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Lv K, Zhang C, Liu B, Yang A, Luan J, Hu P, Yao Z, Liu J, Ma G. White matter structural changes before and after microvascular decompression for hemifacial spasm. Brain Struct Funct 2024; 229:959-970. [PMID: 38502329 DOI: 10.1007/s00429-023-02741-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/22/2023] [Indexed: 03/21/2024]
Abstract
Hemifacial spasm (HFS) is a syndrome characterized by involuntary contractions of the facial muscles innervated by the ipsilateral facial nerve. Currently, microvascular decompression (MVD) is an effective treatment for HFS. Diffusion weighted imaging (DWI) is a non-invasive advanced magnetic resonance technique that allows us to reconstruct white matter (WM) virtually based on water diffusion direction. This enables us to model the human brain as a complex network using graph theory. In our study, we recruited 32 patients with HFS and 32 healthy controls to analyze and compare the topological organization of whole-brain white matter networks between the groups. We also explored the potential relationships between altered topological properties and clinical outcomes. Compared to the HC group, the white matter network was disrupted in both preoperative and postoperative groups of HFS patients, mainly located in the somatomotor network, limbic network, and default network (All P < 0.05, FDR corrected). There was no significant difference between the preoperative and postoperative groups (P > 0.05, FDR corrected). There was a correlation between the altered topological properties and clinical outcomes in the postoperative group of patients (All P < 0.05, FDR corrected). Our findings indicate that in HFS, the white matter structural network was disrupted before and after MVD, and that these alterations in the postoperative group were correlated with the clinical outcomes. White matter alteration here described may subserve as potential biomarkers for HFS and may help us identify patients with HFS who can benefit from MVD and thus can help us make a proper surgical patient selection.
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Affiliation(s)
- Kuan Lv
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Chuanpeng Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Neurosurgery, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Bing Liu
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Aocai Yang
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jixin Luan
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pianpian Hu
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Zeshan Yao
- Jingjinji National Center of Technology Innovation, Beijing, China
| | - Jiang Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China.
| | - Guolin Ma
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China.
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
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Sun C, Zhao P, Zhu W, Zhang X, Zhang Y, Xu J. To be thorough or tailored: influence of the arachnoid dissection range on the surgical outcomes of microvascular decompression for hemifacial spasm. Neurosurg Rev 2024; 47:187. [PMID: 38656561 DOI: 10.1007/s10143-024-02421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND As one of the most fundamental elements in exposure and decompression, the dissection of arachnoid has been rarely correlated with the surgical results in studies on Microvascular decompression (MVD) procedures for Hemifacial spasm (HFS). MATERIALS AND METHODS Patients' records of the HFS cases treated with MVD from January 2016 to December 2021 in our center was retrospectively reviewed. The video of the procedures was inspected thoroughly to evaluate the range of dissection of arachnoid. Four areas were defined in order to facilitate the evaluation of the dissection range. The correlation between the arachnoid dissection and the surgical outcomes were analyzed. RESULTS The arachnoid structures between the nineth cranial nerve and the seventh, eighth cranial nerves were dissected in all cases, other areas were entered based on different consideration. The rate of neurological complications of the extended dissection pattern group was higher than that of the standard pattern group (P < 0.05). The procedures in which the arachnoid structure above the vestibulocochlear nerve was dissected, led to more neurological complications (P < 0.05). CONCLUSION Thorough dissection as an initial aim for all cases was not recommended in MVD for HFS, arachnoid dissection should be tailored to achieving safety and effectiveness during the procedure.
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Affiliation(s)
- Chongjing Sun
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Puyuan Zhao
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Wei Zhu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Xiaobiao Zhang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yu Zhang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jin Xu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Giammattei L, Wuerzner G, Theiler K, Vollenweider P, Dunet V, Al Barajraji M, Squair JW, Bloch J, Daniel RT. Lateral medullary vascular compression manifesting as paroxysmal hypertension. Acta Neurochir (Wien) 2024; 166:139. [PMID: 38488893 PMCID: PMC10943153 DOI: 10.1007/s00701-024-06032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024]
Abstract
Neurovascular compression of the rostral ventrolateral medulla (RVLM) has been described as a possible cause of refractory essential hypertension. We present the case of a patient affected by episodes of severe paroxysmal hypertension, some episodes associated with vago-glossopharyngeal neuralgia. Classical secondary forms of hypertension were excluded. Imaging revealed a neurovascular conflict between the posterior inferior cerebellar artery (PICA) and the ventrolateral medulla at the level of the root entry zone of the ninth and tenth cranial nerves (CN IX-X REZ). A MVD of a conflict between the PICA and the RVLM and adjacent CN IX-X REZ was performed, resulting in reduction of the frequency and severity of the episodes. Brain MRI should be performed in cases of paroxysmal hypertension. MVD can be considered in selected patients.
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Affiliation(s)
- L Giammattei
- Department of Neurosurgery, Lausanne University Hospital, Lausanne and University of Lausanne, Lausanne, Switzerland.
| | - G Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - K Theiler
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - P Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - V Dunet
- Department of Medical Radiology, Service of Diagnostic and Interventional Radiology, Neuroradiology Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Al Barajraji
- Department of Neurosurgery, Lausanne University Hospital, Lausanne and University of Lausanne, Lausanne, Switzerland
| | - J W Squair
- Department of Neurosurgery, Lausanne University Hospital, Lausanne and University of Lausanne, Lausanne, Switzerland
| | - J Bloch
- Department of Neurosurgery, Lausanne University Hospital, Lausanne and University of Lausanne, Lausanne, Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore), CHUV/UNIL/EPFL, 1005, Lausanne, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospitzal (CHUV) and University of Lausanne (UNIL), 1005, Lausanne, Switzerland
| | - R T Daniel
- Department of Neurosurgery, Lausanne University Hospital, Lausanne and University of Lausanne, Lausanne, Switzerland
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Go KO, Ji SY, Kwon JE, Hwang K, Cho M, Park BH, Park KS, Kim JM, Koo CH, Jeon YT, Park S, Ryu JH, Han JH. Intraoperative Brainstem Auditory Evoked Potentials and Postoperative Nausea and Vomiting After Microvascular Decompression. World Neurosurg 2024:S1878-8750(24)00426-1. [PMID: 38493889 DOI: 10.1016/j.wneu.2024.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND We performed this study to investigate the effect of intraoperative brainstem auditory evoked potential (IBAEP) changes on the development of postoperative nausea and vomiting (PONV) after microvascular decompression (MVD) for neurovascular cross compression. METHODS A total of 373 consecutive cases were treated with MVD. The use of rescue antiemetics after surgery was used as an objective indicator of PONV. IBAEP monitoring was routinely performed in all. RESULTS The use of rescue antiemetics was significantly associated with female sex (OR = 3.427; 95% CI, 2.077-5.654; P < 0.001), PCA use (OR = 3.333; 95% CI, 1.861-5.104; P < 0.001), and operation time (OR = 1.017; 95% CI, 1.008-1.026; P < 0.001). A Wave V peak delay of more than 1.0 milliseconds showed a significant relation with the use of rescue antiemetics (OR = 1.787; 95% CI, 1.114-2.867; P = 0.016) and a strong significant relation with the use of rescue antiemetics more than 5 times (OR = 2.426; 95% CI, 1.372-4.290; P = 0.002). CONCLUSIONS A wave V peak delay of more than 1.0 milliseconds might have value as a predictor of PONV after MVD. More detailed neurophysiological studies will identify the exact pathophysiology underlying PONV after MVD.
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Affiliation(s)
- Kyeong-O Go
- Department of Neurosurgery, Gyeongsang National University Hospital, Jinju-si, Gyengsangnam-Do, South Korea
| | - So Young Ji
- Department of Neurosurgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-Do, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji-Eyon Kwon
- Department of Neurosurgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-Do, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-Do, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Minjae Cho
- Department of Neurosurgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-Do, South Korea
| | - Byung Hwa Park
- Department of Neurology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-Do, South Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-Do, South Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-Do, South Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang-Hoon Koo
- Department of Anesthesiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-Do, South Korea; Department of Anesthesiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Young-Tae Jeon
- Department of Anesthesiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-Do, South Korea; Department of Anesthesiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sanghon Park
- Department of Anesthesiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-Do, South Korea; Department of Anesthesiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Hee Ryu
- Department of Anesthesiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-Do, South Korea; Department of Anesthesiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-Do, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea.
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Khaleghi M, Carlstrom LP, Weber MD, Biswas C, Dalm B, Prevedello D. Microvascular Decompression for Trigeminal Neuralgia Caused by Vascular Compression on the Trigeminal Sensory Nucleus and Descending Trigeminal Tract. World Neurosurg 2024; 183:106-112. [PMID: 38143032 DOI: 10.1016/j.wneu.2023.12.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is characterized by paroxysmal episodes of severe shocklike orofacial pain typically resulting from arterial compression on the trigeminal root entry zone. However, neurovascular conflict in more proximal parts of the trigeminal pathway within the pons is extremely rare. METHODS The authors present a case of microvascular decompression for TN caused by dual arterial compression on the dorsolateral pons, along with a brief literature review. RESULTS Our patient was a 74-year-old man with episodic left-sided facial stabbing pain. Brain magnetic resonance imaging revealed a dual arterial compression on dorsolateral pons, the known site of the trigeminal sensory nucleus and descending trigeminal tract. Microvascular decompression was performed via a retrosigmoid approach. Complete pain relief and partial improvement of the facial hypesthesia were achieved immediately after surgery and the Barrow Neurological Institute (BNI) pain intensity score improved from V to I, and the BNI hypesthesia score decreased from III to II within a month following surgery. The literature review identified 1 case of TN secondary to an arteriovenous malformation in root entry zone with lateral pontine extension. One month following partial coagulation of the draining vein, the patient was reportedly able to reduce medication dosage by half to achieve an improvement of BNI pain intensity score from V to IIIa. CONCLUSIONS Neurovascular compression in the trigeminal tract and nucleus is a rare but potential cause of TN. A thorough investigation of the trigeminal pathway should be considered during preoperative evaluation and intraoperative inspection, particularly if no clear offending vessel is identified.
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Affiliation(s)
- Mehdi Khaleghi
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lucas P Carlstrom
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthieu D Weber
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Chandrima Biswas
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian Dalm
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
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Doshi TL, Dorsey SG, Huang W, Kane MA, Lim M. Proteomic Analysis to Identify Prospective Biomarkers of Treatment Outcome After Microvascular Decompression for Trigeminal Neuralgia: A Preliminary Study. J Pain 2024; 25:781-790. [PMID: 37838347 PMCID: PMC10922145 DOI: 10.1016/j.jpain.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
Trigeminal neuralgia (TN) is a severe neuropathic facial pain disorder, often caused by vascular or neuronal compression of the trigeminal nerve. In such cases, microvascular decompression (MVD) surgery can be used to treat TN, but pain relief is not guaranteed. The molecular mechanisms that affect treatment response to MVD are not well understood. In this exploratory study, we performed label-free quantitative proteomic profiling of plasma and cerebrospinal fluid samples from patients undergoing MVD for TN, then compared the proteomic profiles of patients graded as responders (n = 7) versus non-responders (n = 9). We quantified 1,090 proteins in plasma and 1,087 proteins in the cerebrospinal fluid, of which 12 were differentially regulated in the same direction in both sample types. Functional analyses of differentially regulated proteins in protein-protein interaction networks suggested pathways of the immune system, axon guidance, and cellular stress response to be associated with response to MVD. These findings suggest potential biomarkers of response to MVD, as well as possible mechanisms of variable treatment success in TN patients. PERSPECTIVE: This exploratory study evaluates proteomic profiles in plasma and cerebrospinal fluid of patients undergoing microvascular decompression surgery for trigeminal neuralgia. Differential expression of proteins between surgery responders versus non-responders may serve as biomarkers to predict surgical success and provide insight into surgical mechanisms of pain relief in trigeminal neuralgia.
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Affiliation(s)
- Tina L. Doshi
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Susan G. Dorsey
- Department of Pain and Translational Symptom Science, University of Maryland, Baltimore, MD
| | - Weiliang Huang
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD
| | - Maureen A. Kane
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD
| | - Michael Lim
- Department of Neurosurgery, Stanford University, Palo Alto, CA
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Cui B, Wang N, Meng DW, Guo YP, Sun JD, Wang XS, Chen GQ, Wang L. Surgical management of nervus intermedius neuralgia: A report of 4 cases and literature review. J Clin Neurosci 2024; 121:11-17. [PMID: 38308978 DOI: 10.1016/j.jocn.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Nervus intermedius neuralgia (NIN) is characterized by paroxysmal episodes of sharp, lancinating pain in the deep ear. Unfortunately, only a few studies exist in the literature on this pain syndrome, its pathology and postoperative outcomes. METHOD We conducted a retrospective review of four cases diagnosed with NIN who underwent a neurosurgical intervention at our center from January 2015 to January 2023. Detailed information on their MRI examinations, intraoperative findings and other clinical presentations were obtained, and the glossopharyngeal and vagus nerves were isolated for immunohistochemistry examination. RESULTS A total of 4 NIN patients who underwent a microsurgical intervention at our institution were included in this report. The NI was sectioned in all patients and 3 of them underwent a microvascular decompression. Of these 4 patients, 1 had a concomitant trigeminal neuralgia (TN), and 1 a concomitant glossopharyngeal neuralgia (GPN). Three patients underwent treatment for TN and 2 for GPN. Follow-up assessments ranged from 8 to 99 months. Three patients reported complete pain relief immediately after the surgery until last follow-up, while in the remaining patient the preoperative pain gradually resolved over the 3 month period. Immunohistochemistry revealed that a greater amount of CD4+ and CD8+ T cells had infiltrated the glossopharyngeal versus vagus nerve. CONCLUSIONS NIN is an extremely rare condition showing a high degree of overlap with TN/GPN. An in depth neurosurgical intervention is effective to completely relieve NIN pain, without any serious complications. It appears that T cells may play regulatory role in the pathophysiology of CN neuralgia.
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Affiliation(s)
- Bin Cui
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Ning Wang
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Da-Wei Meng
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Yu-Peng Guo
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Ji-Dong Sun
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Xiao-Song Wang
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Guo-Qiang Chen
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Lin Wang
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China.
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Nishiyama Y, Hasegawa M, Adachi K, Hirose Y. Role of a Tortuous Vertebrobasilar Artery and Anchoring Perforators in the Etiology of Hemifacial Spasm. World Neurosurg 2024; 183:e707-e714. [PMID: 38185455 DOI: 10.1016/j.wneu.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
BACKGROUND In >70% of patients with hemifacial spasm (HFS), the offending artery is either the anterior inferior cerebellar artery (AICA) or posterior inferior cerebellar artery (PICA), without a tortuous vertebrobasilar artery (VBA). We hypothesized that anchoring perforators around the root exit zone (REZ) of the AICA or PICA might induce vascular deviation and compression. We investigated the occurrence of these perforators from the AICA or PICA and the extent of VBA tortuosity to reveal the pathology of vascular compression. METHODS This retrospective review included 110 patients after excluding those with vertebral artery (VA) compression alone. The occurrence of perforators was determined according to operative findings within 5 mm of the REZ, and VBA tortuosity was evaluated using MATLAB. We analyzed the association between perforators, VBA tortuosity, and the surgical implications. RESULTS The occurrence of perforators from the offending AICA or PICA around the REZ was significantly higher in the group without VA compression (Group A) than in the group with VA compression (Group B). VBA tortuosity was significantly lower in Group A. VBA tortuosity was inversely correlated with the presence of AICA or PICA perforators in all 110 patients. Operative results were similar between the groups, although patients with low VBA tortuosity tended to require interposition in decompression procedures. CONCLUSIONS Anchoring perforators around the REZ play a crucial role in vascular compression for patients with less tortuous VBAs. Moreover, surgeons should be prepared to deal with multiple perforators in a more complicated surgery in cases of less tortuous VBA.
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Affiliation(s)
- Yuya Nishiyama
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan.
| | - Mitsuhiro Hasegawa
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan; Department of Neurosurgery, Tokyo D Tower Hospital, Tokyo, Japan
| | - Kazuhide Adachi
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan
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Rheaume AR, Pietrosanu M, Ostertag C, Sankar T. Repeat Surgery for Recurrent or Refractory Trigeminal Neuralgia: A Systematic Review and Meta-Analysis. World Neurosurg 2024:S1878-8750(24)00310-3. [PMID: 38403014 DOI: 10.1016/j.wneu.2024.02.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Surgery can effectively treat Trigeminal neuralgia (TN), but postoperative pain recurrence or nonresponse are common. Repeat surgery is frequently offered but limited data exist to guide the selection of salvage surgical procedures. We aimed to compare pain relief outcomes after repeat microvascular decompression (MVD), percutaneous rhizotomy (PR), or stereotactic radiosurgery (SRS) to determine which modality was most efficacious for surgically refractory TN. METHODS A PRISMA systematic review and meta-analysis was performed, including studies of adults with classical or idiopathic TN undergoing repeat surgery. Primary outcomes included complete (CPR) and adequate (APR) pain relief at last follow-up, analyzed in a multivariate mixed-effect meta-regression of proportions. Secondary outcomes were initial pain relief and facial numbness. RESULTS Of 1299 records screened, 61 studies with 68 treatment arms (29 MVD, 14 PR, and 25 SRS) comprising 2165 patients were included. Combining MVD, PR, and SRS study data, 68.8% achieved initial CPR after a repeat TN procedure. On average, 49.6% of the combined sample of MVD, PR, and SRS had CPR at final follow-up, which was on average 2.99 years postoperatively. The proportion (with 95% CI) achieving CPR at final follow-up was 0.57 (0.51-0.62) for MVD, 0.60 (0.52-0.68) for PR, and 0.35 (0.30-0.41) for SRS, with a significantly lower proportion of pain relief with SRS. Estimates of initial CPR for MVD were 0.82 (0.78-0.85), 0.68 for PR (0.6-0.76), and 0.41 for SRS (0.35-0.48). CONCLUSIONS Across MVD, PR, and SRS, about half of TN patients maintain complete CPR at an average follow-up time of 3 years after repeat surgery. In treating refractory or recurrent TN, MVD and PR were superior to SRS in both initial pain relief and long-term pain relief at final follow-up. These findings can inform surgical decision-making in this challenging population.
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Affiliation(s)
- Alan R Rheaume
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Pietrosanu
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Curtis Ostertag
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tejas Sankar
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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Jiang C, Wang J, Chong Y, Xu W, Liang W. Microvascular decompression for hemifacial spasm after Bell's palsy: a retrospective clinical study. Neurosurg Rev 2024; 47:92. [PMID: 38396231 DOI: 10.1007/s10143-024-02328-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE This study aimed to investigate the clinical characteristics of hemifacial spasm (HFS) after Bell's palsy and to evaluate the therapeutic efficacy of microvascular decompression (MVD). METHODS A retrospective analysis was conducted on 18 patients who underwent MVD for HFS after Bell's palsy at our institution between January 1, 2017, and December 31, 2021. Clinical presentations, intraoperative findings, postoperative outcomes, and complications were comprehensively assessed. RESULTS Neurovascular compression (NVC) was identified in all the 18 patients. The offending vessels included anterior inferior cerebellar artery (AICA) in 6 patients (33.3%), posterior inferior cerebellar artery (PICA) in 7 patients (38.9%), vertebral artery (VA) combined with AICA in 3 patients (16.7%), and VA alongside PICA in 2 patients (11.1%). Notably, marked arachnoid membrane adhesion was evident in 11 patients (61.1%). 15(83.3%) patients were cured immediately after MVD, delayed relief was found in 3 (16.7%) patients. During the follow-up period, recurrence was not documented. Surgical complications were limited to facial paralysis in 3 patients and auditory impairment in 1 patient. No additional surgical complications were recorded. CONCLUSIONS In patients manifesting HFS after Bell's palsy, NVC predominantly underlies the etiology. MVD is a reliably safe and efficacious therapeutic intervention.
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Affiliation(s)
- Chengrong Jiang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu, 210009, China
| | - Jing Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu, 210009, China
| | - Yulong Chong
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu, 210009, China
| | - Wu Xu
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu, 210009, China.
| | - Weibang Liang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu, 210009, China.
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12
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Zheng X, Zhang B, Shao D, Cai L, Xie S, Li Y, Jiang Z. Fully endoscopic microvascular decompression for hemifacial spasm: a clinical study and analysis. Neurosurg Rev 2024; 47:83. [PMID: 38363437 PMCID: PMC10873216 DOI: 10.1007/s10143-024-02311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/14/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
Fully endoscopic microvascular decompression (MVD) of the facial nerve is the main surgical treatment for hemifacial spasm. However, the technique presents distinct surgical challenges. We retrospectively analyzed prior cases to consolidate surgical insights and assess clinical outcomes. Clinical data from 16 patients with facial nerve spasms treated at the Department of Neurosurgery in the First Affiliated Hospital of Bengbu Medical College, between August 2020 and July 2023, were retrospectively examined. Preoperatively, all patients underwent magnetic resonance angiography to detect any offending blood vessels; ascertain the relationship between offending vessels, facial nerves, and the brainstem; and detect any cerebellopontine angle lesions. Surgery involved endoscopic MVD of the facial nerve using a mini Sigmoid sinus posterior approach. Various operative nuances were summarized and analyzed, and clinical efficacy, including postoperative complications and the extent of relief from facial paralysis, was evaluated. Fully endoscopic MVD was completed in all patients, with the offending vessels identified and adequately padded during surgery. The offending vessels were anterior inferior cerebellar artery in 12 cases (75%), vertebral artery in 3 cases (18.75%), and posterior inferior cerebellar artery in 1 case (6.25%). Intraoperative electrophysiological monitoring revealed that the lateral spread response of the facial nerve vanished in 15 cases and remained unchanged in 1 case. Postoperative facial spasms were promptly alleviated in 15 cases (93.75%) and delayed in 1 case (6.25%). Two cases of postoperative complications were recorded-one intracranial infection and one case of tinnitus-both were resolved or mitigated with treatment. All patients were subject to follow-up, with no instances of recurrence or mortality. Fully endoscopic MVD of the facial nerve is safe and effective. Proficiency in endoscopy and surgical skills are vital for performing this procedure.
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Affiliation(s)
- Xialin Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
- School of Continuing Education, Anhui Medical University, Hefei, China
| | - Binbin Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Dongqi Shao
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Longjie Cai
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Shan Xie
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Yu Li
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Zhiquan Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China.
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13
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Revuelta-Gutiérrez R, Contreras-Vázquez OR, Piñón-Jiménez F, Martínez-Anda JJ. Trigeminal neuralgia secondary to epidermoid cyst and neurovascular conflict: An illustrative case with literature review. Surg Neurol Int 2024; 15:36. [PMID: 38468668 PMCID: PMC10927216 DOI: 10.25259/sni_925_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/09/2024] [Indexed: 03/13/2024] Open
Abstract
Background Trigeminal neuralgia (TN) is a highly disabling facial pain syndrome, historically known as the suicide disease, in which most cases can be cured with appropriate surgical treatment. Case Description We present the case of a 43-year-old male farmer with acute, self-limiting episodes of shock-like pain on the left side of the face that started in June of 2021. He was diagnosed with TN and was treated with carbamazepine. Magnetic resonance imaging was performed, which revealed an epidermoid cyst (EC) at the prepontine cistern with an extension to the left cerebellopontine angle. The neurosurgery department at our institution was consulted, which performed surgical tumor resection and Vth cranial nerve decompression. During the resection, a neurovascular conflict (NVC) was identified at the root entry zone. After the resection around the nerve and its whole tract was completed, a microvascular decompression (MVD) was performed. Conclusion TN secondary to EC in association with a NVC is a rare phenomenon, due to the growth pattern of the EC. TN may remit if an appropriate treatment is carried out. In cases of NVC, an MVD is required apart from an appropriate resection to achieve pain relief.
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14
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Sharafudeen A, Komatsu F, Kabulo KDM, Kato Y. How I do it: endoscopic microvascular decompression for hemifacial spasm associated with anterior inferior cerebellar artery-posterior inferior cerebellar artery common trunk. Acta Neurochir (Wien) 2024; 166:49. [PMID: 38289407 DOI: 10.1007/s00701-024-05963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/06/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Multiple vessels from the anterior inferior cerebellar artery-posterior inferior cerebellar artery common trunk (APC) variation of the posterior circulation can cause hemifacial spasm (HFS). METHOD Endoscopic microvascular decompression (eMVD) was performed using 0° and 30° endoscopes through a retrosigmoid keyhole. The root exit zone (REZ) was decompressed by transpositioning the offending anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) arising from the APC under excellent endoscopic view. CONCLUSION eMVD is an advanced, minimally invasive and reliable technique to resolve the neurovascular conflict (NVC) in HFS due to offenders from APC.
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Affiliation(s)
- Afsal Sharafudeen
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Japan.
| | - Fuminari Komatsu
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Japan
| | | | - Yoko Kato
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Japan
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15
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Nunta-Aree S, Kateyoi T, Sitthinamsuwan B. Delayed complete remission of hemifacial spasms following microvascular decompression and the implications for optimal time of revision surgery. Acta Neurochir (Wien) 2024; 166:12. [PMID: 38227077 DOI: 10.1007/s00701-024-05891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Microvascular decompression (MVD) is an effective method for directly treating hemifacial spasms (HFS). The timing for the consideration of failed MVD and reoperation has been paradoxical. OBJECTIVE This study aimed to investigate the delayed complete remission of HFS in terms of prevalence rate, duration between surgery and delayed complete remission, and predictive factors. METHODS A hundred patients with HFS who underwent MVD from 2012-2021 were enrolled in the study. All HFS occurred as a result of compression of the facial nerve by adjacent blood vessels. Clinical information, intraoperative findings, and surgical outcomes were incorporated for data analysis. RESULTS In the first week after MVD, 67 of 100 patients achieved complete remission of HFS, while the remaining 33 had incomplete remission. In long-term follow-up, 26 individuals gradually developed delayed complete remission with a median duration of 9.1 months. Finally, 86 of 100 patients achieved complete long-term remission. Recurrent HFS and incomplete remission were found in 7 and 7 patients, respectively. Factors associated with postoperative complete remission in the first week were a severe degree of facial nerve compression (p = 0.047, OR 2.75, 95% CI 1.01-7.40), with long-term complete remission was left-sided HFS (p = 0.012, OR 5.73, 95% CI 1.47-22.36), and with the appearance of delayed complete remission was the prolonged duration of HFS at least 3 years before MVD (p = 0.046, OR 3.75, 95% CI 1.03-13.76). Transient facial paresis was found in 11% of the patients. Of them, facial nerve function recovered completely in all cases. CONCLUSIONS A delayed complete remission of HFS could be expected in long-term follow-up after MVD and is probably related to a longer duration of HFS before surgery. Unnecessary reoperation should be avoided in the early years following the first surgery.
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Affiliation(s)
- Sarun Nunta-Aree
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Thanthip Kateyoi
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
- Department of Surgery, Prajuabkirikhan Hospital, Prajuabkirikhan, Thailand
| | - Bunpot Sitthinamsuwan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand.
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16
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Xie ME, Halbert-Elliott K, Nair SK, Huang J, Yedavalli VS, Bettegowda C, Xu R. Application of Sequential Thresholding-Based Automated Reconstruction of the Trigeminal Nerve in Trigeminal Neuralgia. World Neurosurg 2024; 181:e567-e577. [PMID: 37890771 DOI: 10.1016/j.wneu.2023.10.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE High-resolution magnetic resonance imaging (MRI) of the trigeminal nerve is indispensable for workup of trigeminal neuralgia (TN) before microvascular decompression; however, the evaluation is often subjective and prone to variability. We aim to develop and assess sequential thresholding-based automated reconstruction of the trigeminal nerve (STAR-TN) as an algorithm for segmenting the trigeminal nerve and contacting structures that will allow for a structured method for assessing neurovascular conflict. METHODS A total of 42 patients with TN who underwent high-resolution MRI before microvascular decompression in 2022 were included in our study. Segmentation of the trigeminal nerve and contacting structures was performed on preoperative MRI scans using STAR-TN. The segmentations were then evaluated for neurovascular conflict and compared to the preoperative radiology and operative notes. Geometric features, including the area of contact and distance to conflict, were extracted. RESULTS Of the 42 patients, 32 (76.2%) were found to show neurovascular conflict based solely on their STAR-TN segmentations and 10 (23.8%) were found to not show neurovascular conflict. Compared with the intraoperative findings, this resulted in a sensitivity of 78.0% and specificity of 100%. In contrast, assessments of neurovascular conflict by radiologists using only 2-dimensional MRI views had a sensitivity of 68.3% and specificity of 100%. Of the 32 patients with neurovascular conflict, 29 (90.9%) had conflict within the root entry zone. Overall, the patients had a median area of contact of 10.66 mm2. CONCLUSIONS STAR-TN allows for 3-dimensional visualization and identification of neurovascular conflict with improved sensitivity compared with neuroradiologist assessments from MRI slices.
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Affiliation(s)
- Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kyra Halbert-Elliott
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vivek S Yedavalli
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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17
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Kasimu M, Tuersun M, Maimaitituerxun Y, Abulizi W, Li S, Fulati N. Abnormal Rhomboid Lip and Choroid Plexus Should be Valued in Microvascular Decompression for Vestibulocochlear Diseases. World Neurosurg 2024; 181:e607-e614. [PMID: 37898278 DOI: 10.1016/j.wneu.2023.10.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Surgical outcomes for functional vestibulocochlear diseases vary, and the influencing factors are not fully understood. The role of a rhomboid lip (RL) and choroid plexus (CP) in microvascular decompression (MVD) of the vestibulocochlear nerve has not been studied. This study aims to evaluate the surgical efficacy of MVD for vestibulocochlear diseases, with and without addressing the RL and CP, to enhance our understanding of their etiology. METHODS A total of 15 patients who underwent MVD for the vestibulocochlear nerve between 2013 and 2022 were retrospectively identified and followed up. The patients were classified into 4 categories: vestibular paroxysmia (VP), benign positional paroxysmal vertigo (BPPV), and Meniere disease (MD). The fourth was a "tinnitus" group. The relief of symptoms, recurrence, satisfaction after surgery, available relevant imaging studies, and intraoperative observation data were evaluated. RESULTS Following MVD, 6 of the 7 patients in the VP group, the 1 patient in the BPPV group, and 1 of 2 patients in the MD group were completely relieved of vertigo. The seventh VP patient showed significant improvement. The 5 patients in the "tinnitus" group remained unchanged. Retrospectively, 4 patients from the VP, BPPV, and MD groups who underwent RL incision and CP excision were also free of vertigo, although vascular compression was not confirmed in these cases. CONCLUSIONS MVD is generally considered a useful treatment for VP and could also be effective in managing recurrent vertigo caused by BPPV and MD. Our results highlight the potential role of an abnormal RL and CP in the development of vertigo symptoms. Patients presenting with "tinnitus" require further investigation and might not be suitable for MVD.
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Affiliation(s)
- Maimaitijiang Kasimu
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China.
| | - Maidina Tuersun
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Yiliyasijiang Maimaitituerxun
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Wulamuaili Abulizi
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Shu Li
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Nijiati Fulati
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
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18
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Niazi F, Elkaim LM, Zadeh Khomami NM, Levett JJ, Weil AG, Hodaie M, Alotaibi NM. Microvascular Decompression and Trigeminal Neuralgia: Patient Sentiment Analysis Using Natural Language Processing. World Neurosurg 2023; 180:e528-e536. [PMID: 37778624 DOI: 10.1016/j.wneu.2023.09.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Microvascular decompression (MVD) as a treatment for trigeminal neuralgia (TGN) has high success rate but is associated with risks of complication. This study analyzes Twitter to provide insights into discussions surrounding MVD for patients with TGN. METHODS A Twitter search performed in April 2022 yielded 491 tweets from 426 accounts. Tweets and accounts were classified thematically, and descriptive statistics were used for various social media metrics. Using a natural language processing machine learning algorithm, sentiment analysis (SA) was performed to evaluate patient perspectives before and after surgery, and a multivariate regression model was used to identify predictors of higher engagement metrics (likes, retweets, quote tweets, replies). RESULTS Most accounts were patients, caregivers, and other members of the public (70%). The most encountered themes were research (47%) and personal experiences (33.4%). SA of tweets about patient experiences showed that 40.2% of tweets were positive, 31.1% were neutral and 28.7% were negative. Negative tweets decreased significantly in postoperative tweets and mostly discussed complications or failure of surgery (63%). On multivariate analysis, only inclusion of media (photo or video) in a Tweet was associated with higher engagement metrics. CONCLUSIONS This study provides a comprehensive review of Twitter use discussing MVD in TGN and is the first to assess patient satisfaction after treatment using SA. The data presented on patient perspectives on social media could help physicians establish direct lines of communication with patients, fostering a more patient-focused care.
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Affiliation(s)
- Farbod Niazi
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Lior M Elkaim
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
| | | | - Jordan J Levett
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Alexander G Weil
- Division of Neurosurgery, Sainte Justine Hospital, Montreal, Quebec, Canada
| | - Mojgan Hodaie
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Naif M Alotaibi
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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Bezerra GMDS, Leal PRL, Cavalcante-Neto JF, Rivera A, da Ponte KF, Cristino-Filho G. Microvascular decompression using autologous muscle graft for trigeminal neuralgia: a case series and meta-analysis. Acta Neurochir (Wien) 2023; 165:3833-3843. [PMID: 38059995 DOI: 10.1007/s00701-023-05871-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/14/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE We aimed to describe a case series of patients diagnosed with trigeminal neuralgia (TN) who were submitted to microvascular decompression (MVD) using autologous muscle graft (AMG) and perform a systematic review and meta-analysis. METHODS Forty-four adult patients who underwent MVD using AMG between 2012 and 2022 were studied retrospectively. Demographic, clinical, and surgical factors were assessed. We systematically reviewed PubMed, Embase, and Cochrane Library from inception to May 2023. We used random-effects model for all outcomes. Heterogeneity was assessed with I2. We used R software 4.3.1 for all statistical analyses. RESULTS Among patients in the case series, the mean age was 52 ± 12.9 years, and the proportion of females was 65.9%. Forty-one patients (93.2%) presented complete pain relief after a mean follow-up of 7.7 years. The pooled analysis of immediate pain relief was 91.3% (95% CI 82-96%; I2=78%). The good pain relief during follow-up was 88.2% (95% CI 78-94%; I2=80%) at follow-up. The recurrence rates at 6, 12, 36 months, and during follow-up were 6.2%, 10.5%, 10.3%, and 11%, respectively. CONCLUSION In this case series and meta-analysis of over 440 patients, our findings suggest that the practice of MVD using AMG may be an efficient option in the short term as surgical treatment for TN. Further trials should compare AMG with other materials and its effectiveness in a long-term follow-up.
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Affiliation(s)
| | - Paulo Roberto Lacerda Leal
- Departament of Neurosurgery, Federal University of Ceará, 100 Comandante Maurocélio Rocha Pontes Avenue, Sobral, Ceará, 62042-250, Brazil.
- Department of Neurosurgery, North Regional Hospital, Sobral, Brazil.
| | - Joaquim Francisco Cavalcante-Neto
- Departament of Neurosurgery, Federal University of Ceará, 100 Comandante Maurocélio Rocha Pontes Avenue, Sobral, Ceará, 62042-250, Brazil
| | - André Rivera
- Department of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil
| | - Keven Ferreira da Ponte
- Departament of Neurosurgery, Federal University of Ceará, 100 Comandante Maurocélio Rocha Pontes Avenue, Sobral, Ceará, 62042-250, Brazil
- Department of Neurosurgery, North Regional Hospital, Sobral, Brazil
| | - Gerardo Cristino-Filho
- Departament of Neurosurgery, Federal University of Ceará, 100 Comandante Maurocélio Rocha Pontes Avenue, Sobral, Ceará, 62042-250, Brazil
- Department of Neurosurgery, North Regional Hospital, Sobral, Brazil
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Hatipoglu Majernik G, Wolff Fernandes F, Al-Afif S, Heissler HE, Krauss JK. Microsurgical posterior fossa re-exploration for recurrent trigeminal neuralgia after previous microvascular decompression: common grounds-scarring, deformation, and the "piston effect". Acta Neurochir (Wien) 2023; 165:3877-3885. [PMID: 37955684 PMCID: PMC10739219 DOI: 10.1007/s00701-023-05877-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Microvascular decompression (MVD) is a well-accepted treatment modality for trigeminal neuralgia (TN) with high initial success rates. The causes for recurrence of TN after previously successful MVD have not been fully clarified, and its treatment is still a matter of debate. Here, we present the surgical findings and the clinical outcome of patients with recurrent TN after MVD who underwent posterior fossa re-exploration. METHODS Microsurgical posterior fossa re-exploration was performed in 26 patients with recurrent TN (mean age 59.1 years) who underwent MVD over a period of 10 years. The trigeminal nerve was exposed, and possible factors for recurrent TN were identified. Arachnoid scars and Teflon granulomas were dissected meticulously without manipulating the trigeminal nerve. Outcome of posterior fossa re-exploration was graded according to the Barrow Neurological Institute (BNI) pain intensity score. Follow-up was analyzed postoperatively at 3, 12, and 24 months and at the latest available time point for long-term outcome. RESULTS The mean duration of recurrent TN after the first MVD was 20 months. Pain relief was achieved in all patients with recurrent TN on the first postoperative day. Intraoperative findings were as follows: arachnoid scar tissue in 22/26 (84.6%) patients, arterial compression in 1/26 (3.8%), venous contact in 8/26 (30.8%), Teflon granuloma in 14/26 (53.8%), compression by an electrode in Meckel's cave used for treatment of neuropathic pain in 1/26 (3.8%), evidence of pulsations transmitted to the trigeminal nerve through the Teflon inserted previously/scar tissue ("piston effect") in 15/26 (57.7%), and combination of findings in 18/26 (69.2%). At long-term follow-up (mean 79.5 months; range, 29-184 months), 21/26 (80.8%) patients had favorable outcome (BNI I-IIIa). New hypaesthesia secondary to microsurgical posterior fossa re-exploration occurred in 5/26 (19.2%) patients. CONCLUSIONS Posterior fossa re-exploration avoiding manipulation to the trigeminal nerve, such as pinching or combing, may be a useful treatment option for recurrent TN after previously successful MVD providing pain relief in the majority of patients with a low rate of new hypaesthesia.
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Affiliation(s)
- Gökce Hatipoglu Majernik
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Lower Saxony, Germany
| | - Filipe Wolff Fernandes
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Lower Saxony, Germany.
| | - Shadi Al-Afif
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Lower Saxony, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Lower Saxony, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Lower Saxony, Germany
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Kilgore CB, Kalluri AL, Nair SK, Halbert-Elliot KM, Ejimogu E, Dong B, Chakravarti S, Abdulrahim MW, Jackson CM, Lim M, Huang J, Bettegowda C, Xu R. Frailty Predicts Worse Pain Outcomes for Older TN Patients Treated with Microvascular Decompression. World Neurosurg 2023; 180:e700-e705. [PMID: 37821032 DOI: 10.1016/j.wneu.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a debilitating orofacial pain disorder. Recent data from a national database suggest that microvascular decompression (MVD) in frail patients is associated with more postoperative complications. However, the long-term pain outcomes for frail TN patients are not known. We aimed to elucidate the relationship between frailty and long-term pain outcomes after MVD for TN. METHODS From 2007 to 2020, 368 TN patients aged ≥60 years underwent MVD at our institution. Patient demographics, clinical characteristics, postoperative complications, and long-term pain outcomes were recorded. Frailty was assessed using the modified 5-item frailty index (mFI-5) score, and the patients were dichotomized into nonfrail (mFI-5 <2) and frail (mFI-5 >1). Differences were assessed via the t test, χ2 test, multivariate ordinal regression, and Cox proportional hazards analysis. RESULTS Of the 368 patients analyzed, 9.8% were frail. The frail patients were significantly older (P = 0.02) with a higher body mass index (P = 0.01) and a greater incidence of comorbidities (P < 0.001). Frail patients presented with significantly higher pain levels at the final follow-up (P = 0.04). On multivariate analysis, frailty was independently associated with more pain at follow-up (P = 0.01), as was younger age, female sex, and black race. The relationship between frailty and postoperative pain recurrence showed a trend toward significance (P = 0.06), and younger age and black race were significantly associated with recurrence. CONCLUSIONS Frail patients undergoing MVD are at risk of worse long-term pain outcomes. Our results provide clinicians with useful information pertaining to the influence of frailty on the long-term efficacy of MVD in treating TN.
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Affiliation(s)
- Collin B Kilgore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anita L Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kyra M Halbert-Elliot
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emeka Ejimogu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bryan Dong
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sachiv Chakravarti
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mostafa W Abdulrahim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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22
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Carnevale JA, Knopman J. Atrophy and Severe Kinking of Trigeminal Nerve Root by Duplicate Trunks of Superior Cerebellar Artery in an Elderly Patient with Trigeminal Neuralgia. World Neurosurg 2023; 179:100-101. [PMID: 37625634 DOI: 10.1016/j.wneu.2023.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
Trigeminal neuralgia, or tic douloureux, clinically presents as a unilateral paroxysmal, stabbing, intense pain of the face, lasting for seconds but occurring frequently. Alternative causes including multiple sclerosis or mass of the brainstem or cranial nerves must be ruled out. Medical treatment, most commonly with carbamazepine, remains an effective first-line treatment. Ultimately, if medical management becomes refractory or symptoms progressive, then procedural and surgical options including microvascular decompression, stereotactic radiosurgery, radiofrequency thermocoagulation, and others should be considered. Most notably, microvascular decompression, as in this case, can be considered with an 85%-95% initial success rate.
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Affiliation(s)
- Joseph A Carnevale
- Department of Neurological Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA.
| | - Jared Knopman
- Department of Neurological Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
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Almqvist Téran N, Loayza R, Wikström J, Ericson H, Abu Hamdeh S, Svedung Wettervik T. Posterior Fossa Volume and Dimensions: Relation to Pathophysiology and Surgical Outcomes in Classic Trigeminal Neuralgia. World Neurosurg 2023; 179:e397-e403. [PMID: 37652132 DOI: 10.1016/j.wneu.2023.08.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE A small posterior fossa (PF) has been hypothesized to explain the increased incidence of trigeminal neuralgia (TN) in females and could make microvascular decompression (MVD) more challenging. The aim of this study was to investigate the association between the PF volume and dimensions in relation to biological sex, type of neurovascular conflict (NVC), and outcome after MVD in classic TN. METHODS In this observational study, 84 patients with TN operated on with MVD with a preoperative head computed tomography(CT) scan were included. Eighty-two adults without TN who had undergone head CT for other reasons were included as controls. PF volume and dimensions (x-axis, y-axis, and z-axis) were evaluated on the CT scans. For the patients with TN, Barrow Neurological Institute (BNI) grade was evaluated 6 months after MVD. RESULTS There was no difference in PF volume or dimensions between the patients with TN and controls. Women showed a smaller volume and narrower (x-axis) PF than men, but these differences did not manifest when comparing patients with TN and controls within each sex. Patients with an NVC involving the superior cerebellar artery had a narrower (x-axis) and shorter (y-axis) PF than did patients with an NVC resulting from other arteries. PF volume or dimensions were not associated with BNI grade after MVD. CONCLUSIONS PF anatomy was related to the NVC type but did not differ between patients with TN and controls and was not related to the surgical outcome after MVD.
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Affiliation(s)
- Nicolas Almqvist Téran
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Richard Loayza
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Johan Wikström
- Department of Surgical Sciences, Section of Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Hans Ericson
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Sami Abu Hamdeh
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
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Hashikata H, Maki Y, Futamura G, Yoshimoto N, Goto M, Hayashi H, Nishida N, Iwasaki K, Toda H. Functionality and Usability of the Exoscope in Microvascular Decompression for Hemifacial Spasm and Trigeminal Neuralgia. World Neurosurg 2023; 179:e539-e548. [PMID: 37683924 DOI: 10.1016/j.wneu.2023.08.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Studies on the functionality and usability of the exoscope in neurosurgical procedures against surgical microscopes (SMs) are limited. This study aimed to examine the functionality and usability of the exoscope during microvascular decompression (MVD) surgery. METHODS Seven neurosurgeons evaluated the usefulness of a 4 K, 3-dimension digital exoscope in MVD by answering a questionnaire. The questionnaire inquired about the functionality and usability of the exoscope by utilizing a visual analog scale (VAS; 1-10). A score of 5 on VAS was equivalent to the corresponding quality of the SM. The learning effect of the exoscope was evaluated using mean VAS scores in the first and last 3 cases for each neurosurgeon. RESULTS The functionality of the exoscope in MVD was superior to that in SM (P < 0.001). In the last 3 surgeries, the mean VAS scores of the exoscope were excellent in terms of ease of arm handling, exchange of surgical instruments, ease of surgical procedure, and intraoperative physical stress. The mean VAS scores of the exoscope in intraoperative asthenopia were significantly higher than those of the SM (P < 0.001). No statistical significance was found in operation time, discharge outcome, and 1-year post-surgery outcome between MVD performed using the exoscope and SM. CONCLUSIONS Neurosurgeons may experience reduced stress levels during MVD when using the exoscope. As the outcome of MVD using the exoscope did not demonstrate a statistical difference compared with MVD using the SM, the exoscope may prove to be a useful tool for performing MVD.
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Affiliation(s)
- Hirokuni Hashikata
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan.
| | - Yoshinori Maki
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone, Japan; Department of Rehabilitation, Hikari Hospital, Otsu, Japan
| | - Gen Futamura
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Naoya Yoshimoto
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Masanori Goto
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Hideki Hayashi
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Namiko Nishida
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Koichi Iwasaki
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Hiroki Toda
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
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Guan H, Li S, Wang X. Fully endoscopic microvascular decompression for trigeminal neuralgia: technical note and early outcomes. Neurosurg Rev 2023; 46:292. [PMID: 37910277 DOI: 10.1007/s10143-023-02188-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
Microscopic microvascular decompression (MVD) has been considered a curative and reliable method for treating classical trigeminal neuralgia (TN) for decades. Endoscopy can provide bright illumination and a panoramic view, which enhances the visualization of the posterior fossa. In view of the above advantages of endoscopy, it gradually became an option for MVD for treating TN. This study was performed to evaluate the advantages of fully endoscopic MVD for treating TN and is presented with a description of our operative technique. From January 2020 to January 2022, 95 classical TN patients underwent fully endoscopic MVD performed by the same surgeon and assistant in our department. The assistant held the endoscope, and the surgeon operated. Brain stem auditory evoked potentials (BEMPs) were routinely monitored. For every patient, the neurovascular conflict was identified, and complete decompression was achieved. The Barrow Neurological Institute (BNI) pain intensity score was used to evaluate the degree of facial pain. The intraoperative findings, postoperative outcomes, and complications were analyzed. Immediately after the operation, 93 patients (97.9%) achieved complete pain relief (BNI score of I). Two patients (2.1%) still had some pain, but it could be adequately controlled with medicine (BNI score of III). During the 12-36 months of follow-up, recurrence was found in 3 patients (3.2%), including one patient (1.1%) with a BNI score of II and 2 patients (2.1%) with a BNI score of III. Complications were found in 5 patients (5.3%), including facial numbness in 3 patients (3.2%), vertigo in one patient (1.1%), and headache in one patient (1.1%). There were no cases of mortality, stroke, hearing impairment, facial paralysis, or other complications. Fully endoscopic MVD is a safe and effective method for treating TN. It provides bright illumination and a panoramic view for surgeons to better observe neurovascular conflicts in deep areas of the cerebellopontine angle (CPA).
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Affiliation(s)
- Hongpeng Guan
- Department of Neurosurgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Kongjiang Road & No.1665, Shanghai, 200092, China
| | - Shiting Li
- Department of Neurosurgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Kongjiang Road & No.1665, Shanghai, 200092, China
| | - Xuhui Wang
- Department of Neurosurgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Kongjiang Road & No.1665, Shanghai, 200092, China.
- Department of Neurosurgery, Chongming Hospital Affiliated with Shanghai University of Medicine and Health Sciences, Nanmen Road & No. 25, Shanghai, 202150, China.
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Alkhayri A, Bourdillon P, Chauvet D, Bugdadi A, Alyousef M, Alsalmi S, Apra C, Lefaucheur JP, Aldea S, Le Guérinel C. Surgical treatment of hemifacial spasms: how to predict failure and complications through a series of 200 patients. Neurochirurgie 2023; 69:101498. [PMID: 37741362 DOI: 10.1016/j.neuchi.2023.101498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/16/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023]
Abstract
Primary hemifacial spasm (pHFS) is a benign but disabling movement disorder caused by a neurovascular conflict involving the facial nerve. Surgical treatment by microvascular decompression (MVD) is the most effective therapeutic. Predictors of surgical failure and surgical complications are still lacking. The aim of this study is to identify such predictors through the retrospective analysis of a series of 200 consecutive patients. All patients who underwent MVD for pHFS from January 1991 to December 2017 were included. All patients had at least two years follow-up. In addition to the demographic data, the outcome and the complications were collected. The primary outcome analysis showed that 7.5% of patients had a recurrence. Multiple and AICA related neurovascular conflicts were statistically associated to a higher recurrence rate after MVD (respectively p < 0.001 and p = 0.02). Permanent facial palsy occurred in 2.5% of patients, hearing loss in 9.0% (2.0% of complete unilateral impairment) and dizziness in 2.5%. The risk of each of these peripheral neurological impairments was statistically increased by a long duration between the first pHFS symptom and the MVD (p < 0.001). In case of recurrence, a second MDV was offered. Long term follow-up showed that all patients had a complete resolution of the HFS. Post-operative complication rate was not significantly increased after a second MVD. Multiple and AICA related neurovascular conflicts are associated to a higher risk of surgical failure. When a pHFS recurrence occurs, a second surgical procedure is associated with excellent outcome without significant increase of post-operative complications and should therefore be recommended.
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Affiliation(s)
- Abdu Alkhayri
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France; Paris Cité University, Faculty of Medicine, Paris, France
| | - Pierre Bourdillon
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France; Paris Cité University, Faculty of Medicine, Paris, France.
| | - Dorian Chauvet
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Abdulgadir Bugdadi
- Department of Surgery, Faculty of Medicine, Umm Al Qura University, Makkah, Almukarramah, Saudi Arabia
| | - Mohammed Alyousef
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sultan Alsalmi
- Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Caroline Apra
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France; Sorbonne University, Faculty of Medicine, Paris, France
| | - Jean-Pascal Lefaucheur
- Department of Neuro-physiology, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France; University of Paris-Est, Paris, France
| | - Sorin Aldea
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
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Chen L, Shang Y, Zhang Y, Zhao Y. Endoscopic microvascular decompression versus microscopic microvascular decompression for trigeminal neuralgia: A systematic review and meta-analysis. J Clin Neurosci 2023; 117:73-78. [PMID: 37776679 DOI: 10.1016/j.jocn.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/11/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND To compare the efficacy and safety of full endoscopic or endoscope-assisted microvascular decompression (E-MVD) and microscopic microvascular decompression (M-MVD) for primary trigeminal neuralgia (TN). METHODS We systematically searched the online database, including PubMed, Embase and Cochrane Library. The search terms used included, but were not limited to, "Trigeminal Neuralgia", "Microvascular Decompression Surgery" and "Endoscope". Postoperative facial pain relief and postoperative complications were considered for meta-analysis. All the outcomes were calculated as odds ratios (ORs) with 95% confidence intervals using R language. RESULTS A total of three studies involving 442 (E-MVD [218] versus M-MVD [224]) patients were included for analysis in our study. Postoperative facial pain relief (very much improved or much improved) was no difference between the two groups (OR, 0.95;95% CI, 0.57-1.58; I2 = 0%; p = 0.83). In addition, the occurrence of some postoperative complications was not statistically different between the two groups, including CSFleak (OR, 1.35;95% CI, 0.16-11.13; I2 = 0%; p = 0.94), facial paralysis (OR, 0.26;95% CI, 0.03-2.54; I2 = 0%; p = 0.67), hearing loss (OR, 0.87;95% CI, 0.30-2.55; I2 = 32%; p = 0.22), facial numbness (OR, 1.03;95% CI, 0.56-1.87; I2 = 62%; p = 0.10). CONCLUSIONS Both endoscopic microvascular decompression and microscopic microvascular decompression for trigeminal neuralgia appear to provide patients with equivalent facial pain relief outcomes. Complication rates were also similar between the groups.
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Affiliation(s)
- Lulu Chen
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Yuchun Shang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Yesen Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Yongxuan Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China.
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Peng W, Zhao R, Guan F, Liang X, Jing B, Zhu G, Mao B, Hu Z. Fully endoscopic microvascular decompression for the treatment of hemifacial spasm, trigeminal neuralgia, and glossopharyngeal neuralgia: a retrospective study. BMC Surg 2023; 23:331. [PMID: 37891595 PMCID: PMC10612333 DOI: 10.1186/s12893-023-02214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Microvascular decompression (MVD) is already the preferred surgical treatment for medically refractory neurovascular compression syndromes (NVC) such as hemifacial spasm (HFS), trigeminal neuralgia (TN), and glossopharyngeal neuralgia (GPN). Endoscopy has significantly advanced surgery and provides enhanced visualization of MVD. The aim of this study is to analyze the efficacy and safety of fully endoscopic microvascular decompression (E-MVD) for the treatment of HFS, TN, and GPN, as well as to present our initial experience. MATERIALS AND METHODS This retrospective case series investigated fully E-MVD performed in 248 patients (123 patients with HFS, 115 patients with TN, and 10 patients with GPN ) from December 2008 to October 2021 at a single institution. The operation duration, clinical outcomes, responsible vessels, intra- and postoperative complications, and recurrences were recorded. Preoperative and immediate postoperative magnetic resonance imaging (MRI) and computerized tomography (CT) were performed for imageological evaluation. The Shorr grading and Barrow Neurological Institute (BNI) pain score were used to evaluate clinical outcomes. The efficacy, safety, and risk factors related to the recurrence of the operation were retrospectively analysed, and the surgical techniques of fully E-MVD were summarised. RESULTS A total of 248 patients (103 males) met the inclusion criteria and underwent fully E-MVD were retrospectively studied. The effective rate of 123 patients with HFS was 99.1%, of which 113 cases were completely relieved and 9 cases were significantly relieved. The effective rate of 115 patients with TN was 98.9%, of which 105 cases had completely pain relieved after surgery, 5 cases had significant pain relieved, 4 cases had partial pain relieved but still needed to be controlled by medication. The effective rate of 10 patients with GPN was 100%, 10 cases of GPN were completely relieved after surgery. As for complications, temporary facial numbness occurred in 4 cases, temporary hearing loss in 5 cases, dizziness with frequent nausea and vomiting in 8 cases, headache in 12 cases, and no cerebral hemorrhage, intracranial infection, and other complications occurred. Follow-up ranged from 3 to 42 months, with a mean of 18.6 ± 3.3 months. There were 4 cases of recurrence of HFS and 11 cases of recurrence of TN. The other effective patients had no recurrence or worsening of postoperative symptoms. The cerebellopontine angle (CPA) area ratio (healthy/affected side), the length of disease duration, and the type of responsible vessels are the risk factors related to the recurrence of HFS, TN, and GPN treated by fully E-MVD. CONCLUSIONS In this retrospective study, our results suggest that the fully E-MVD for the treatment of NVC such as HFS, TN, and GPN, is a safe and effective surgical method. Fully E-MVD for the treatment of NVC has advantages and techniques not available with microscopic MVD, which may reduce the incidence of surgical complications while improving the curative effect and reducing the recurrence rate.
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Affiliation(s)
- Weicheng Peng
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Haidian District, Beijing, 100038, China
| | - Rui Zhao
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Haidian District, Beijing, 100038, China
| | - Feng Guan
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Haidian District, Beijing, 100038, China
| | - Xin Liang
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Haidian District, Beijing, 100038, China
| | - Bei Jing
- Department of Neurosurgery, Peking University Ninth School of Clinical Medicine, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 10038, China
| | - Guangtong Zhu
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Haidian District, Beijing, 100038, China
| | - Beibei Mao
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Haidian District, Beijing, 100038, China
| | - Zhiqiang Hu
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Haidian District, Beijing, 100038, China.
- Department of Neurosurgery, Peking University Ninth School of Clinical Medicine, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 10038, China.
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Wu Z, Zhao Y, Wu F, Fan Y, Yang Y. Percutaneous radiofrequency thermocoagulation and microvascular decompression for treating glossopharyngeal neuralgia: a retrospective clinical study. BMC Neurol 2023; 23:384. [PMID: 37872489 PMCID: PMC10591372 DOI: 10.1186/s12883-023-03415-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/30/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the differences in the effectiveness of percutaneous radiofrequency thermocoagulation (PRT) and microvascular decompression (MVD) in treating glossopharyngeal neuralgia (GPN). METHODS Medical records of patients were reviewed to investigate their baseline characteristics and immediate postoperative prognosis. Long-term outcomes of these patients were obtained through telephone interviews. Visual analog scale (VAS) and Pittsburgh sleep quality index (PSQI) scores at 1 day and 1, 4, 12, 24, and 48 weeks after surgery were compared between the MVD and PRT groups, in addition to complete pain relief rate, effective rate, adverse reactions, length of hospital stay, and economic indicators. RESULTS The VAS and PSQI scores of the two groups at 1 day and 1, 4, 12, 24, and 48 weeks after surgery were significantly lower (P < 0.05) than those before surgery. At 48 weeks, the complete remission rate was significantly higher (P < 0.05) in the MVD group than in PRT group. No significant difference in adverse reactions was observed between the two groups. The length of hospital stay, operative time, and cost were significantly higher (P < 0.05) in the MVD group than in the PRT group. CONCLUSIONS Both PRT and MVD can significantly reduce patients' degree of pain and improve their sleep quality. In the medium term, MVD is better than PRT in terms of the complete curative effect. In young patients with GPN, MVD is more often recommended than PRT; however, MVD is costlier than PRT.
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Affiliation(s)
- Zeyu Wu
- Department of Pain,The Affiliated Nanchong Central Hospital of North Sichuan Medical College, 97, South Renmin Road, Shunqing District, Nanchong, Sichuan, China
| | - Yongming Zhao
- Department of Pain,The Affiliated Nanchong Central Hospital of North Sichuan Medical College, 97, South Renmin Road, Shunqing District, Nanchong, Sichuan, China
| | - Fan Wu
- Department of Pharmacy, Sichuan Nanchong Mental Health center, The Second People's Hospital of Nanchong, Nanchong, Sichuan, China
| | - Yiyue Fan
- Department of Pain,The Affiliated Nanchong Central Hospital of North Sichuan Medical College, 97, South Renmin Road, Shunqing District, Nanchong, Sichuan, China.
| | - Ying Yang
- Department of Pain,The Affiliated Nanchong Central Hospital of North Sichuan Medical College, 97, South Renmin Road, Shunqing District, Nanchong, Sichuan, China.
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Kalluri AL, So RJ, Nair SK, Materi J, Wang D, Behera N, Kornberg MD, Huang J, Lim M, Bettegowda C, Xu R. The role of multiple sclerosis subtype in microvascular decompression outcomes for patients with trigeminal neuralgia. Clin Neurol Neurosurg 2023; 233:107967. [PMID: 37703615 DOI: 10.1016/j.clineuro.2023.107967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES While patients with concomitant trigeminal neuralgia (TN) and multiple sclerosis (MS) are understood to experience a more intractable pain phenotype, whether TN pain outcomes differ by the presenting MS subtype is not well characterized. This study's objective is to compare post-operative pain and numbness outcomes following microvascular decompression (MVD) in TN patients with either relapsing-remitting MS (RRMS) or progressive MS. METHODS We retrospectively reviewed all TN patients who underwent MVDs at our institution from 2007 to 2020. Of the 1044 patients reviewed, 45 (4.3%) patients with MS were identified. Patient demographics, procedural characteristics, and post-operative pain and numbness scores were recorded and compared. Factors associated with pain recurrence were assessed using survival analyses and multivariate regressions. RESULTS Of the resulting 45 MS patients, 34 (75.6%) patients presented with the RRMS subtype, whereas 11 (24.4%) patients exhibited progressive MS. Using an adjusted multivariate ordinal regression, the subtype of MS was not significantly associated with the Barrow Neurological Institute (BNI) pain score at final follow-up. Using a Kaplan-Meier survival analysis and a multivariate Cox proportional hazards regression, respectively, RRMS was significantly associated with a shorter post-operative pain-free interval (p = 0.04) as well as a greater risk for pain recurrence (p = 0.02). CONCLUSIONS Although the degree of pain at final follow-up may not differ, RRMS patients are at increased risk for pain recurrence following MVD for TN. These results align with a growing understanding that neuroinflammation may play a significant role in TN pain.
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Affiliation(s)
- Anita L Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Raymond J So
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Joshua Materi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Dorothy Wang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Niranjan Behera
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Michael D Kornberg
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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Basamh M, Sinning N, Ajabnoor W, Illies T, Kehler U. Preoperative assessment of the individual anatomy of the superior petrosal vein complex using balanced fast field echo magnetic resonance imaging. Surg Radiol Anat 2023; 45:1273-1285. [PMID: 37548655 DOI: 10.1007/s00276-023-03220-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Here, we sought to examine the validity and reproducibility of balanced fast field echo (bFFE) for assessing superior petrosal vein (SPV) complex (SPVC) anatomy. METHODS Preoperative bFFE or equivalent scans and operative videos were studied and directly compared with regard to the individual anatomical features of SPVCs and their relation to the operative field. The anatomical details of the bFFE findings of the non-operated side (group 2) of all 50 patients were then reviewed, including the presence of petrosal-galenic anastomosis, and finally compared to the operated SPVCs (group 1). RESULTS A complete correlation between bFFE and intraoperative findings was observed in 62% of cases and had a significant correlation with 3 Tesla magnet strength and higher pixel bandwidth (rbis = - 0.47; p = 0.005). The sensitivity and specificity of bFFE magnetic resonance imaging were 93.7 and 95.2%, respectively, for detecting an SPV disturbing the operative field, and 97.3% and 95% for a disturbing tributary, respectively. Each group had 50 SPVCs, with a total of 70 and 64 SPVs, 10 and 11 general SPVC configurations, as well as 29 and 28 different individual anatomical variations in groups 1 and 2, respectively. Both groups had 1-3 SPVs with a similar distribution of frequencies [Chi-square (4) = 27.56; p = 0.0145 (Fisher's exact test)]. The similarity of the general configurations was not statistically significant. The same four predominant configurations constituted 80% of the SPVCs in each group. The vein of the cerebellopontine fissure was most frequently found in 86% and 88% of cases, and a petrosal-galenic anastomosis was seen in 38% and 40% of groups 1 and 2, respectively. CONCLUSIONS Individual SPVC variations are extensive. Good quality bFFE or equivalents are feasible for preoperative SPVC assessments. However, methods improving vascular visualization are recommended.
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Affiliation(s)
- Mohammed Basamh
- Division of Neurosurgery, King Abdul-Aziz University Hospital, P. O. Box 80125, 21589, Jeddah, Saudi Arabia.
| | - Nico Sinning
- Department of Neurosurgery, Asklepios Klinik Altona, Hamburg, Germany
| | - Waleed Ajabnoor
- Department of Radiology, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia
| | - Till Illies
- Department of Neuroradiology, Asklepios Klinik Altona, Hamburg, Germany
| | - Uwe Kehler
- Department of Neurosurgery, Asklepios Klinik Altona, Hamburg, Germany
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Cai Q, Li Z, Guo Q, Wang W, Ji B, Chen Z, Dong H, Mao S. Microvascular decompression using a fully transcranial neuroendoscopic approach. Br J Neurosurg 2023; 37:1375-1378. [PMID: 33491507 DOI: 10.1080/02688697.2020.1820943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/04/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of microvascular decompression (MVD) using a fully transcranial neuroendoscopic approach. METHODS Thirty-one patients who underwent MVD using a fully transcranial neuroendoscopic approach in our department between May 2016 and September 2019 were retrospectively reviewed. RESULTS All patients successfully underwent MVD, and immediate pain relief was achieved in all 17 cases of trigeminal neuralgia (TGH) and 3 cases of glossopharyngeal neuralgia (GPN). Hemifacial spasm (HFS) was completely resolved in all 11 patients. No mortality or permanent complication was seen. CONCLUSIONS The endoscope is a useful tool for confirming vascular conflict identified by the microscope and is helpful in detecting the vessel responsible for neuralgia without retracting the brain and nerves. MVD using a fully transcranial neuroendoscopic approach is an effective and safe alternative to endoscopic-assisted MVD and traditional MVD.
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Affiliation(s)
- Qiang Cai
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
| | - Zhiyang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
| | - Qiao Guo
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
| | - Wenju Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
| | - Baowei Ji
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
| | - Zhibiao Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
| | - Hongjuan Dong
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
| | - Shanping Mao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
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Goto Y, Inoue T. Abducens Nerve Palsy Due to Neurovascular Compression. World Neurosurg 2023; 178:53-59. [PMID: 37451362 DOI: 10.1016/j.wneu.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Neurovascular compression (NVC) as the cause of abducens nerve palsy is an infrequent event. Only a small number of cases have been reported in the literature, and the efficacy of microvascular decompression (MVD) for abducens nerve palsy remains unclear. METHODS We reviewed previously reported cases of abducens nerve palsy caused by NVC and added our own cases. We analyzed the clinical characteristics of vascular compression abducens nerve palsy and assessed the indication for MVD. RESULTS Twenty-two patients with isolated abducens nerve palsy due to vascular compression were confirmed in total, consisting of 20 patients (19 publications) from the literature search and 2 cases from our experienced cases. All patients had no possible causes for isolated abducens nerve palsy except the NVC on the nerve root. Unlike the sudden onset in the typical abducens nerve palsy, all patients demonstrated gradual development of the symptom in NVC-related abducens palsy. Careful observation was the most common strategy in most patients; however, no noticeable improvement was reported in the conservative treatment. Surgical intervention was performed in 6 patients after observation for several months and showed favorable outcomes in all cases. CONCLUSIONS Vascular compression could be a potential cause of abducens nerve palsy. Gradual onset or episodic symptom of abducens palsy with a definitive radiological finding of vascular compression deserves considering MVD for abducens nerve palsy.
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Affiliation(s)
- Yukihiro Goto
- Department of Neurosurgery, Koto Memorial Hospital, Higashiohmi, Shiga, Japan.
| | - Takuro Inoue
- Department of Neurosurgery, Koto Memorial Hospital, Higashiohmi, Shiga, Japan
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Zhu J, Gu R, Ji F. Microvascular decompression can effectively reduce arterial blood pressure in patients with Trigeminal Neuralgia. Clin Neurol Neurosurg 2023; 233:107945. [PMID: 37611352 DOI: 10.1016/j.clineuro.2023.107945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Microvascular decompression (MVD) has been used in the treatment of Trigeminal Neuralgia (TN) and arterial hypertension (HTN). Results of several reports have supported its clinical effectiveness, however, little attention has been paid on arterial blood pressure changes caused by MVD in patients with TN. METHODS In this single-center retrospective study, a cohort of 80 patients with TN who underwent MVD between 2021 and 2022 had been reviewed. Clinical data such as age, gender, pain duration, operation time, side and range of pain, HTN history, treatment history, VAS score, mean arterial pressure (MAP), and nausea or vomiting after operation were collected and analyzed via Linear regression to select possible related factors. Then, multiple linear regression of the possible predictors was used to identify the variables that significantly predicted MAP reduction. RESULTS The VAS scores of TN patients after MVD surgery was significantly lower than that before operation, irrespective of the gender, side and range of pain, HTN history, RF history, and PONV (Wilcoxon test, P < 0.001). MVD can significantly decreased the blood pressure of TN patients, without interference from other factors. (MAP reduction ratio=14.46% ± 12.32%) (paired t-test, P < 0.001). The univariate and Multiple linear regression analysis showed that the preoperative MAP was significantly related to MAP reduction ratio (P < 0.001). CONCLUSIONS In patients with TN, MVD can significantly decrease arterial blood pressure. Blood pressure reductions were more prominent when cases with higher preoperative MAP.
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Affiliation(s)
- Jin Zhu
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Rui Gu
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Fan Ji
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
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35
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Hirata S, Kobayashi M, Ujihara M, Takabatake K, Fujimaki T. Preoperative findings in relation to the usefulness of endoscopic assistance for microvascular decompression. Acta Neurochir (Wien) 2023; 165:3011-3017. [PMID: 37656306 DOI: 10.1007/s00701-023-05762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Endoscopy is known to be a useful adjunct for microvascular decompression (MVD) surgery, assisting observation in blind spots such as Meckel's cave in cases of trigeminal neuralgia (TN) and the root exit zone (REZ) in hemifacial spasm (HFS). However, few reports have discussed the usefulness of endoscopy in relation to individual patient characteristics or preoperative magnetic resonance imaging (MRI). METHODS We retrospectively reviewed the medical records of 109 patients (98 with HFS and 11 with TN, 85 women, median age 55 years) who had undergone endoscopically assisted MVD at our institution between 2017 and 2021. The usefulness of endoscopy in individual cases was scored by three neurosurgeons using a grading scale: 2, essential and indispensable; 1, useful and helpful; 0, not necessary. The mean value of the assigned scores was taken as an indicator of "usefulness," and endoscopy was considered to have been "useful" in cases with a score of > 1.0. RESULTS Endoscopic assistance was judged to have been useful in 69% of the patients. The proportion of patients evaluated as useful was significantly lower for TN (18.2%) than for HFS (74.5%). Patients with superior cerebellar artery compression had significantly lower scores than patients with other vessels. Endoscopy was considered useful in a significantly higher proportion of patients with anatomically complicated offending vessels (bifurcation or strong meandering) in the REZ detected by preoperative MRI (P < 0.005). CONCLUSION Endoscopy for MVD is useful for patients with HFS, especially when preoperative MRI shows bifurcation or strongly meandering vessels in the REZ.
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Affiliation(s)
- Sachiko Hirata
- Department of Neurosurgery, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan.
| | - Masahito Kobayashi
- Department of Neurosurgery, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan
| | - Masaki Ujihara
- Department of Neurosurgery, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan
| | - Kazuhiko Takabatake
- Department of Neurosurgery, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan
| | - Takamitsu Fujimaki
- Department of Neurosurgery, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan
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Shi H, Li Y, Zhang K, Wen X, Shi H, Qian T. Application value of calcium phosphate cement in complete cranial reconstructions of microvascular decompression craniectomies. J Plast Reconstr Aesthet Surg 2023; 85:210-216. [PMID: 37524033 DOI: 10.1016/j.bjps.2023.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/29/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To investigate the application value of calcium phosphate cement (CPC) in repairing cranial defects during microvascular decompression (MVD) surgery via the retrosigmoid approach. METHODS A retrospective study was carried out on patients who underwent MVD. According to the two different cranial reconstruction methods, patients were divided into a titanium mesh (TM) group and a CPC group. We compared in the two groups the length of postoperative hospital stay, the incidence of postoperative cerebrospinal fluid (CSF) leakage, the number of patients with suspected postoperative intracranial infection who underwent lumbar puncture, the number of patients with a definitive etiologic diagnosis of intracranial infection, and the imaging evaluation of plastic shape satisfaction. RESULTS Patients in the CPC group had an average hospital stay of 9.15 ± 2.00 days, shorter than that in the TM group (10.69 ± 2.86 days), P < 0.001. In the TM group, the rate of plasticity satisfaction was 70/89 (78.65%), which was significantly lower than that in the CPC group (60/66, 90.91%), P = 0.040. Among the patients with a definitive etiologic diagnosis of intracranial infection, there were eight cases in the TM group and one case in the CPC group, and the difference was statistically significant, P = 0.049. CONCLUSIONS CPC is another viable alternative for complete cranial reconstructions of microvascular decompression craniectomies. The use of CPC does not increase the incidence of postoperative complications, such as CSF leakage and intracranial infection, and can reduce the average length of hospital stay and the incidence of etiologic diagnosis of intracranial infection. Furthermore, the evaluation of the plastic shape is satisfactory.
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Affiliation(s)
- Hailiang Shi
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang, China
| | - Yang Li
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang, China
| | - Kuo Zhang
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang, China
| | - Xiaolong Wen
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang, China
| | - Haowei Shi
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang, China
| | - Tao Qian
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang, China.
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Brazzoli S, Levi L, Stiles MA, Pinto A. A Patient with Refractory Trigeminal Neuralgia was Referred for Suspected Odontogenic Pain. Dent Clin North Am 2023; 67:683-685. [PMID: 37714624 DOI: 10.1016/j.cden.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Chronic pain of the face with a sudden, unilateral, and electric shock-like pain in the distribution of the trigeminal nerve is known as Trigeminal neuralgia (TN). This case report presents a patient with TN symptoms, along with concomitant tooth pain. The diagnostic process and management of the patient are discussed, emphasizing the importance of interdisciplinary collaboration for optimal patient care.
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Affiliation(s)
- Stefania Brazzoli
- Division of Orofacial Pain, Department of Oral and Maxillofacial Pain, Thomas Jefferson University Hospital, Philadelphia, PA 19109, USA
| | - Lauren Levi
- Division of Orofacial Pain, Department of Oral and Maxillofacial Pain, Thomas Jefferson University Hospital, Philadelphia, PA 19109, USA.
| | - Marlind Alan Stiles
- Division of Orofacial Pain, Department of Oral and Maxillofacial Pain, Thomas Jefferson University Hospital, Philadelphia, PA 19109, USA
| | - Andres Pinto
- Department of Oral and Maxillofacial Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Ghaffari-Rafi A, Choi SY, Leon-Rojas J, Shahlaie K. Predictors of Multi-Vessel Identification, Outcome, and Optimal Surgical Timing for Microvascular Decompression in Hemifacial Spasm. Clin Neurol Neurosurg 2023; 233:107841. [PMID: 37544024 DOI: 10.1016/j.clineuro.2023.107841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES AND BACKGROUND Hemifacial spasm (HFS) is a disabling condition that imposes significant burden upon patients. Microvascular decompression (MVD) surgery is the most effective and long-lasting treatment for HFS, but outcomes following this surgery may vary based on a variety of clinical and operative factors. A more thorough understanding of the variables that impact patient outcome after MVD surgery is needed. METHODS A systematic review and meta-analysis of Medline, Embase, and Central was conducted (n = 2108 screened; n = 86 included) with the goal of determining the impact of the following variables on outcome: duration of disease, geographic location, intraoperative use of an endoscope, and intraoperative finding of single versus multi-vessel neurovascular compression. RESULTS Most cases of hemifacial spasm occur on the left side (53.9%, p < 0.001) and are more common in women than men (66.5% versus 33.5%, p < 0.0001). The offending vessel frequencies were: 40.8% anterior inferior cerebellar artery [AICA], 24.9% posterior inferior cerebellar artery [PICA], 17.2% multiple vessels, and 4.7% vertebral artery [VA]. Multiple vessel combinations involved: 26.5% PICA + AICA, 24.6% PICA + VA, 23.1% AICA + VA, and 4.7% AICA + PICA + VA. Relative to the Americas, AICA was less frequent in Europe (p = 0.005), while PICA more frequent in Europe (p = 0.009) and Asia (p < 0.0001). With endoscope assistance, frequency of multiple vessels identified was 31.7% (versus 14.7% with non-endoscopic, p = 0.005), and 27.4% for AICA (43.5% with non-endoscopic, p = 0.003). Spasm improvement was 94.1% near discharge and 96.0% at maximum follow-up. Complications occurred in 16.5% of cases, with spasm recurrence in 2.4%. Greatest frequency of spasm improvement (p < 0.0001) and lowest spasm recurrence rates (p = 0.0005) were reported in series from Asia. For every additional month of pre-operative spasm, the effect size of post-operative improvement decreased (p = 0.04). With every subsequent postoperative month, the effect size of spasm improvement increased (p = 0.0497). The frequency of spasm improvement was significantly higher in series published after 2005 (94.4% versus 97.4%, p = 0.005). CONCLUSION Clinical outcomes following MVD for HFS have improved since 2005. Consideration should be given to earlier operation (shorter disease duration) and use of an endoscope may increase detection of multiple offending vessels. Further studies are needed to understand regional differences in culprit vessel incidence and surgical outcomes in the Americas, Europe, and Asia.
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Affiliation(s)
- Arash Ghaffari-Rafi
- University of California, Davis, School of Medicine, Department of Neurological Surgery, Sacramento, CA, USA; University of Hawai'i at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA.
| | - So Yung Choi
- University of Hawai'i at Mānoa, John A. Burns School of Medicine, Department of Quantitative Health Sciences, Biostatistics Core Facility, Honolulu, HI, USA
| | - Jose Leon-Rojas
- Universidad de las Americas, Escuela de Medicina, Quito, Ecuador; University College London, Queen Square Institute of Neurology, London, England, UK
| | - Kiarash Shahlaie
- University of California, Davis, School of Medicine, Department of Neurological Surgery, Sacramento, CA, USA.
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Zheng W, Wang L, Wang H, Zhou H, Du Q. Trigeminal neuralgia caused by vertebrobasilar dolichoectasia: efficacy of stepwise decompression technique. Acta Neurochir (Wien) 2023; 165:3019-3026. [PMID: 37353618 DOI: 10.1007/s00701-023-05691-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To explore and analyze the clinical efficacy of a stepwise decompression technique in the treatment of trigeminal neuralgia (TN) caused by vertebrobasilar dolichoectasia (VBD). METHODS A total of 918 patients with TN admitted to our hospital from June 2015 to May 2020 were divided into the VBD group (n = 61) and the conventional group (n = 857). The VBD group underwent stepwise decompression, while the conventional group received traditional microvascular decompression (MVD) surgery. Patients associated with the VBD were divided into direct compression (n = 14) and indirect compression group (n = 47) who had compression by other vessels in the presence of the VBD. Thereafter, the clinical data, intraoperative findings, efficacy, and complications were analyzed. RESULTS The curative ratio, efficacy, and recurrence rate for the VBD and conventional group were 83.6% and 89.6%, 93.4% and 95.3%, and 8.2% and 5.3%, respectively. The curative ratio, efficacy, and recurrence rate for the direct compression and indirect compression group were 85.7% and 83.0%, 92.9% and 93.6%, and 7.1% and 8.5%, separately. There were no significant differences in the curative ratio, efficacy, recurrence rate, and the incidence of complications between the two series (P > 0.05). CONCLUSION For TN caused by VBD, stepwise decompression not only reduces the direct compression of the trigeminal nerve by VBA but also allows identification and decompression of the actual vessels responsible for the compression. It has a good curative ratio, efficacy, and long-term pain relief rate, and it does not significantly increase the incidences of complications after surgery.
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Affiliation(s)
- Wenhao Zheng
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linjie Wang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Heng Wang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Haotian Zhou
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Quan Du
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Williams SC, Ahmed R, Davids JD, Funnell JP, Hanrahan JG, Layard Horsfall H, Muirhead W, Nicolosi F, Thorne L, Marcus HJ, Grover P. Benchtop simulation of the retrosigmoid approach: Validation of a surgical simulator and development of a task-specific outcome measure score. World Neurosurg X 2023; 20:100230. [PMID: 37456690 PMCID: PMC10344945 DOI: 10.1016/j.wnsx.2023.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/11/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background Neurosurgical training is changing globally. Reduced working hours and training opportunities, increased patient safety expectations, and the impact of COVID-19 have reduced operative exposure. Benchtop simulators enable trainees to develop surgical skills in a controlled environment. We aim to validate a high-fidelity simulator model (RetrosigmoidBox, UpSurgeOn) for the retrosigmoid approach to the cerebellopontine angle (CPA). Methods Novice and expert Neurosurgeons and Ear, Nose, and Throat surgeons performed a surgical task using the model - identification of the trigeminal nerve. Experts completed a post-task questionnaire examining face and content validity. Construct validity was assessed through scoring of operative videos employing Objective Structured Assessment of Technical Skills (OSATS) and a novel Task-Specific Outcome Measure score. Results Fifteen novice and five expert participants were recruited. Forty percent of experts agreed or strongly agreed that the brain tissue looked real. Experts unanimously agreed that the RetrosigmoidBox was appropriate for teaching. Statistically significant differences were noted in task performance between novices and experts, demonstrating construct validity. Median total OSATS score was 14/25 (IQR 10-19) for novices and 22/25 (IQR 20-22) for experts (p < 0.05). Median Task-Specific Outcome Measure score was 10/20 (IQR 7-17) for novices compared to 19/20 (IQR 18.5-19.5) for experts (p < 0.05). Conclusion The RetrosigmoidBox benchtop simulator has a high degree of content and construct validity and moderate face validity. The changing landscape of neurosurgical training mean that simulators are likely to become increasingly important in the delivery of high-quality education. We demonstrate the validity of a Task-Specific Outcome Measure score for performance assessment of a simulated approach to the CPA.
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Affiliation(s)
- Simon C. Williams
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Razna Ahmed
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
- Queen Square Institute of Neurology, University College London, London, UK
| | - Joseph Darlington Davids
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Institute of Global Health Innovation and Hamlyn Centre for Robotics Surgery, Imperial College London, London, UK
| | - Jonathan P. Funnell
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - John Gerrard Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - William Muirhead
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Federico Nicolosi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Lewis Thorne
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Patrick Grover
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Rubio AS, Rodríguez-Rubio HA, López-Rodríguez R, Bonilla-Suastegui A, Piñón-Jiménez F, Contreras-Vázquez OR, Revuelta-Gutiérrez R. Microvascular decompression for hemifacial spasm: Complications after 292 procedures without neurophysiological monitoring. Surg Neurol Int 2023; 14:343. [PMID: 37810311 PMCID: PMC10559543 DOI: 10.25259/sni_578_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Background Hemifacial spasm (HFS) is characterized by involuntary, progressive, and intermittent spasms in the upper and lower facial muscles. Due to the high success rate, microvascular decompression (MVD) is the treatment of choice, and intraoperative neuromonitoring (INM) is considered useful for achieving safe surgery. Still, most centers do not have this technology. Methods We analyzed 294 patients with HFS treated with MVD without INM. We only included patients with a neurovascular etiology while excluding other causes, such as tumors. As part of the postoperative evaluation, we assessed preoperative magnetic resonance imaging and pure-tone audiometry. Results The main complication was peripheral facial paralysis in 50 patients, followed by hypoacusis in 22 patients and deafness in 17 patients, associated with a failed surgical outcome (P = 0.0002). The anterior inferior cerebellar artery (AICA) was an offending vessel, and the involvement of more than one vessel was significantly associated with the development of facial nerve palsy (P = 0.01). AICA was also associated with hearing impairment (P = 0.04). Over 90% of immediate complications improve in the follow-up (6 months), and one patient did not show a cure for initial HFS. Conclusion MVD is the method with the highest long-term cure rates for treating HFS; however, we must inquire into the multiple factors of the patient and the surgeon to predict surgical outcomes. INM is not a must during MVD for HFS. We recommend its use depending on the availability and mainly on the surgeon's skills, for surgeons.
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Affiliation(s)
| | | | | | | | | | | | - R. Revuelta-Gutiérrez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Li Z, Xie Z, Tang G, Jin S. Comparison of percutaneous balloon compression and microvascular decompression in the treatment of trigeminal neuralgia. Pak J Med Sci 2023; 39:1451-1455. [PMID: 37680844 PMCID: PMC10480759 DOI: 10.12669/pjms.39.5.8049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 09/09/2023] Open
Abstract
Objective To compare the effect of percutaneous balloon compression (PBC) and microvascular decompression (MVD) in the treatment of trigeminal neuralgia (TN). Methods Data of 98 patients with TN, admitted to Chenzhou First People's Hospital from May 2020 to May 2022, were retrospectively collected. Patients were divided into two groups based on the surgical method. A total of 53 patients treated with PBC comprised the PBC-group and 45 patients treated with MVD comprised the MVD-group. The immediate pain relief, long-term efficacy, surgical complications, and masticatory muscle strength of the two groups were compared and analyzed. Results There was no significant difference in the immediate pain relief and long-term e efficacy, between the two groups (P>0.05). Complication rate in the PBC-group was significantly lower than that in the MVD-group (3.77% vs 17.78%, P<0.05). Medical records within 14 days after the operation showed that the incidence of facial numbness and masticatory muscle weakness in the PBC-group were 37.74% and 28.30% respectively, significantly higher than those in MVD-group (4.44% and 2.22%) (P<0.05). These symptoms gradually improved three months after the surgery, and were almost completely resolved after six months. Conclusions Compared with MVD, PBC has the same effect in the treatment of TN. PBC is a minimally invasive, safe, and effective method with a low complication rate. Although masticatory muscle strength is slightly impacted by PBC, it gradually recovers within six months after the operation.
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Affiliation(s)
- Zhenyong Li
- Zhenyong Li, Department of Neurosurgery, Chenzhou First People’s Hospital, Chenzhou 423000, Hunan Province, P.R. China
| | - Zhuqing Xie
- Zhuqing Xie, Department of Neurosurgery, Chenzhou First People’s Hospital, Chenzhou 423000, Hunan Province, P.R. China
| | - Guoqiang Tang
- Guoqiang Tang, Department of Neurosurgery, Chenzhou First People’s Hospital, Chenzhou 423000, Hunan Province, P.R. China
| | - Shihui Jin
- Shihui Jin, Department of Neurosurgery, Chenzhou First People’s Hospital, Chenzhou 423000, Hunan Province, P.R. China
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Adidharma P, Prasetya M, Sulistyanto A, Arham A, Fadhil, Oswari S, Keswani RR, Kusdiansah M, Aji YK, Inoue T. Single-surgeon approach in microvascular decompression for trigeminal neuralgia: Lessons from an Indonesian Tertiary-Level Neurological Center. J Clin Neurosci 2023; 115:53-59. [PMID: 37487448 DOI: 10.1016/j.jocn.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Microvascular decompression (MVD) is effective for refractory trigeminal neuralgia (TN), but its accessibility is often limited in lower-to-middle-income countries (LMICs). This study aims to assess the impact of implementing a single-surgeon policy on MVD for TN in LMICs. METHODS A prospective cohort study was conducted from 2014 to 2020, comparing outcomes between multi-surgeon and single-surgeon policies. Residents were included in MVD procedures starting in 2019. The Barrow Neurological Institute (BNI) pain scale (P), numbness scale (N), and result conclusion scale (P + N) were used to evaluate outcomes (1 week, 1 month, 1 year, and yearly thereafter). Propensity score matching was performed before comparing the groups. Pain-free survival was assessed using Kaplan-Meier and Cox-regression analysis. RESULTS We comprehensively analyzed data from 72 patients with a minimum one-year follow-up. The implementation of the single-surgeon policy had several notable impacts. Firstly, it led to an increased referral rate (p < 0.05) and a reduced duration to surgery (p < 0.05). During MVD, there was a significant increase in the identification of complex compression (p < 0.05) and a reduced frequency of internal neurolysis (p < 0.05). After surgery, the single-surgeon group exhibited a superior pain-control profile (RR 1.9, p < 0.001; ARR 26-36%), higher pain-free survival rate (p < 0.001), lower likelihood of pain recurrence (HR 0.2, p < 0.0001), and fewer additional surgical interventions compared to the multi-surgeon group. Moreover, the involvement of residents did not significantly impact surgical outcomes. CONCLUSIONS Implementing a single-surgeon policy for MVD in LMICs has the potential to improve surgical outcomes, provide social benefits, and offer educational opportunities.
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Affiliation(s)
- Peter Adidharma
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia.
| | - Mustaqim Prasetya
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Adi Sulistyanto
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Abrar Arham
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Fadhil
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Selfy Oswari
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Ryan Rhiveldi Keswani
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Muhammad Kusdiansah
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Yunus Kuntawi Aji
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Takuro Inoue
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia; Department of Neurosurgery, Subarukai Koto Memorial Hospital, Shiga, Japan
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Revuelta-Gutiérrez R, Piñon-Jiménez F, Contreras-Vázquez OR, Vales-Hidalgo LO, Martinez-Anda JJ. Glossopharyngeal and vagoglossopharyngeal neuralgia: Long-term surgical outcomes in a single institution. Surg Neurol Int 2023; 14:267. [PMID: 37560568 PMCID: PMC10408601 DOI: 10.25259/sni_518_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/06/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Glossopharyngeal neuralgia (GPN) and vagoglossopharyngeal neuralgia (VGPN) are infrequent syndromes that can have great negative impact on a patient's quality of life. The objective of this study is to describe the characteristics and long-term results of patients with GPN-VGPN who are treated surgically with microvascular decompression (MVD) in one institution. METHODS This is a retrospective series of 20 patients with the diagnosis of GPN-VGPN who underwent MVD. Demographic characteristics, surgical results, complications, and long-term follow-up were analyzed. RESULTS The mean age of symptom onset was 51.25 years and the majority of patients were women (60%). The posterior inferior cerebellar artery was the main offending vessel (75%). The immediate MVD success rate was 100%, but during follow-up, two patients (10%) were diagnosed with VGPN and both cases presented pain recurrence. The mean follow-up was 120.4 (25-333) months. VGPN (P = 0.005) and a ≥5 day hospital stay (P = 0.032) were associated with unsuccessful outcomes. Two complications were documented, which resolved without sequelae. There was no surgical mortality. CONCLUSION MVD is an effective and safe treatment for long-term pain relief of GPN-VGPN. VGPN and a prolonged hospital stay were associated with poor outcomes. More studies are required to confirm these findings.
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Affiliation(s)
- Rogelio Revuelta-Gutiérrez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Ciudad de México, Mexico
| | - Fernando Piñon-Jiménez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Ciudad de México, Mexico
| | - Oscar Rubén Contreras-Vázquez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Ciudad de México, Mexico
| | - Lourdes Olivia Vales-Hidalgo
- Department of Neuro-otology, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Ciudad de México, Mexico
| | - Jaime Jesús Martinez-Anda
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Ciudad de México, Mexico
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Li S, Cheng G, Wu Y, Liao C, Zhang W. Long-term pain outcomes in trigeminal neuralgia patients with concomitant continuous pain: a comparison of first-time microvascular decompression and percutaneous balloon compression. Neurosurg Rev 2023; 46:183. [PMID: 37486589 DOI: 10.1007/s10143-023-02089-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Shuo Li
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo Cheng
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwei Wu
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenlong Liao
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenchuan Zhang
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Chai S, Wu J, Cai Y, Zhao J, Mei Z, Zhou Y, Wang Y, Xu H, Zhou J, Xiong N. Early lateral spread response loss during microvascular decompression for hemifacial spasm: its preoperative predictive factors and impact on surgical outcomes. Neurosurg Rev 2023; 46:174. [PMID: 37442820 DOI: 10.1007/s10143-023-02083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
When early lateral spread response (LSR) loss before decompression in HFS surgery happens, the value of intraoperative monitoring of LSR for locating neurovascular conflicts and confirming adequate decompression was considered to be reduced. This study aimed to identify preoperative parameters predicting early LSR loss and figure out the impact of early LSR loss on prognosis. Hemifacial spasm (HFS) patients who received microvascular decompression (MVD) under intraoperative electrophysiological monitoring during the period of March 2013-January 2021 were reviewed retrospectively. The patients were divided into two groups according to the disappearance of their LSR before or after decompression. Preoperative clinical and radiological predictors for early LSR loss were evaluated using logistic regression. The relationship between early LSR loss and surgical outcomes was statistically analyzed. A total of 523 patients were included in the study, and the disappearance of their LSR before decompression occurred in 129 patients. In the multivariate analysis, three independent factors predicting early LSR loss were identified: (1) smaller vessel compression; (2) milder nerve deviation; (3) lower posterior fossa crowdedness index (PFCI, calculated as hindbrain volume (HBV)/the posterior fossa volume (PFV) using 3D Slicer software). The median follow-up time was about five years, and no significant differences in the spasm relief and complication rates were found between the 2 groups. Smaller responsible vessels, milder nerve deviation, and more spacious posterior cranial fossa are associated with early LSR loss. However, early LSR loss seems to have no significant adverse effect on MVD outcomes in skilled hands.
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Affiliation(s)
- Songshan Chai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China
| | - Ji Wu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China
- Department of Neurosurgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Yuankun Cai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China
| | - Jingwei Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China
| | - Zhimin Mei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China
| | - Yixuan Zhou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China
| | - Yihao Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Xu
- Department of Neurosurgery, Wuhan Changjiang Shipping General Hospital, Wuhan, China.
| | - Jiabin Zhou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China.
| | - Nanxiang Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China.
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Adidharma P, Prasetya M, Wardhana AW, Inoue T, Sulistyanto A, Oswari S, Keswani RR, Kusdiansah M, Aji YK, Ramadhan R, Arham A. Analyzing the cost-effectiveness of microvascular decompression and percutaneous radiofrequency rhizotomy for trigeminal neuralgia: the role of clinical classification. Neurosurg Rev 2023; 46:144. [PMID: 37347372 DOI: 10.1007/s10143-023-02047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023]
Abstract
Trigeminal neuralgia (TN) is a neuropathic pain that can be treated with microvascular decompression (MVD) or percutaneous radiofrequency rhizotomy (PRR) when medications fail. However, the cost-effectiveness of these interventions is uncertain, and it is unclear whether TN should be considered as a single entity for cost-effectiveness analysis. To address these issues, a prospective cohort study was conducted between 2017 and 2020, documenting Burchiel et al.'s clinical classification, pain-free survival, complications, and costs. Two models of quality-adjusted life years (QALYs) were calculated: pain-specific (PQALY) and pain-complication-specific (PCQALY), based on pain-free survival and complications data, followed by cost-effectiveness analysis. The study included 112 patients, of whom 70 underwent MVD and 42 underwent PRR. Our findings revealed that MVD was less cost-effective in the PCQALY model than PRR, but more cost-effective in the PQALY model and had an incremental cost-effectiveness ratio (ICER) that met the World Health Organization cost-effectiveness threshold in both models. Further clinical classification analysis showed that MVD was only cost-effective in type 1 TN patients, with an ICER of 0.9 and 1.3 times the GDP/capita, based on PQALY and PCQALY, respectively, meeting the cost-effectiveness criteria. Conversely, MVD was economically dominated by PRR for type 2 TN patients based on PQALY. These findings indicate that PRR may be more cost-effective for type 2 TN patients, while MVD remains the cost-effective option for type 1 TN patients. Our study highlights the importance of clinical classification and complication in determining the cost-effectiveness of MVD and PRR for refractory TN.
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Affiliation(s)
- Peter Adidharma
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Jakarta, Indonesia.
| | - Mustaqim Prasetya
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Jakarta, Indonesia
| | - Aji Wahyu Wardhana
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Jakarta, Indonesia
| | - Takuro Inoue
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Jakarta, Indonesia
- Department of Neurosurgery, Subarukai Koto Memorial Hospital, Shiga, Japan
| | - Adi Sulistyanto
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Jakarta, Indonesia
| | - Selfy Oswari
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Jakarta, Indonesia
| | - Ryan Rhiveldi Keswani
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Jakarta, Indonesia
| | - Muhammad Kusdiansah
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Jakarta, Indonesia
| | - Yunus Kuntawi Aji
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Jakarta, Indonesia
| | - Randy Ramadhan
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Jakarta, Indonesia
| | - Abrar Arham
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Jakarta, Indonesia
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Nakamura S, Shimizu T, Tsuneoka H, Miyagishima T, Yoshimoto Y. Glossopharyngeal neuralgia with repeated cardiac syncope: A case report. Surg Neurol Int 2023; 14:208. [PMID: 37404509 PMCID: PMC10316134 DOI: 10.25259/sni_432_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
Background Glossopharyngeal neuralgia (GPN) is an uncommon craniofacial pain syndrome. Although rare, it is occasionally associated with cardiac syncope, as vago-glossopharyngeal neuralgia (VGPN). Case Description We present the case of a 73-year-old man with VGPN misdiagnosed as trigeminal neuralgia. The patient was diagnosed with sick sinus syndrome, and a pacemaker was introduced. However, syncope still recurred. Magnetic resonance imaging revealed a branch of the right posterior inferior cerebellar artery contacting the root exit zone of the right glossopharyngeal and vagus nerves. We diagnosed VGPN due to neurovascular compression and performed microvascular decompression (MVD). The symptoms disappeared postoperatively. Conclusion Diagnosis of VGPN needs appropriate medical interviews and physical examination. MVD is the only curative treatment for VGPN occurring as a neurovascular compression syndrome.
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Affiliation(s)
- Shunsuke Nakamura
- Corresponding author: Shunsuke Nakamura, Department of Neurosurgery, Gunma University, Maebashi, Japan.
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Chojak R, Koźba-Gosztyła M, Gaik M, Madej M, Majerska A, Soczyński O, Czapiga B. Meningitis after elective intracranial surgery: a systematic review and meta-analysis of prevalence. Eur J Med Res 2023; 28:184. [PMID: 37291583 DOI: 10.1186/s40001-023-01141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
Meningitis is a potential complication of elective intracranial surgery (EIS). The prevalence of meningitis after EIS varies greatly in the literature. The objective of this study was to estimate the overall pooled prevalence of meningitis following EIS. Four databases (PubMed, Scopus, Web of Science, and Embase) were searched to identify relevant studies. Meta-analyses of proportions were used to combine data. Cochran's Q and I2 statistics were used to assess and quantify heterogeneity. Additionally, several subgroup analyses were conducted to investigate the source of heterogeneity and examine differences in the prevalence based on variables such as geographical regions, income level, and meningitis type. The meta-analysis included 83 studies (30 959 patients) from 26 countries. The overall pooled prevalence of meningitis after EIS was 1.6% (95% CI 1.1-2.1), with high heterogeneity present (I2 = 88%). The pooled prevalence in low- to middle-income countries and high-income countries was 2.7% (95% CI 1.6-4.1) and 1.2% (95% CI 0.8-1.7), respectively. Studies that reported only aseptic meningitis had a pooled prevalence of 3.2% (95% CI 1.3-5.8). The pooled prevalence was 2.8% (95% CI 1.5-4.5) in studies that reported only bacterial meningitis. Similar prevalence rates of meningitis were observed in the subgroups of tumor resection, microvascular decompression, and aneurysm clipping. Meningitis is a rare but not exceptional complication following EIS, with an estimated prevalence of 1.6%.
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Affiliation(s)
- Rafał Chojak
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland.
| | | | - Magdalena Gaik
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Marta Madej
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Aleksandra Majerska
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Oskar Soczyński
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Bogdan Czapiga
- Department of Neurosurgery, 4th Military Hospital in Wroclaw, Wrocław, Poland
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
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Loayza R, Wikström J, Grabowska A, Semnic R, Ericson H, Abu Hamdeh S. Outcome after microvascular decompression for trigeminal neuralgia in a single center-relation to sex and severity of neurovascular conflict. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05642-2. [PMID: 37284837 DOI: 10.1007/s00701-023-05642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/16/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN), a severe type of facial pain, is mainly caused by a neurovascular conflict (NVC). The severity of the NVC seems associated with the outcome following microvascular decompression (MVD) surgery. This study aimed to investigate the outcome after MVD and whether it is affected by NVC severity and sex. METHODS TN patients (n = 109) were followed for 5 to 10 years after MVD. Barrow Neurology Index (BNI), Patients Global Impression of Change (PGIC), complications, and time to relapse were evaluated. The NVC severity was retrospectively reviewed from presurgical MRI. Demographic and clinical factors and NVC severity were analyzed for potential association with outcome after MVD. RESULTS The success rate (BNI ≤ 2) was 80% after 5 to 10 years follow-up for TN patients with severe NVC (grade 2-3) and 56% for TN patients with mild NVC (grade 0-1, P = 0.003). No sex difference was observed in outcome for patients with both mild (P = 0.924) and severe NVC (P = 0.883) respectively. Three patients (2.8%) during the hospital stay, and two patients (1.8%) at 6 weeks, experienced a complication requiring invasive treatment. At long-term 52/109 patients (47.7%) reported some type of persistent adverse event, of which the majority were mild and required no treatment. CONCLUSIONS MVD offers an 80% probability of long-term pain relief in TN patients with severe NVC, with low frequency of serious complications. NVC severity significantly affects outcome after MVD, while no sex differences in outcome were found. In consistency with previous work, the results stress the importance of adequate neuroradiological assessment of the NVC for preoperative patient selection.
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Affiliation(s)
- Richard Loayza
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, 751 85, Sweden
| | - Johan Wikström
- Department of Surgical Sciences/Section of Neuroradiology, Uppsala University Hospital, Uppsala University, Uppsala, 751 85, Sweden
| | - Anna Grabowska
- Department of Surgical Sciences/Section of Neuroradiology, Uppsala University Hospital, Uppsala University, Uppsala, 751 85, Sweden
| | - Robert Semnic
- Department of Surgical Sciences/Section of Neuroradiology, Uppsala University Hospital, Uppsala University, Uppsala, 751 85, Sweden
| | - Hans Ericson
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, 751 85, Sweden
| | - Sami Abu Hamdeh
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, 751 85, Sweden.
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