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Yun GY, Ahn JM, Park JH, Oh HJ, Shim JJ, Yoon SM. Preliminary Report of Fully Endoscopic Microvascular Decompression. J Korean Neurosurg Soc 2024:jkns.2024.0003. [PMID: 38583999 DOI: 10.3340/jkns.2024.0003] [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: 01/03/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024] Open
Abstract
Objective Microscopic microvascular decompression (MVD) has been considered to be a useful treatment modality for medically refractory hemifacial spasm (HFS) and trigeminal neuralgia (TN). But, the advent of the endoscopic era has presented new possibilities to MVD surgery. While the microscope remains a valuable tool, the endoscope offers several advantages with comparable clinical outcomes. Thus, fully endoscopic MVD (E-MVD) could be a reasonable alternative to microscopic MVD. This paper explores the safety and efficacy of the fully E-MVD technique. Methods A single-center retrospective study was conducted in 25 patients diagnosed with HFS between September 2019 and July 2023. All surgeries were performed by a single neurosurgeon using the fully E-MVD technique without any assistance of a microscope. The study reviewed intraoperative brainstem auditory evoked potentials and disappearance of the lateral spread response. Outcomes were assessed based on the patients' clinical status immediately after surgery and at their last follow-up. Complications, including facial palsy, hearing loss, ataxia, dysphagia, palsy of other cranial nerves, and cerebrospinal fluid (CSF) leakage, were also examined. Results The most common offending artery was the anterior inferior cerebellar artery (AICA) in 15 cases (60.0%), followed by the posterior inferior cerebellar artery (PICA) in 8 cases (32.0%), vertebral artery (VA) in 1 case (4.0%), tandem lesions involving the AICA and VA in 1 case (4.0%). Ten patients (40.0%) had pre-operative facial palsy on the ipsilateral side, and 8 patients (32.0%) experienced delayed facial palsy on the ipsilateral side, from which they fully recovered by the last follow-up. The median operation time was 105 minutes. All patients were symptom free immediately after surgery and at the last follow-up. One patient experienced a permanent complication, such as high-frequency hearing loss, from which he partially recovered over time. Conclusion Fully E-MVD demonstrated similar clinical outcomes to microscopic MVD. It offered a similar complication rate, shorter operation time, and a panoramic view with a smaller craniectomy size. Although there is a learning curve associated with fully E-MVD, it presents a viable alternative in the endoscopic era.
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Affiliation(s)
- Gi-Yong Yun
- Department of Neurosurgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae-Min Ahn
- Department of Neurosurgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jong-Hyun Park
- Department of Neurosurgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyuk-Jin Oh
- Department of Neurosurgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jai-Joon Shim
- Department of Neurosurgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Seok Mann Yoon
- Department of Neurosurgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Truong VT, Ngo MQ, Phan D, Le H, Tran Hoang NA. Results from 228 Patients with Hemifacial Spasm Undergoing Microvascular Decompression without Intraoperative Neuroelectrophysiology Monitoring. World Neurosurg 2024:S1878-8750(24)00246-8. [PMID: 38369107 DOI: 10.1016/j.wneu.2024.02.053] [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: 01/30/2024] [Accepted: 02/09/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Intraoperative neuroelectrophysiology monitoring (IONM) has been used to decrease complications and to increase the successful rate of microvascular decompression (MVD) MVD for hemifacial spasm (HFS). Still, it is not available at limited resource centers. We report the outcome of patients undergoing MVD for HFS without using IONM. METHODS The variables concerning the patients' demographics (age and gender), clinical characteristics, offending vessels (vertebral artery type and non-vertebral artery type), postoperative grade of HFS, and postoperative complications of HFS patients undergoing MVD were retrospectively reviewed and collected. The scoring system provided by the Japan Society for MVD was used to evaluate the postoperative outcome of HFS. Postoperative hearing ability was evaluated according to a subjective assessment of the patients. RESULTS A total of 228 patients were recruited. Their median age was 51.0 (44.0-57.0) years old. The total cure effect was observed in 207 (90.8%) patients within the first week after the surgery and in 200 (96.1%) patients in a 2-year follow-up. Permanent hearing disturbance happened in 2 patients (0.9%). No patient had permanent unilateral deafness (0%). No postoperative permanent facial paralysis was reported. CONCLUSIONS MVD without IONM may be performed safely and effectively to treat patients with HFS.
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Affiliation(s)
- Van Tri Truong
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare system, Ho Chi Minh City, Vietnam.
| | - Minh Quan Ngo
- Department of Neurosurgery, Nhan Dan Gia Dinh hospital, Ho Chi Minh City, Vietnam
| | - Duy Phan
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare system, Ho Chi Minh City, Vietnam
| | - Hung Le
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare system, Ho Chi Minh City, Vietnam
| | - Ngoc Anh Tran Hoang
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare system, Ho Chi Minh City, Vietnam
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Pauna HF, Silva VAR, Lavinsky J, Hyppolito MA, Vianna MF, Gouveia MDCL, Monsanto RDC, Polanski JF, Silva MNLD, Soares VYR, Sampaio ALL, Zanini RVR, Abrahão NM, Guimarães GC, Chone CT, Castilho AM. Task force of the Brazilian Society of Otology - evaluation and management of peripheral facial palsy. Braz J Otorhinolaryngol 2023; 90:101374. [PMID: 38377729 PMCID: PMC10884764 DOI: 10.1016/j.bjorl.2023.101374] [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: 11/13/2023] [Accepted: 11/25/2023] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. CONCLUSIONS Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.
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Affiliation(s)
- Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Cirurgia, Porto Alegre, RS, Brazil
| | - Miguel Angelo Hyppolito
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | | | | | - José Fernando Polanski
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Maurício Noschang Lopes da Silva
- Hospital de Clínicas de Porto Alegre (UFRGS), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Porto Alegre, RS, Brazil
| | - Vítor Yamashiro Rocha Soares
- Hospital Flávio Santos and Hospital Getúlio Vargas, Grupo de Otologia e Base Lateral do Crânio, Teresina, PI, Brazil
| | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Raul Vitor Rossi Zanini
- Hospital Israelita Albert Einstein, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Nicolau M Abrahão
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Guilherme Correa Guimarães
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
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Hou Y, Liang H, Fan C, Feng Y. 5-Hydroxytryptamine and postoperative nausea and vomiting after microvascular decompression surgery. J Clin Neurosci 2023; 116:27-31. [PMID: 37597331 DOI: 10.1016/j.jocn.2023.08.010] [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: 06/05/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND The incidence of postoperative nausea and vomiting (PONV) after microvascular decompression (MVD) surgery is high; however, its underlying mechanisms remain unknown. Serum 5-hydroxytryptamine (5-HT) levels are elevated in patients with PONV. However, the relationship between 5-HT and patients experiencing PONV after MVD surgery is still unknown. Therefore, we hypothesized that 5-HT levels are associated with PONV after MVD surgery. METHODS This prospective study included 85 patients with hemifacial spasm who received MVD surgery. Blood samples were collected preoperatively, postoperatively, and on postoperative day 1, and cerebrospinal fluid samples were collected intraoperatively. 5-HT levels were detected by enzyme-linked immunosorbent assay (ELISA). The incidence and severity of PONV were evaluated at 2, 6, and 24 h after MVD surgery. RESULTS In the multivariate regression analysis, PONV within 24 h after MVD surgery was associated with elevated cerebrospinal fluid 5-HT levels [odds ratio (OR) = 1.21, 95% confidence interval (CI): 1.01-1.45, p = 0.044], and reduction of intraocular pressure [OR = 11.54, 95% CI: 1.43-92.84, p = 0.022]. Receiver operating characteristic curve analysis revealed an area under the curve of 0.873 (95% CI: 0.77-0.98, p < 0.001). CONCLUSION Our study found that the cerebrospinal fluid 5-HT levels is an independent risk factor for PONV within 24 h after MVD surgery.
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Affiliation(s)
- Yuantao Hou
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China.
| | - Hansheng Liang
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China.
| | - Cungang Fan
- Department of Neurosurgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China.
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China.
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Berckemeyer MA, Suarez-Meade P, Carcelen MFV, Ricci MD, Cheshire WP, Trifiletti DM, Middlebrooks EH, Quinones-Hinojosa A, Grewal SS. Current advances in the surgical treatment of glossopharyngeal neuralgia. Neurosurg Rev 2023; 46:47. [PMID: 36725770 DOI: 10.1007/s10143-023-01948-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/16/2022] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Abstract
Glossopharyngeal neuralgia (GPN) is a neurological condition characterized by paroxysmal, stabbing-like pain along the distribution of the glossopharyngeal nerve that lasts from a couple of seconds to minutes. Pharmacological treatment with anticonvulsants is the first line of treatment; however, about 25% of patients remain symptomatic and require surgical intervention, which is usually done via microvascular decompression (MVD) with or without rhizotomy. More recently, the use of stereotactic radiosurgery (SRS) has been utilized as an alternative treatment method to relieve patient symptoms by causing nerve ablation. We conducted a systematic review to analyze whether MVD without rhizotomy is an equally effective treatment for GPN as MVD with the use of concurrent rhizotomy. Moreover, we sought to explore if SRS, a minimally invasive alternative surgical option, achieves comparable outcomes. We included retrospective studies and case reports in our search. We consulted PubMed and Medline, including articles from the year 2000 onwards. A total of 36 articles were included for review. Of all included patients with glossopharyngeal neuralgia, the most common offending artery compressing the glossopharyngeal nerve was the posterior inferior cerebellar artery (PICA). MVD alone was successful achieving pain relief immediately postoperatively in about 85% of patients, and also long term in 65-90% of patients. The most common complication found on MVD surgery was found to be transient hoarseness and transient dysphagia. Rhizotomy alone shows an instant pain relief in 85-100% of the patients, but rate of long-term pain relief was lower compared to MVD. The most common adverse effects observed after a rhizotomy were dysphagia and dysesthesia along the distribution of the glossopharyngeal nerve. SRS had promising results in pain reduction when using 75 Gy radiation or higher; however, long-term rates of pain relief were lower. MVD, rhizotomy, and SRS are effective methods to treat GPN as they help achieve instant pain relief and the decrease use of medication. Patients with MVD alone presented with less adverse effects than the group that underwent MVD plus rhizotomy. Although SRS may be a viable alternative treatment for GPN, further studies must be done to evaluate long-term treatment efficacy.
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Affiliation(s)
| | | | | | - Mariel Dyer Ricci
- School of Medicine, Faculty of Human Medicine, Universidad San Martin de Porres, Lima, Peru
| | | | | | | | | | - Sanjeet S Grewal
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
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Park JS, Ahn YH. Glossopharyngeal Neuralgia. J Korean Neurosurg Soc 2023; 66:12-23. [PMID: 36480819 PMCID: PMC9837485 DOI: 10.3340/jkns.2022.0178] [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: 07/21/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Glossopharyngeal neuralgia (GPN) is a rare disease that must be differentiated from trigeminal neuralgia. The purpose of this article is to provide a comprehensive review of anatomy, pathophysiology, diagnostic criteria, and several options of treatment for GPN. Lessons learned through our experience of treating GPN are presented in detail, as well as cases of misdiagnosis and diagnostic pitfalls. Microvascular decompression (MVD) should be primarily considered for medically intractable GPN. Techniques employed in MVD for GPN are categorized and described. Especially, we underscore the advantages of the 'transposition' technique where insulating material is positioned 'off' the root entry zone (REZ), instead of 'on' it. We believe this 'off-the-REZ' technique can fundamentally prevent recurrence, if applicable. In addition, Gamma Knife radiosurgery can be an alternative option when a patient is ineligible for MVD, though it is categorized as a destructive procedure.
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Affiliation(s)
- Jae Sung Park
- Department of Neurosurgery, Konyang University College of Medicine, Daejeon, Korea
| | - Young Hwan Ahn
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea
- Neuroscience Graduate Program, Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Korea
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Noro S, Seo Y, Honjo K, Okuma M, Asayama B, Amano Y, Kyono M, Sako K, Nakamura H. Intravenous fosphenytoin therapy for rescue of acute trigeminal neuralgia crisis in patients awaiting neurosurgical procedures: A cross-sectional study. J Clin Neurosci 2021; 94:59-64. [PMID: 34863463 DOI: 10.1016/j.jocn.2021.09.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/30/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
Few treatments exist for acute attacks of trigeminal neuralgia. Therefore, this study aimed to investigate the efficacy and safety of an intravenous fosphenytoin therapy protocol in a trigeminal neuralgia crisis. We conducted a single-center, retrospective, observational study of the records of 20 patients with trigeminal neuralgia who received intravenous fosphenytoin therapy (15 mg/mL in normal saline at 50 mg/min for 15 min, total 750 mg) during hospitalization between September 2015 and August 2020. Serum phenytoin concentration was measured 30 min post-infusion. Pain severity was evaluated using a numerical rating scale and was analyzed for statistical significance. The mean age of the patients was 67.5 years (female, 50.0%). The median numerical rating scale score (interquartile range) of pain severity was 2.35 (0-10), 0.65 (0-5), 0.15 (0-1), 2.00 (0-8), and 4.30 (0-10) at 15, 30, and 60 min, and 12 and 24 h, respectively (p < .001); the numerical rating scale score was 10 before treatment. Reduction in pain 24 h following treatment was significant. The mean phenytoin concentration was 12.8 μg/mL 30 min post-treatment. While mild dizziness occurred in four patients, all could walk independently within 60 min. The mean age and weight of patients with mild dizziness were significantly higher and lower, respectively (p < .001), than those of other patients. These results may provide physicians with new insights into the innovative therapeutic option of intravenous fosphenytoin and contribute to advancements in treating acute trigeminal neuralgia crisis.
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Affiliation(s)
- Shusaku Noro
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan.
| | - Yoshinobu Seo
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Kaori Honjo
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Masahiro Okuma
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Bunsho Asayama
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Yuki Amano
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Masanori Kyono
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Kazuya Sako
- Department of Neurology, Nakamura Memorial Hospital, Sapporo, Japan
| | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
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Nakayama Y, Kawaguchi T, Fukuda M, Oishi M. Intraoperative findings of abnormal muscle response for hemifacial spasm following botulinum neurotoxin treatment. Acta Neurochir (Wien) 2021; 163:3303-3309. [PMID: 34626274 DOI: 10.1007/s00701-021-05017-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to investigate the effect of preoperative botulinum toxin (BTX) injection on intraoperative abnormal muscle response (AMR) in patients with hemifacial spasm (HFS). METHODS A total of 104 patients (32 men, 72 women) who underwent microvascular decompression (MVD) for HFS were included in this study. A total of 62 patients without and 42 patients with preoperative BTX treatments were assigned to group A and group B, respectively. AMR recordings were obtained from the orbicularis oculi and mentalis muscles by stimulation of the marginal mandibular branch and zygomatic branch of the facial nerve, respectively. The intraoperative AMR monitoring findings and therapeutic effects were compared between groups A and B. RESULTS The rates of the patients with unavailable AMRs recorded from the orbicularis oculi muscles in group B (38.1%) were significantly higher than those in group A (14.5%, p = 0.006). Moreover, in cases with over 4 times BTX injection, the recordings of AMR from the orbicularis oculi muscles were poorer than the cases with less BTX injection (p = 0.001). There were no significant differences in the rates of the patients with unavailable AMRs recorded from the mentalis muscles between the two groups. There were no significant differences in the surgical results obtained between the two groups. CONCLUSIONS Preoperative BTX injections should be less than 4 times to ensure effective AMR monitoring. MVD using AMR monitoring is useful for patients with HFS who were previously treated by BTX as well as those who were not treated.
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Louges MA, Kleiber JC, Bazin A, Chays A, Dubernard X. Efficacy of microsurgical vascular decompression in trigeminal neuralgia. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 137:285-289. [PMID: 32862993 DOI: 10.1016/j.anorl.2019.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Analysis of the long-term efficacy of microvascular decompression surgery in trigeminal neuralgia. MATERIAL AND METHODS A single-center retrospective study included patients undergoing microvascular decompression surgery for trigeminal neuralgia after failure of well-conducted medical or complementary therapy, with visualization of nerve compression syndrome on MRI. RESULTS Eighty-seven patients were included. Nerve compression was alleviated without interposition of polytetrafluoroethylene in 79.3% of cases. Postoperative efficacy on pain was immediate in 97.7% of cases. There were no postoperative deaths, and the rate of severe complications was low (2.3%). The efficacy of microvascular decompression surgery was total at 2 years in 90.8% of cases and at 10 years in 92.3%, without resumption of medical treatment. The failure rate was 10.3%; 26.3% of these patients had been previously treated by a lesional technique (P: 0.043) and 33.3% by interposition of polytetrafluoroethylene (P: 0.003). CONCLUSIONS With confirmed clinical and radiological diagnosis, microvascular decompression surgery for trigeminal nerve compression was safe, with total effectiveness in the immediate, short and long terms. It should be considered in first line in case of failure or intolerance of well-conducted medical treatment.
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Affiliation(s)
- M-A Louges
- Service ORL et CCF, hôpital Robert-Debré, CHU de Reims, 51100 Reims, France.
| | - J-C Kleiber
- Service de neurochirurgie, hôpital Maison-Blanche, CHU de Reims, 51100 Reims, France
| | - A Bazin
- Service de neurochirurgie, hôpital Maison-Blanche, CHU de Reims, 51100 Reims, France
| | - A Chays
- Service ORL et CCF, hôpital Robert-Debré, CHU de Reims, 51100 Reims, France
| | - X Dubernard
- Service ORL et CCF, hôpital Robert-Debré, CHU de Reims, 51100 Reims, France
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Corrêa de Almeida Teixeira B, Ramina R, Montibeller GR. Image Fusion in Neurovascular Compression Syndrome Related to Hemifacial Spasm. World Neurosurg 2020; 147:125-127. [PMID: 33348101 DOI: 10.1016/j.wneu.2020.11.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/05/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/19/2022]
Abstract
Neurovascular compression syndromes have well characterized clinical symptoms, but precise identification of the pathologic contact between the nerves and vessels can be challenging at neuroimaging. Considering that neurovascular contacts are frequent imaging findings in asymptomatic patients, correct visualization of pathological contact is crucial for the diagnosis and surgical planning. We have used magnetic resonance imaging fusion by overlaying color-coded T1-weighted postcontrast onto high-resolution T2-weighted images to better delineate imaging findings by enhancing vascular structures.
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Affiliation(s)
| | - Ricardo Ramina
- Department of Neurosurgery, Neurological Institute of Curitiba (INC), Curitiba, Paraná, Brazil
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Lee JH, Lee JM, Choi CH. Personal experience with microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia. Yeungnam Univ J Med 2020; 38:202-207. [PMID: 33222427 PMCID: PMC8225491 DOI: 10.12701/yujm.2020.00745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/30/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022] Open
Abstract
Background Trigeminal neuralgia (TN) is a severe, paroxysmal pain in the distribution of the fifth cranial nerve. Microvascular decompression (MVD) is the most widely used surgical treatment for TN. We undertook this study to analyze the effects of and complications of MVD and to refine the surgical procedure for treating TN. Methods A total of 88 patients underwent for TN underwent surgery at our hospital. Among them, 77 patients underwent MVD alone, and 11 underwent partial sensory rhizotomy (PSR) with or without MVD. The medical records of these patients were retrospectively analyzed for patient characteristics, clinical results, offending vessels, and complications if any. Results The mean follow-up duration was 43.2 months (range, 3–216 months). The most common site of pain was V2+V3 territory (n=27), followed by V2 (n=25) and V3 (n=23). The most common offending vessels were the superior cerebellar artery and anterior inferior cerebellar artery in that order. The overall rate of postoperative complications was 46.1%; however, most complications were transient. There were two cases of permanent partial hearing disturbance. In the MVD alone group, the cure rate was 67.5%, and the improvement rate was 26.0%. Among 11 patients who underwent PSR with or without MVD, the cure rate was 50.0%, and the improvement rate was 30.0%. Conclusion The clinical results of MVD were satisfactory. Although the outcomes of PSR were not as favorable as those of pure MVD in this study, PSR can be considered in cases where there is no significant vascular compressive lesion or uncertainty of the causative vessel at the surgery.
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Affiliation(s)
- Jung Hwan Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan, Korea
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan, Korea
| | - Chang Hwa Choi
- Department of Neurosurgery, Pusan National University Hospital, Busan, Korea
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Ruscheweyh R, Lutz J, Mehrkens JH. [Trigeminal neuralgia : Modern diagnostic workup and treatment]. Schmerz 2020; 34:486-494. [PMID: 32960312 DOI: 10.1007/s00482-020-00496-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/02/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 12/23/2022]
Abstract
The present article gives an update of relevant aspects in the diagnosis and therapy of trigeminal neuralgia from the neurological, neuroradiological and neurosurgical point of view. The diagnosis of trigeminal neuralgia is clinical, but high-quality imaging is mandatory to identify secondary causes and a neurovascular contact. New methods such as DTI (diffusion tensor imaging) allow a more differentiated assessment of the consequences of a vascular contact on the trigeminal nerve. Carbamazepine and oxcarbazepine continue to be first choice for the medical treatment, but have been supplemented by additional options such as pregabaline, lamotrigine, and onabotulinumtoxin A. In patients insufficiently responding to medical treatment, there are neurosurgical treatment options giving very good results. The best long-term results have been described for microvascular decompression, but percutaneous and radiosurgical treatments also are good options, especially in patients with an increased surgical risk profile, in secondary trigeminal neuralgia, and in case of recurrence after microvascular decompression.
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Affiliation(s)
- Ruth Ruscheweyh
- Neurologische Klinik, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Jürgen Lutz
- Radiologisches Zentrum München (RZM), Pippingerstr. 25, 81245, München, Deutschland
| | - Jan-Hinnerk Mehrkens
- Neurochirurgische Klinik, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
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Wei SC, Yu R, Meng Q, Qu C. Efficacy of microvascular decompression in patients with trigeminal neuralgia with negative neurovascular relationship shown by magnetic resonance tomography. Clin Neurol Neurosurg 2020; 197:106063. [PMID: 32679513 DOI: 10.1016/j.clineuro.2020.106063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/23/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To explore the surgical efficacy of microvascular decompression(MVD) when the recent magnetic resonance tomography angiography(MRA) is unable to determine the relationship between blood vessels and nerves in patients with trigeminal neuralgia(TN). MATERIALS AND METHODS The MRI images of 146 patients with TN who underwent MVD from January 2016 to December 2019 were analyzed retrospectively. The relationship between nerves and vessels was categorized as no contact, suspicious contact, and clear contact. Suspicious contact and clear contact were both defined as positive neurovascular relationship, whereas no contact was defined as negative neurovascular relationship. The efficacy of MVD in positive and negative groups was compared. RESULTS 1. A total of 146 TN patients underwent MVD. Intraoperative examination revealed that out of 146, 143 patients exhibited contacts, including 110 cases with arterial contact, 22 cases with combined arterial and venous contact, and 11 cases with venous contact. Considering the surgical result as a gold standard, the sensitivity of three-dimensional time leap angiography (3D-TOF-MRA) in assessing vascular compression in TN was 74.0 %; and the sensitivity of three-dimensional steady-state precession rapid imaging sequence (3D-FIESTA) in determining vascular compression was 82.2 %. Out of a total of 17 cases demonstrating negative neurovascular relationship by 3D-TOF-MRA together with 3D-FIESTA, 14 cases were found to have vascular contact during the surgery, and the sensitivity was determined to be 88.4 %. 2.Among the 38 patients with a negative neurovascular relationship demonstrated by 3D-TOF, postoperative efficacy was noted as a cure: 30 cases, improved: 5 cases, no effect: 3 cases. 3D-FIESTA showed 26 cases of negative neurovascular relationship, among them, cured: 20 cases, improved: 3 cases, no effect: 3 cases. A total of 17 patients with negative neurovascular relationships were established by 3D-TOF-MRA together with 3D-FIESTA, and the postoperative effects were found to be cure: 13 cases, improvement: 2 cases, and no effect: 2 cases. There was no statistically significant difference between the negative group and the positive group (x2 test; p > 0.05). CONCLUSION To conclude, 3D-TOF-MRA, together with 3D-FIESTA, can illustrate the large blood vessels surrounding the trigeminal nerve efficiently, and determine whether it is the offending blood vessel. The interpretation would help reproduce the local anatomical spatial structure of the site before surgery, yet it is impossible to assess the peripheral anatomical relationship of the trigeminal nerve cistern comprehensively and accurately. This hints that a perfect prediction of the surgical effect of MVD is not possible at present. Thus, typical symptoms of TN are the most critical indicators for MVD surgery.
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Affiliation(s)
- Sheng Cheng Wei
- The Department of Neurosurgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province,250033, China.
| | - Rui Yu
- The Department of Neurosurgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province,250033, China.
| | - Qinghu Meng
- The Department of Neurosurgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province,250033, China.
| | - Chuncheng Qu
- The Department of Neurosurgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province,250033, China.
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López-Elizalde R, Reyes-Velasco E, Campero Á, Ajler P, Cornelio-Freer KC, Godínez-Rubí M. Minimally invasive asterional approach for microvascular decompression in trigeminal neuralgia. GAC MED MEX 2019; 155:S56-S63. [PMID: 31638613 DOI: 10.24875/gmm.m19000291] [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] [Indexed: 11/17/2022] Open
Abstract
Objective Trigeminal neuralgia (TN) is a neuropathic disorder that can be treated surgically. This study aimed to present the surgical findings and the clinical outcomes of 26 patients with TN treated by minimally invasive asterional surgery. Methods Longitudinal descriptive study. Twenty-six patients with TN underwent minimally invasive asterional surgery. The medical history, surgical findings, therapeutic response, and complications were registered. They were followed for 36 months. Results Nineteen cases were associated with vascular compression; five were associated with arachnoiditis. The two remaining cases were associated with multiple sclerosis and post-herpetic neuralgia. The pain was substantially reduced in all patients in the immediate postoperative period. At 36 months, in 25 patients, total or acceptable pain control was achieved. In the long term, 22 patients evolved with no permanent complications. Conclusion The microvascular decompression surgery by an asterional approach is an alternative with similar results to the classic retrosigmoid approach to treat TN, but that adds the benefits of the principles of minimally invasive surgery. Constant efforts need to be made to optimize minimally invasive surgical techniques for TN.
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Affiliation(s)
- Ramiro López-Elizalde
- Health Regulatory Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, City of Mexico, Mexico.,Neurosurgery Department, OPD Hospital Civil Juan I. Menchaca, Guadalajara, Jalisco, Mexico
| | - Esteban Reyes-Velasco
- Health Regulatory Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, City of Mexico, Mexico
| | - Álvaro Campero
- Neurosurgery Department, Hospital Padilla, Tucumán, Argentina
| | - Pablo Ajler
- Department of Neurological Surgery, Hospital Italiano, Buenos Aires, Argentina
| | - Karla Cecilia Cornelio-Freer
- Health Regulatory Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, City of Mexico, Mexico
| | - Marisol Godínez-Rubí
- Health Regulatory Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, City of Mexico, Mexico.,Department of Microbiology and Pathology, University Center of Health Sciences, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
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15
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Park SK, Joo BE, Park K. Intraoperative Neurophysiological Monitoring during Microvascular Decompression Surgery for Hemifacial Spasm. J Korean Neurosurg Soc 2019; 62:367-375. [PMID: 31290293 PMCID: PMC6616990 DOI: 10.3340/jkns.2018.0218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/27/2018] [Accepted: 04/04/2019] [Indexed: 12/02/2022] Open
Abstract
Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.
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Affiliation(s)
- Sang-Ku Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Euk Joo
- Department of Neurology, Myongji Hospital, Hanyang University Medical Center, Goyang, Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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López-Elizalde R, Reyes-Velasco E, Campero Á, Ajler P, Cornelio-Freer KC, Godínez-Rubí M. [Abordaje asterional mínimamente invasivo para descompresión microvascular en neuralgia del trigémino]. GAC MED MEX 2019; 155:S70-S78. [PMID: 31182878 DOI: 10.24875/gmm.19005130] [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] [Indexed: 11/17/2022] Open
Abstract
Objective Trigeminal neuralgia (TN) is a neuropathic disorder that can be treated surgically. This study aimed to present the surgical findings and the clinical outcomes of 26 patients with TN treated by minimally invasive asterional surgery. Methods Longitudinal descriptive study. Twenty-six patients with TN underwent minimally invasive asterional surgery. The medical history, surgical findings, therapeutic response, and complications were registered. They were followed for 36 months. Results Nineteen cases were associated with vascular compression; five were associated with arachnoiditis. The two remaining cases were associated with multiple sclerosis and post-herpetic neuralgia. The pain was substantially reduced in all patients in the immediate postoperative period. At 36 months, in 25 patients, total or acceptable pain control was achieved. In the long term, 22 patients evolved with no permanent complications. Conclusion The microvascular decompression surgery by an asterional approach is an alternative with similar results to the classic retrosigmoid approach to treat TN, but that adds the benefits of the principles of minimally invasive surgery. Constant efforts need to be made to optimize minimally invasive surgical techniques for TN.
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Affiliation(s)
- Ramiro López-Elizalde
- Dirección Normativa en Salud, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México.,Servicio de Neurocirugía, OPD Hospital Civil Juan I. Menchaca, Guadalajara, Jalisco, México
| | - Esteban Reyes-Velasco
- Dirección Normativa en Salud, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Álvaro Campero
- Servicio de Neurocirugía, Hospital Padilla, Tucumán, Argentina
| | - Pablo Ajler
- Departamento de Cirugía Neurológica, Hospital Italiano, Buenos Aires, Argentina
| | - Karla Cecilia Cornelio-Freer
- Dirección Normativa en Salud, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Marisol Godínez-Rubí
- Dirección Normativa en Salud, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México.,Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
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17
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Chen JN, Yu WH, Du HG, Jiang L, Dong XQ, Cao J. Prospective Comparison of Redo Microvascular Decompression and Percutaneous Balloon Compression as Primary Surgery for Recurrent Trigeminal Neuralgia. J Korean Neurosurg Soc 2018; 61:747-752. [PMID: 30081435 PMCID: PMC6280063 DOI: 10.3340/jkns.2017.0196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/24/2017] [Accepted: 11/24/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To prospectively compare facial pain outcomes for patients having either a repeat microvascular decompression (MVD) or percutaneous balloon compression (PBC) as their surgery for trigeminal neuralgia (TN) recurrence. METHODS Prospective cohort study of 110 patients with TN recurrence who had either redo MVD (n=68) or PBC (n=42) from July 2010 until September 2016. The mean follow-up was 45.6 months. RESULTS After redo MVD, 65 patients (95.6%) experienced immediate relief of pain. After PBC, 34 patients (81%) were immediately relieved of their neuralgia. After 1 month, the clinical effect of redo MVD was better than PBC (p<0.01). Patients who had redo MVD more commonly were pain free off medications (93.4% at 1 year, 78.2% at 4 years) compared with the PBC patients (85.1% at 1 year, 59.3% at 4 years). However, mean length of stay was longer (p>0.05). Patients after PBC who occurred developed herpes simplex (35.7%), facial numbness (76.2%), annoying dysesthesia (21.4%) more frequently compared with patients after redo MVD who occurred developed herpes simplex (14.7%), facial numbness (8.8%), hypoesthesia (5.9%) (p<0.05). The symptoms recurred respectively in 15 patients (22.1%) and 19 patients (45.2%) after redo MVD and PBC within the entire 6-year follow-up period. CONCLUSION For the patients with TN recurrence, redo MVD was a more effective procedure than PBC. The cure rate and immediate relief of pain were better, and the incidence of complications was lower.
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Affiliation(s)
- Jing-Nan Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Wen-Hua Yu
- Department of Neurosurgery, The First People's Hospital of Hangzhou, Hangzhou, China
| | - Hang-Gen Du
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Li Jiang
- Department of Neurosurgery, The First People's Hospital of Hangzhou, Hangzhou, China
| | - Xiao-Qiao Dong
- Department of Neurosurgery, The First People's Hospital of Hangzhou, Hangzhou, China
| | - Jie Cao
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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18
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Brinzeu A, Dumot C, Sindou M. Role of the petrous ridge and angulation of the trigeminal nerve in the pathogenesis of trigeminal neuralgia, with implications for microvascular decompression. Acta Neurochir (Wien) 2018; 160:971-6. [PMID: 29353407 DOI: 10.1007/s00701-018-3468-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/08/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Vascular compression is the main pathogenetic factor in apparently primary trigeminal neuralgia; however some patients may present with clinically classical neuralgia but no vascular conflict on MRI or even at surgery. Several factors have been cited as alternative or supplementary factors that may cause neuralgia. This work focuses on the shape of the petrous ridge at the point of exit from the cavum trigeminus as well as the angulation of the nerve at this point. METHODS Patients with trigeminal neuralgia that had performed a complete imagery workup according to our protocol and had microvascular decompression were included as well as ten controls. In all subjects, the angle of the petrous ridge as well as the angle of the nerve on passing over the ridge were measured. These were compared from between the neuralgic and the non-neuralgic side and with the measures performed in controls. RESULTS In 42 patients, the bony angle of the petrous ridge was measured to be 86° on the neuralgic side, significantly more acute than that of controls (98°, p = 0.004) and with a trend to be more acute than the non-neuralgic side (90°, p = 0.06). The angle of the nerve on the side of the neuralgia was measured to be on average 141°, not significantly different either from the other side (144°, p = 0.2) or from controls (142°, p = 0.4). However, when taking into account the grade of the conflict, the angle was significantly more acute in patients with grade II/III conflict than on the contralateral side, especially when the superior cerebellar artery was the conflicting vessel. CONCLUSION This pilot study analyzes factors other than NVC that may contribute to the pathogenesis of the neuralgia. It appears that aggressive bony edges may contribute-at least indirectly-to the neuralgia. This should be considered for surgical indication and conduct of surgery when patients undergo MVD.
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Park CK, Lee SH, Rhee BA, Choi SK. Puncture of Cerebellar Horizontal Fissure for Retrosigmoid Approach: A Prospective and Quantitative Analysis. Oper Neurosurg (Hagerstown) 2017; 13:689-692. [PMID: 28605565 DOI: 10.1093/ons/opx048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/15/2016] [Accepted: 06/07/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) drainage is important in retrosigmoid approached surgery; however, in some cases, it is not feasible due to cerebellar swelling. OBJECTIVE To introduce a method, puncture of the horizontal fissure of the cerebellum, which can reduce the cerebellum to easily obtain a good operative corridor and slowly drain CSF. METHODS Between January and December 2014, we estimated the precise location of the horizontal fissure in 56 patients who underwent surgery via a retrosigmoid approach. Then, we collected and analyzed CSF drained by puncturing the horizontal fissure. We investigated whether a good operative corridor was obtained with this method. RESULTS The location of the precise horizontal fissure was a mean of 3.97 mm caudal to transverse sinus and the mean amount of CSF drained in 56 patients was 50.4 mL. A good corridor was obtained in 46 (82.1%) of 56 patients without additional cistern puncture. CONCLUSION The puncture of the horizontal fissure can be useful in retrosigmoid approach surgery. Moreover, inexperienced surgeons can use this method to effectively avoid injury of the cerebellum.
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Affiliation(s)
- Chang Kyu Park
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Sung Ho Lee
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.,Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
| | - Bong Arm Rhee
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.,Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
| | - Seok Keun Choi
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.,Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
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20
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Kim MK, Park JS, Ahn YH. Microvascular Decompression for Glossopharyngeal Neuralgia: Clinical Analyses of 30 Cases. J Korean Neurosurg Soc 2017; 60:738-748. [PMID: 29142635 PMCID: PMC5678068 DOI: 10.3340/jkns.2017.0506.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 06/07/2017] [Revised: 08/29/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022] Open
Abstract
Objective We present our experience of microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN) and evaluate the postoperative outcomes in accordance with four different operative techniques during MVD. Methods In total, 30 patients with intractable primary typical GPN who underwent MVD without rhizotomy and were followed for more than 2 years were included in the analysis. Each MVD was performed using one of four different surgical techniques: interposition of Teflon pieces, transposition of offending vessels using Teflon pieces, transposition of offending vessels using a fibrin-glue-coated Teflon sling, and removal of offending veins. Results The posterior inferior cerebellar artery was responsible for neurovascular compression in 27 of 30 (90%) patients, either by itself or in combination with other vessels. The location of compression on the glossopharyngeal nerve varied; the root entry zone (REZ) only (63.3%) was most common, followed by both the REZ and distal portion (26.7%) and the distal portion alone (10.0%). In terms of detailed surgical techniques during MVD, the offending vessels were transposed in 24 (80%) patients, either using additional insulation, offered by Teflon pieces (15 patients), or using a fibrin glue-coated Teflon sling (9 patients). Simple insertion of Teflon pieces and removal of a small vein were also performed in five and one patient, respectively. During the 2 years following MVD, 29 of 30 (96.7%) patients were asymptomatic or experienced only occasional pain that did not require medication. Temporary hemodynamic instability occurred in two patients during MVD, and seven patients experienced transient postoperative complications. Neither persistent morbidity nor mortality was reported. Conclusion This study demonstrates that MVD without rhizotomy is a safe and effective treatment option for GPN.
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Affiliation(s)
- Mi Kyung Kim
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea
| | - Jae Sung Park
- Department of Neurosurgery, Konkuk University School of Medicine, Chungju, Korea
| | - Young Hwan Ahn
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea.,Neuroscience Graduate Program, Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Korea
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Xing YZ, Wang XJ, Liang QH. [The study of hearing loss after microvascular decompression for hemifacial spasm]. Zhonghua Yi Xue Za Zhi 2017; 97:2451-2453. [PMID: 28835048 DOI: 10.3760/cma.j.issn.0376-2491.2017.31.014] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare the difference of hearing loss after microvascular decompression for hemifacial spasm between control and experimental groups, and to explore the possible causes. Methods: A retrospective analysis including 443 patients was performed, including 203 cases of group A (before the operation was improved) and 240 cases of group B (after the operation was improved). Chi-square test was used to compare the rate of hearing loss. Results: There were 18(8.9%) cases with postoperative hearing loss in group A, including 9 cases of conductive hearing loss and 9 cases of sensorineural hearing loss.While 2 cases of conductive hearing loss and 3 cases of sensorineural hearing loss occurred in group B. Conductive hearing loss and sensorineural hearing loss of two groups had the significant deference (P=0.015 and P=0.04). Conclusion: The type of hearing loss after microvascular decompression for hemifacial spasm included conductive and sensorineural hearing loss.It could be reduced by early closing of the mastoid air chamber, avoiding continuous traction of the cerebellum, avoiding excessive irrigation and exhaust, and intraoperative auditory brainstem evoked potential monitoring.
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Affiliation(s)
- Y Z Xing
- Depatment of Neurosurgery, People's Hospital of Henan Province & People's Hospital of Zhengzhou University, Zhengzhou 450000, China
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22
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Yang YM, Wang ZW, Cui Z, Jiang HZ, Sha C, Yuan QG, Xie HW, Wang DM. [Anatomy and management of superior petrosal vein in microvascular decompression for trigeminal neuralgia]. Zhonghua Yi Xue Za Zhi 2017; 97:522-524. [PMID: 28260292 DOI: 10.3760/cma.j.issn.0376-2491.2017.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the characteristics of superior petrosal vein (SPV) and its influence on the surgical field in microvascular decompression (MVD) for trigeminal neuralgia (TN), and to analyze the effect of the surgical treatment of SPV on the surgical approach, indication and prognosis. Methods: The clinical data of 280 patients with trigeminal neuralgia between Jan. 2013 and Jun. 2016 were collected, including the trunks and the branches of SPV, intraoperative electrocoagulation status, the surgery outcome and complications. Results: The petrosal vein during the operation was fully preserved in 152 cases (54.29%). The SPV were completely sectioned in 25 cases (8.92%), while some branches of SPV were sectioned in 103 cases (36.79%). We found that SPV have 1 to 3 trunks, accounted for 67 cases (23.90%), 168 cases (60%), and 45 cases (16.10%), while the SPV with 1 to 4 branches accounted for 17 cases (6.07%), 112 cases (40%), 136 cases (48.57%), and 15 cases (5.36%). The SPV was identified as offending vessel in 17 cases (6.07%). One patient with cutoff SPV trunk encountered cerebellar infarction and recovered completely at 2 weeks after MVD by using intravenous medication. Conclusions: MVD is the recommended treatment method for PTN, mostly SPV is unnecessary to be sectioned completely and small branches of SPV could be sacrificed. Very few patients may develop cerebellar infarction or hematoma.
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Affiliation(s)
- Y M Yang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
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23
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Huang C, Miao S, Chu H, Dai C, Wu J, Wang J, Zuo H, Ma Y. An optimized abnormal muscle response recording method for intraoperative monitoring of hemifacial spasm and its long-term prognostic value. Int J Surg 2016; 38:67-73. [PMID: 28027998 DOI: 10.1016/j.ijsu.2016.12.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 09/12/2016] [Revised: 11/15/2016] [Accepted: 12/20/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraoperative electrophysiological monitoring is used to determine whether decompression is sufficient during microvascular decompression (MVD) for hemifacial spasm (HFS). However, the real offending vessel is sometimes neglected by the neurosurgeons. Here, we reported our experience in using optimized abnormal muscle response (AMR) monitoring and continuous intraoperative monitoring for MVD. METHODS This study included 2161 HFS patients who underwent MVD using traditional (1023 patients) and optimized (1138 patients) methods. Modified AMR monitoring was adopted in our study, with the zygomatic branch of the facial nerve stimulated and the temporal branch, buccal branch, marginal mandibular branch and cervical branch of the facial nerve detected for AMR. These cases were analyzed retrospectively with emphasis on the postoperative outcomes and intraoperative findings. The therapeutic effect was evaluated at day 1, month 3 and year 1 after operation. RESULTS The relief rate at day 1, month 3 and year 1 after operation for patients who employed optimized AMR recording method was 95.1%, 97.4% and 99.3%, comparing with 92.2%, 95.0% and 97.8% in traditional method. There was significant difference in achieved immediate remission and recovery rate during 12-month follow-up between the two groups (P < 0.05). The modified intraoperative monitoring showed the sensitivity of AMR disappearance to judge the relief at day 1, month 3 and year 1 after HFS operation was 95.7%, 96.3% and 97.3%, respectively; the specificity was 44.6%, 43.3% and 50.0%, respectively; the accuracy was 93.1%, 94.9% and 97.4%, respectively. CONCLUSIONS Our findings demonstrated that the optimized method could improve the positive detection rate of AMR and accuracy of decompression effect prediction. The evaluation for the decompression effect by optimized intraoperative monitoring can increase the immediate remission rate and reduce the delayed recovery rate.
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Affiliation(s)
- Chuyi Huang
- Clinical Neuroscience Institute, Yuquan Hospital, Medical Center, Tsinghua University, No. 5 Shijingshan Road, Shijingshan District, Beijing, 100040, China; Department of Neurology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200030, China
| | - Suhua Miao
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, No. 5 Shijingshan Road, Shijingshan District, Beijing, 100049, China
| | - Heling Chu
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Mid. Wulumuqi Road, Shanghai, 200040, China
| | - Chuanfu Dai
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China
| | - Jinting Wu
- Clinical Neuroscience Institute, Yuquan Hospital, Medical Center, Tsinghua University, No. 5 Shijingshan Road, Shijingshan District, Beijing, 100040, China; Department of Neurosurgery, Tsinghua University Yuquan Hospital, No. 5 Shijingshan Road, Shijingshan District, Beijing, 100049, China
| | - Junhua Wang
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, No. 5 Shijingshan Road, Shijingshan District, Beijing, 100049, China
| | - Huancong Zuo
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, No. 5 Shijingshan Road, Shijingshan District, Beijing, 100049, China.
| | - Yu Ma
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, No. 5 Shijingshan Road, Shijingshan District, Beijing, 100049, China.
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Chung YH, Kim WH, Chung IS, Park K, Lim SH, Seo DW, Lee JJ, Yang SI. Effects of partial neuromuscular blockade on lateral spread response monitoring during microvascular decompression surgery. Clin Neurophysiol 2015; 126:2233-40. [PMID: 25716546 DOI: 10.1016/j.clinph.2014.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 11/13/2014] [Accepted: 12/23/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We evaluated the effect of partial neuromuscular blockade (NMB) and no NMB on successful intraoperative monitoring of the lateral spread response (LSR) during microvascular decompression (MVD) surgery. METHODS Patients were randomly allocated into one of three groups: the TOF group, the NMB was targeted to maintain two counts of train-of-four (TOF); the T1 group, maintain the T1/Tc (T1: amplitude of first twitch, Tc: amplitude of baseline twitch) ratio at 50%; and the N group, no relaxants after tracheal intubation. Successful LSR monitoring was defined as effective baseline establishment and maintenance of the LSR until dural opening. RESULTS The success rate of LSR monitoring was significantly lower in the TOF group. But, there was no significant difference between T1 and N. The detection rate of spontaneous free-run electromyography (EMG) activity was significantly higher in the N group compared with the TOF and T1 groups. CONCLUSIONS Partial NMB with a target of T1/Tc ratio at 50% allows good recording of LSR with same outcome as surgery without NMB, and reduced spontaneous EMG activity. SIGNIFICANCE We suggested the availability of partial NMB for intraoperative LSR monitoring.
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Zaidi HA, Spetzler RF. Microvascular decompression of the brainstem. World Neurosurg 2014; 82:e401-2. [PMID: 24636938 DOI: 10.1016/j.wneu.2014.03.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/11/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Hasan A Zaidi
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Robert F Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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