artery/vein conflictions account for 7/11. 9 (81.8%) patients achieved immediate excellent outcomes. One recurrence was observed after 5 months and refused the second surgery. CONCLUSIONS The etiology of pediatric onset trigeminal neuralgia is still vascular conflict, whose patterns are different from adults, of which combined artery/vein and singular venous compression patterns have a much more higher proportion. Because of the smaller operative space and fragile-thin venous wall with adhesion to other structures, it is much more difficult to decompress the trigeminal nerve among pediatric patients. Sufficient arachnoid release, full exploration, and decompression along the trigeminal nerve were necessary, which will increase the excellent rate among pediatric patients.
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Villalonga JF, Baldoncini M, Pailler JI, Saenz A, Lucifero AG, Luzzi S, Pipolo DO, Campero A. Classification and Management of Pontecerebellar-Petrosal Bridging Veins. World Neurosurg 2022; 160:e481-e486. [PMID: 35074544 DOI: 10.1016/j.wneu.2022.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The risks and benefits of coagulating intradural venous elements during a retrosigmoid approach for trigeminal neurovascular decompression has not been accurately established. The objectives of this study are to identify the veins that drain into the superior petrosal sinus, classify them in relation to the suprameatal tubercle and determine the implication of their coagulation. MATERIAL AND METHODS A retrospective study of 3D surgical videos of retrosigmoid approaches for trigeminal neurovascular decompression from the LINT (Laboratory of Neurosurgical Innovations of Tucumán) digital archive was carried out. The veins encountered were classified into 3 groups: retromeatal, meatal and premeatal. The neurosurgical postoperative complication scale proposed by Landriel et al. was utilized to assess complications from venous coagulation. A Grade 0 was added for patients without complications. The STATA 14 program was utilized for statistical analysis. RESULTS The pontocerebellar-petrosal veins of 28 patients who underwent trigeminal decompressive surgery were analyzed. In 7 cases these were found in the retromeatal region; 100% were sacrificed. 11 cases revealed veins within the meatal region; 90,91% were coagulated. Veins in the premeatal region were found in 14 cases; 57,14% were sacrificed. In the postoperative follow-up, 27 patients were grade 0 and 1 patient developed postoperative meningitis (grade Ib complication). No patient suffered vascular complications. CONCLUSION The venous elements identified in trigeminal neurovascular decompressive surgery are variable. We propose classifying them into retromeatal, metal and premeatal groups. Retromeatal and meatal veins can be safely sacrificed for appropriate visualization of the neurovascular conflict. The premeatal venous elements should be coagulated only in justified cases.
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Affiliation(s)
- Juan F Villalonga
- Laboratory of Neurosurgical Innovations of Tucumán, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina; Department of Neurological Surgery, Hospital Padilla, Tucumán, Argentina
| | - Matías Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, Argentina.
| | - José I Pailler
- Laboratory of Neurosurgical Innovations of Tucumán, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Amparo Saenz
- Laboratory of Neurosurgical Innovations of Tucumán, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Derek O Pipolo
- Laboratory of Neurosurgical Innovations of Tucumán, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Alvaro Campero
- Laboratory of Neurosurgical Innovations of Tucumán, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina; Department of Neurological Surgery, Hospital Padilla, Tucumán, Argentina
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14
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Jay GW, Barkin RL. Trigeminal neuralgia and persistent idiopathic facial pain (atypical facial pain). Dis Mon 2022; 68:101302. [PMID: 35027171 DOI: 10.1016/j.disamonth.2021.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gary W Jay
- Department of Neurology, Division: Headache/Pain, University of North Carolina, Chapel Hill, USA.
| | - Robert L Barkin
- Departmentts of Anesthesilogy, Family Medicine, Pharrmacology, Rush University Medical College, Chicago Illinois, USA
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Verbraeken B, Lavrysen E, Aboukais R, Menovsky T. Polyvinyl Alcohol Sponges to Facilitate Cerebral Bypass Surgery: Technical Note. World Neurosurg 2021; 156:53-55. [PMID: 34508907 DOI: 10.1016/j.wneu.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The standard way of isolating bypass vessels from surrounding structures during cerebral bypass surgery has been to use a rubber dam or neurosurgical patty. Here, the use of polyvinyl alcohol (PVA) sponges is described as a possible upgrade from these traditional bypass dams. METHODS PVA sponges were used to isolate bypass arteries from surrounding tissues during microvascular anastomosis in 25 patients undergoing bypass surgery at our institution. RESULTS There were no adverse events related to the use of PVA for microvascular anastomosis. PVA sponges offered some specific advantages when compared with rubber and cottonoid dams. CONCLUSIONS Although preliminary, our experience using PVA sponges during microvascular anastomosis suggests some of their properties can facilitate cerebral bypass surgery.
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Affiliation(s)
- Barbara Verbraeken
- Department of Neurosurgery, Antwerp University Hospital (UZA), Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Eno Lavrysen
- Department of Neurosurgery, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Rabih Aboukais
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital (UZA), Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Yamoto T, Nishibayashi H, Ogura M, Nakao N. Three-dimensional morphology of the superior cerebellar artery running in trigeminal neuralgia. J Clin Neurosci 2020; 82:9-12. [PMID: 33317746 DOI: 10.1016/j.jocn.2020.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Abstract
The superior cerebellar artery (SCA) is the most frequent offending vessel in trigeminal neuralgia. This study aims to elucidate the patterns of the SCA running in 34 patients with typical trigeminal neuralgia using three-dimensional computer graphics. The SCA which runs in the medial aspect of the trigeminal nerve compressed predominantly the root entry zone at the distal segment of the caudal loop. Meanwhile, the SCA which runs in the cranial or lateral aspect of the trigeminal nerve compressed predominantly the mid-third portion at the proximal segment of the caudal loop. The site of neurovascular compression differed depending on the shape of the initial segment of SCA. Transposition methods could not be performed in several patients with arch-shaped SCA. Three-dimensional computer graphics revealed different characteristics of the SCA running in trigeminal neuralgia depending on the site of neurovascular compression and shape of the SCA. These differences might affect procedures for microvascular decompression.
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Affiliation(s)
- Toshikazu Yamoto
- Department of Neurological Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Hiroki Nishibayashi
- Department of Neurological Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan.
| | - Mitsuhiro Ogura
- Department of Neurological Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Naoyuki Nakao
- Department of Neurological Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
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Ikeda R, Kikuchi T, Sato S, Oshima H, Kawamura Y, Kusano Y, Kawase T, Katori Y, Kobayashi T. Pulsatile tinnitus caused by pneumocephalus after Janneta surgery. Auris Nasus Larynx 2020; 48:793-796. [PMID: 32586740 DOI: 10.1016/j.anl.2020.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/04/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
Pulsatile tinnitus of nonvascular origin is rare. We herein present a case of pulsatile tinnitus complicated with Jannetta surgery due to a communication created between the drilled mastoid cells and epidural space. She was successfully cured by otological surgery where the mastoid tip was packed with bone cement. A 68-year-old woman was referred to the previous hospital with complaints of right autophony, aural fullness, hyperacusis to her footsteps, and pulsatile tinnitus for the past three years. She had received Jannetta surgery for right hemifacial spasm seven years before. The computed tomography (CT) of the right temporal bone showed bony dehiscence between the mastoid cells and posterior cranial fossa. She underwent otological surgery to obliterate the tip of the mastoid cavity with artificial bone cement (BIOPEXⓇ) under general anesthesia. Her annoying aural symptoms were immediately abolished and she has been free from symptoms at ten months after surgery. It is critical to ensure the closure of any communication created between the middle ear and epidural space during surgeries in order to prevent the occurrence of pulsatile tinnitus.
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Affiliation(s)
- Ryoukichi Ikeda
- Sen-En Rifu Otological Surgery Center, Miyagi, Japan; Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine, 1 1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
| | - Toshiaki Kikuchi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine, 1 1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Shunsuke Sato
- Department of Neurosurgery, Southern Tohoku General Hospital, Fukushima, Japan.
| | | | - Yoshinobu Kawamura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine, 1 1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
| | - Yusuke Kusano
- Sen-En Rifu Otological Surgery Center, Miyagi, Japan; Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine, 1 1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Tetsuaki Kawase
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine, 1 1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University School of Medicine, 1 1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
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Toda H, Iwasaki K, Yoshimoto N, Miki Y, Hashikata H, Goto M, Nishida N. Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm. Neurosurg Focus 2019; 45:E2. [PMID: 29961378 DOI: 10.3171/2018.4.focus18122] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In 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. METHODS The 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. RESULTS The 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). CONCLUSIONS Dissection 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.
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Affiliation(s)
- Hiroki Toda
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and.,2Department of Neurosurgery, Fukui Red Cross Hospital, Fukui, Japan
| | - Koichi Iwasaki
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and
| | - Naoya Yoshimoto
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and
| | - Yoshihito Miki
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and
| | - Hirokuni Hashikata
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and
| | - Masanori Goto
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and
| | - Namiko Nishida
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and
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Panczykowski DM, Jani RH, Hughes MA, Sekula RF. Development and Evaluation of a Preoperative Trigeminal Neuralgia Scoring System to Predict Long-Term Outcome Following Microvascular Decompression. Neurosurgery 2019; 87:71-79. [DOI: 10.1093/neuros/nyz376] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/05/2019] [Indexed: 01/03/2023] Open
Abstract
AbstractBACKGROUNDMicrovascular decompression (MVD) can be an effective intervention for trigeminal neuralgia (TN); however, an optimal system for patient selection and surgical outcome prediction has not been defined.OBJECTIVETo develop and validate a preoperative TN grading system for the prediction of long-term pain relief after MVD.METHODSThis retrospective cohort study included consecutive patients suffering unilateral TN who underwent MVD with >18-mo follow-up. A grading system was formulated using 3 previously validated preoperative characteristics. The primary end-point was long-term, pain-free status without use of medication. Ability to predict pain-free status was analyzed by multiple regression and assessed by area under the receiver operating characteristic curve (AUC). Clinical utility to predict MVD success and reduce unnecessary surgeries was assessed by decision-curve analysis.RESULTSOf 208 patients analyzed, 73% were pain-free without medication at >18-mo follow-up. Pain-free status was predicted by classical TN type, positive response to carbamazepine and/or oxcarbazepine, and presence and nature of neurovascular compression demonstrated on MRI (all P < .01). The TN grading system demonstrated good discriminatory ability for prediction of pain-free status (AUC 0.85, 95% CI 0.80-0.91). Decision-curve analysis demonstrated a net reduction of 20 cases likely to be unsuccessful per 100 patients evaluated with this grading system above a decision threshold of 80%.CONCLUSIONThis TN grading system reliably predicts long-term pain-free status without medications following MVD. The use of the TN grading system as part of a comprehensive work-up may reduce the number of unsuccessful operations.
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Affiliation(s)
- David M Panczykowski
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ronak H Jani
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marion A Hughes
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Abstract
PURPOSE OF REVIEW To review current treatments for trigeminal neuralgia, with an emphasis on determining which patients may benefit from neurosurgical procedures. RECENT FINDINGS A detailed history is the most helpful tool for diagnosing trigeminal neuralgia (TN) and predicting response to neurosurgical treatments. Patients with classic trigeminal neuralgia will describe severe, unilateral, intermittent facial pain that is triggered by innocuous sensory stimuli. In most cases, pain is caused by compression of the trigeminal nerve by a blood vessel near the brainstem. Magnetic resonance imaging is necessary to rule out TN secondary to multiple sclerosis or tumor. Modern high-resolution T2 images may demonstrate neurovascular contact, particularly when analyzed by a neurosurgeon with expertise in TN. Initial management involves a trial of medication, usually carbamazepine or oxcarbazepine. Microvascular decompression (MVD) is safe and effective surgery, for patients with classic TN related to neurovascular compression. For patients with TN secondary to multiple sclerosis, and for patients who are otherwise poor candidates for MVD, neurosurgical options include percutaneous trigeminal rhizotomy and radiosurgery. Neurosurgical procedures are less effective in relieving atypical facial pain. In the clinical evaluation of a patient with facial pain, it is important to distinguish classic trigeminal neuralgia from atypical facial pain. A patient with classic trigeminal neuralgia would benefit from neurosurgical consultation. The advent of high-resolution MRI and MRA sequences now allows a neurosurgeon to detect when neurovascular compression is likely, and select the optimal procedure for treatment.
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Affiliation(s)
- Alexander X Tai
- Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, 20007, USA
| | - Vikram V Nayar
- Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, PHC 7, Washington, DC, 20007, USA.
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Improved Microvascular Decompression in Treating Trigeminal Neuralgia: Application of Nest-Shaped Teflon Fibers. World Neurosurg 2018; 110:e1-e5. [DOI: 10.1016/j.wneu.2017.09.138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/18/2022]
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Gao J, Fu Y, Guo SK, Li B, Xu ZX. Efficacy and Prognostic Value of Partial Sensory Rhizotomy and Microvascular Decompression for Primary Trigeminal Neuralgia: A Comparative Study. Med Sci Monit 2017; 23:2284-2291. [PMID: 28502974 PMCID: PMC5441416 DOI: 10.12659/msm.901510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background This study aimed to compare the efficacy and prognostic value of partial sensory rhizotomy (PSR) and microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Material/Methods From June 2010 to June 2012, 117 patients with PTN were recruited for the study, of which 52 cases were treated with MVD (the MVD group) and 65 cases were treated with PSR (the PSR group). Visual Analog Scoring (VAS) was performed at 1 and 2 weeks, and at 1, 3, and 6 month after surgery. The overall response rate (ORR) was determined 1 month after surgery. Barrow Neurological Institute score was adopted to value the reoccurrence at 6, 12, 24, and 36 months after surgery. A 3-year follow-up was conducted and the complications were recorded. Results The ORR 2 weeks after surgery in the MVD and PSR groups was 98.08% and 84.62%, respectively. One and 2 weeks after surgery, the VAS was lower in the MVD group than in the PSR group, but there was no significant difference in VAS between the 2 groups at 1, 3, and 6 months after surgery. Three years after surgery, the recurrence rate was significantly lower in the MVD group than in the PSR group. The recurrence-free survival time was longer in the MVD group than in the PSR group. The occurrence rates of herpes and total postoperative complications were significantly higher in the PSR group than in the MVD group. Conclusions Compared with PSR, MVD is more suitable for PTN treatment, with less disturbance, lower recurrence rate, and better efficacy.
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Affiliation(s)
- Jian Gao
- Department of Neurosurgery, The China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Yao Fu
- Department of Neurosurgery, The First People's Hospital of Shangqiu, Shangqiu, Henan, China (mainland)
| | - Shi-Kun Guo
- Department of Neurosurgery, The First People's Hospital of Shangqiu, Shangqiu, Henan, China (mainland)
| | - Bing Li
- Department of Neurosurgery, The First People's Hospital of Shangqiu, Shangqiu, Henan, China (mainland)
| | - Zhong-Xin Xu
- Department of Neurology, The China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
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