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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] [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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Pines AR, Butterfield RJ, Turcotte EL, Garcia JO, De Lucia N, Algier EJ, Patel NP, Zimmerman RS. Microvascular Transposition Without Teflon: A Single Institution's 17-Year Experience Treating Trigeminal Neuralgia. Oper Neurosurg (Hagerstown) 2021; 20:397-405. [PMID: 33432975 DOI: 10.1093/ons/opaa413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/07/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Trigeminal neuralgia (TN) refractory to medical management is often treated with microvascular decompression (MVD) involving the intracranial placement of Teflon. The placement of Teflon is an effective treatment, but does apply distributed pressure to the nerve and has been associated with pain recurrence. OBJECTIVE To report the rate of postoperative pain recurrence in TN patients who underwent MVD surgery using a transposition technique with fibrin glue without Teflon. METHODS Patients were eligible for our study if they were diagnosed with TN, did not have multiple sclerosis, and had an offending vessel that was identified and transposed with fibrin glue at our institution. All eligible patients were given a follow-up survey. We used a Kaplan-Meier (KM) model to estimate overall pain recurrence. RESULTS A total of 102 patients met inclusion criteria, of which 85 (83%) responded to our survey. Overall, 76 (89.4%) participants responded as having no pain recurrence. Approximately 1-yr pain-free KM estimates were 94.1% (n = 83), 5-yr pain-free KM estimates were 94.1% (n = 53), and 10-yr pain-free KM estimates were 83.0% (n = 23). CONCLUSION Treatment for TN with an MVD transposition technique using fibrin glue may avoid some cases of pain recurrence. The percentage of patients in our cohort who remained pain free at a maximum of 17 yr follow-up is on the high end of pain-free rates reported by MVD studies using Teflon. These results indicate that a transposition technique that emphasizes removing any compression near the trigeminal nerve root provides long-term pain-free rates for patients with TN.
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Affiliation(s)
- Andrew R Pines
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Richard J Butterfield
- Department of Health Sciences Research, Division of Biostatistics Clinic, Scottsdale, Arizona
| | | | - Jose O Garcia
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Noel De Lucia
- Department of Clinical Research, Mayo Clinic, Phoenix, Arizona
| | - Emily J Algier
- Department of Neurologic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Naresh P Patel
- Department of Neurologic Surgery, Mayo Clinic, Phoenix, Arizona
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Yan X, Ma C, Gu J, Qu J, Quan J, Zhang X, Song Q, Zhou L. Facial root entry/exit zone contact in microvascular decompression for hemifacial spasm: a historical control study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:834. [PMID: 34164468 PMCID: PMC8184434 DOI: 10.21037/atm-20-7985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Microvascular decompression (MVD) surgery is recognized as an effective treatment for hemifacial spasm (HFS). In MVD surgery, biocompatible materials are usually implanted in situ at the neurovascular conflict site in contact with the offending vessel and the facial root entry/exit zone (REZ). Another procedure of implanting the materials between the responsible vessel and the supraolivary fossa without REZ contact has also been applied. However, it is unclear whether there are any differences between these 2 procedures (REZ-contact procedure vs. REZ-non-contact procedure). Therefore, the aim of the present study was to investigate the effect of the placement of implants (contacting or not contacting the facial REZ) on surgical operations and outcomes Methods A historical control study was performed. Clinical data of HFS patients who underwent MVD between December 2016 and November 2018 were reviewed and categorized into 1 group with the REZ-contact procedure or another group with the REZ-non-contact procedure according to the decompression strategy they received. Clinical demographics, postoperative outcomes, and complications were collected and compared between the two groups. Results Not all patients are suitable for REZ-non-contact decompression. A total of 205 patients were enrolled: 112 in the REZ-contact group and 93 in the REZ-non-contact group. In the early postoperative period, the complete cure rate in the REZ-non-contact group was significantly higher than that in the REZ-contact group. The reappearance and partial relief rates in the REZ-contact group were significantly higher than those in the REZ-non-contact group. The incidence of short-term neurological complications, especially hearing loss and transient facial palsy, was lower in the REZ-non-contact group (P=0.043). But for long-term follow-up of >1 year, there was no significant difference between the two groups in either curative effects or neurological complications. The operating time for REZ-non-contact decompression was relatively longer than for REZ-contact decompression (P=0.000). An unexpected subdural hemorrhage occurred in the REZ-non-contact group. Conclusions REZ-non-contact decompression procedure showed superiority only in short-term postoperative outcomes. Given its limitations and potential risks, the REZ-non-contact procedure can be used as an alternative individualized strategy in MVD, and there is no need to pursue REZ-non-contact during the decompression.
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Affiliation(s)
- Xianxia Yan
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chengwen Ma
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junxiang Gu
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianqiang Qu
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junjie Quan
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xi Zhang
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qin Song
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Le Zhou
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Hoz SS, Al-Sharshahi ZF, Dolachee AA, Chotai S, Salih H, Albanaa SA, Mohammed HJ. Transposition of Vessels for Microvascular Decompression of Posterior Fossa Cranial Nerves: Review of Literature and Intraoperative Decision-Making Scheme. World Neurosurg 2020; 145:64-72. [PMID: 32890843 DOI: 10.1016/j.wneu.2020.08.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/22/2020] [Accepted: 08/23/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Microvascular decompression with transposition of the involved vessels provides good surgical outcomes in cases of complex and recurrent neurovascular compression syndromes. We conducted a literature review to illustrate the variations in the surgical techniques used for transposition and to provide a practical decision-making scheme for transposition of the involved vessel. METHODS A PubMed Medline database record search was conducted using the following algorithm ("Microvascular Decompression Surgery"[Mesh]) OR (((Microvascular) OR (Macrovascular)) AND decompression AND surgery) AND (transposition). Only articles that detailed the intraoperative techniques were included. RESULTS A total of 48 articles were included. The adjacent anatomical walls to which the compressing vessel can be anchored were divided into 4 groups; A: roof (tentorium cerebelli), B: anterior wall (posterior surface of petrous bone and clivus), C: posterior wall (petrosal surface of the cerebellum), and D: "no wall" required. A new decision-making scheme based on the following 2 questions was designed: 1) is the conflicting vessel amenable to transposition to a nearby wall in the cerebello-brainstem space? 2) what is the closest wall to secure the transposed vessel? CONCLUSIONS Transposition of the involved vessel is a valuable procedure for microvascular decompression of the posterior fossa cranial nerves. Anchoring the vessel to the adjacent anatomical wall ensures secure transposition. The proposed algorithm provides a systemic scheme to identify the optimal anatomical wall, and to determine the technique and material that can be used to anchor involved vessel. This scheme is an efficient method to inform the intraoperative decision-making process.
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Affiliation(s)
- Samer S Hoz
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | | | - Ali Adnan Dolachee
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Diwaniyah, Iraq
| | - Silky Chotai
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hayder Salih
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
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Hasegawa M, Hatayama T, Kondo A, Nagahiro S, Fujimaki T, Amagasaki K, Arita K, Date I, Fujii Y, Goto T, Hanaya R, Higuchi Y, Hongo K, Inoue T, Kasuya H, Kayama T, Kawashima M, Kohmura E, Maehara T, Matsushima T, Mizobuchi Y, Morita A, Nishizawa S, Noro S, Saito S, Shimano H, Shirane R, Takeshima H, Tanaka Y, Tanabe H, Toda H, Yamakami I, Nishiyama Y, Ohba S, Hirose Y, Suzuki T. Prosthesis Used in Microvascular Decompressions: A Multicenter Survey in Japan Focusing on Adverse Events. World Neurosurg 2019; 130:e251-e258. [DOI: 10.1016/j.wneu.2019.06.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
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Breeze RE, Craig DB. Microvascular Decompression for Trigeminal Neuralgia: A Durable, Noncompressive Technique Using Teflon Secured With Mini Clip. Oper Neurosurg (Hagerstown) 2019; 16:580-582. [PMID: 30982904 DOI: 10.1093/ons/opy212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/09/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In cases of trigeminal neuralgia, the importance of durable separation of involved vessels from the trigeminal nerve as well as avoiding ongoing or recurrent compression by implanted material has been affirmed in recent literature. OBJECTIVE To demonstrate a novel and straightforward technique for trigeminal nerve decompression using a construct of Teflon felt patty (Bard Peripheral Vascular, Tempe, Arizona) secured with an aneurysm mini clip to achieve lasting results with no residual contact between implant or vessels and the nerve. METHODS Description of our technique and accompanying surgical video. RESULTS As demonstrated in the video, this technique achieves an ideal, durable separation of the trigeminal nerve from the offending vasculature. CONCLUSION The authors present a description of a technique for decompression with the goal of leaving no contact between implanted material and the nerve. This is accomplished by securing the Teflon felt (Bard Peripheral Vascular) to the tentorium with an aneurysm clip.
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Affiliation(s)
- Robert E Breeze
- Department of Neurosurgery, University of Colorado, Aurora, Colorado
| | - Daniel B Craig
- Department of Neurosurgery, University of Colorado, Aurora, Colorado
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7
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Sindou M, Mercier P. Microvascular decompression for hemifacial spasm : Surgical techniques and intraoperative monitoring. Neurochirurgie 2018; 64:133-143. [DOI: 10.1016/j.neuchi.2018.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/22/2018] [Accepted: 04/06/2018] [Indexed: 11/30/2022]
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Abstract
Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.
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Affiliation(s)
- Yad Ram Yadav
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Yadav Nishtha
- Department of Radio Diagnosis and Imaging, All India Institute of Medical Science, New Delhi, India
| | - Pande Sonjjay
- Department of Radio Diagnosis and Imaging, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Parihar Vijay
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Ratre Shailendra
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Khare Yatin
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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da Silva OT, de Almeida CC, Iglesio RF, de Navarro JM, Teixeira MJ, Duarte KP. Surgical variation of microvascular decompression for trigeminal neuralgia: A technical note and anatomical study. Surg Neurol Int 2016; 7:S571-6. [PMID: 27625893 PMCID: PMC5009571 DOI: 10.4103/2152-7806.188916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 04/23/2016] [Indexed: 11/12/2022] Open
Abstract
Background: In this article, the authors described their experience in microvascular decompression for trigeminal neuralgia. Methods: The microvascular decompression technique used in the authors’ institution is described in a step by step manner with some illustrative cases as well as a cadaver dissection to highlight the differences with other previously described techniques. Results: Since 2013, 107 patients were operated in the Neurosurgery Division of the University of São Paulo using the described technique, with a shorter operative time and avoiding cerebellar retractor compared with classic techniques. Conclusion: Our modified microvascular decompression technique for trigeminal neuralgia can be used with safety and efficiency for treating trigeminal neuralgia.
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Affiliation(s)
- Otávio T da Silva
- Discipline of Neurosurgery, Departament of Neurology, Campinas State University-SP, São Paulo, Brazil
| | - César C de Almeida
- Discipline of Neurosurgery, Departament of Neurology, University of São Paulo-SP, São Paulo, Brazil
| | - Ricardo F Iglesio
- Discipline of Neurosurgery, Departament of Neurology, University of São Paulo-SP, São Paulo, Brazil
| | - Jessie M de Navarro
- Discipline of Neurosurgery, Departament of Neurology, University of São Paulo-SP, São Paulo, Brazil
| | - Manoel J Teixeira
- Discipline of Neurosurgery, Departament of Neurology, University of São Paulo-SP, São Paulo, Brazil
| | - Kleber P Duarte
- Discipline of Neurosurgery, Departament of Neurology, University of São Paulo-SP, São Paulo, Brazil
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Bajwa ZH, Smith SS, Khawaja SN, Scrivani SJ. Cranial Neuralgias. Oral Maxillofac Surg Clin North Am 2016; 28:351-70. [DOI: 10.1016/j.coms.2016.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Deep NL, Graffeo CS, Copeland WR, Link MJ, Atkinson JL, Neff BA, Raghunathan A, Carlson ML. Teflon granulomas mimicking cerebellopontine angle tumors following microvascular decompression. Laryngoscope 2016; 127:715-719. [PMID: 27320780 DOI: 10.1002/lary.26126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/21/2016] [Accepted: 05/11/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To report two patients with a history of microvascular decompression (MVD) for hemifacial spasm who presented with Teflon granulomas (TG) mimicking cerebellopontine angle (CPA) tumors and to perform a systematic review of the English-language literature. STUDY DESIGN Case series at a single tertiary academic referral center and systematic review. METHODS Retrospective chart review with analysis of clinical, radiological, and histopathological findings. Systematic review using PubMed, Embase, MEDLINE, and Web of Science databases. RESULTS Two patients with large skull base TGs mimicking CPA tumors clinically and radiographically were managed at the authors' institution. The first presented 4 years after MVD with asymmetrical sensorineural hearing loss, multiple progressive cranial neuropathies, and brainstem edema due to a growing TG. Reoperation with resection of the granuloma confirmed a foreign-body reaction consisting of multinucleated giant cells containing intracytoplasmic Teflon particles. The second patient presented 11 years after MVD with asymmetrical sensorineural hearing loss and recurrent hemifacial spasm. No growth was noted over 2 years, and the patient has been managed expectantly. Only one prior case of TG after MVD for hemifacial spasm has been reported in the English literature. CONCLUSIONS TG is a rare complication of MVD for hemifacial spasm. The diagnosis should be suspected in patients presenting with a new-onset enhancing mass of the CPA after MVD, even when performed decades earlier. A thorough clinical and surgical history is critical toward establishing an accurate diagnosis to guide management and prevent unnecessary morbidity. Surgical intervention is not required unless progressive neurologic complications ensue. LEVEL OF EVIDENCE 4 Laryngoscope, 127:715-719, 2017.
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Affiliation(s)
- Nicholas L Deep
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona
| | | | - William R Copeland
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - John L Atkinson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Brian A Neff
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Matthew L Carlson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
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Meybodi AT, Habibi Z, Miri M, Tabatabaie SAF. Microvascular decompression for trigeminal neuralgia using the 'Stitched Sling Retraction' technique in recurrent cases after previous microvascular decompression. Acta Neurochir (Wien) 2014; 156:1181-7; discussion 1187. [PMID: 24770729 DOI: 10.1007/s00701-014-2092-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/31/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Microvascular decompression is a well-known therapeutic option for trigeminal neuralgia. It is considered safe and effective, and is the surgical treatment of choice for the malady. However, there is no standard technique for it and different authors have proposed different techniques of performing it. In this study, we observe the clinical results of the so-called 'stitched sling retraction' technique for recurrent cases of trigeminal neuralgia. METHODS Twelve consecutive patients with recurrent trigeminal neuralgia after previous microvascular decompression(s) were admitted to our institution form February 2009 to February 2011 and underwent microvascular decompression of the trigeminal nerve using the 'stitched sling retraction' technique. In this technique, the offending loop of the superior cerebellar artery is retracted from the nerve and, using a silk thread loop around it, is suspended to the adjacent tentorium. RESULTS All patients experienced pain resolution during the immediate post-operative period or within the first 6 months after surgery. They were followed for 24 to 38 months. No recurrence occurred. CONCLUSIONS The 'stitched sling retraction' technique shows promising preliminary results in recurrent cases of trigeminal neuralgia after previous microvascular decompression(s). Since it is a 'transposing' technique, it might be associated with less recurrence rates (due to resuming of the neurovascular conflict) than the classic interposing technique, which uses a prosthesis between the offending vessel and the trigeminal nerve.
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Affiliation(s)
- Ali Tayebi Meybodi
- Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran,
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Grasso G, Meli F, Maugeri R, Certo F, Costantino G, Giambartino F, Iacopino DG. Unusual recurrence of trigeminal neuralgia after microvascular decompression by muscle interposal. Med Sci Monit 2011; 17:CS43-6. [PMID: 21455112 PMCID: PMC3539511 DOI: 10.12659/msm.881703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression (MVD) typically undergo less invasive procedures in the hope of providing pain relief. However, re-operation should be considered in selected patients. CASE REPORT A 48-year-old woman presented with recurrent trigeminal neuralgia (TN) 3 years following microvascular decompression (MVD). The patient underwent brain magnetic resonance angiography (MRA), which did not reveal neurovascular compression; therefore surgical re-exploration was carried out. During the operation, the fifth cranial nerve was seen without impingement from any blood vessels; however, a very firm tissue was observed and identified as the muscle fragment from the previous MVD procedure. The fifth cranial nerve was carefully separated from the muscle. Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura. CONCLUSIONS Our findings, along with similar cases reported in the literature, support the development of new inert materials and alternative surgical strategies that can limit TN recurrence.
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Affiliation(s)
- Giovanni Grasso
- Neurosurgical Clinic, Department of Clinic Neurosciences, University of Palermo, Palermo, Italy.
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[Adjunctive use of endoscopy during microvascular decompression in the cerebellopontine angle: 27 case reports]. Neurochirurgie 2011; 57:68-72. [PMID: 21530987 DOI: 10.1016/j.neuchi.2011.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 03/21/2011] [Indexed: 11/20/2022]
Abstract
Microvascular decompression is an important procedure for the management of microvascular compression syndromes in the cerebellopontine angle (CPA) like trigeminal neuralgia or hemifacial spasm. The ability to identify the offending vessel is the key to success. Can the endoscope help surgeons to identify and understand the responsible conflict in order to treat them? Our series concerns 27 consecutive patients who underwent microvascular decompression systematically using an endoscope with an angulation of 30° at the beginning and the end of the intervention. The decompression procedure was done under microscope. Endoscopic exploration was successful for all patients. Endoscopy improved visualization of the cranial nerves and allowed to see and understand the neurovascular conflicts, which were not able to be observed using the microscope alone for two of the 27 patients. The endoscope is a useful adjunct to microscopic exploration of the cranial nerves in the CPA avoiding significant cerebellar or brainstem retraction.
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Sindou M, Leston JM, Decullier E, Chapuis F. Microvascular decompression for trigeminal neuralgia: the importance of a noncompressive technique--Kaplan-Meier analysis in a consecutive series of 330 patients. Neurosurgery 2008; 63:341-50; discussion 350-1. [PMID: 18981841 DOI: 10.1227/01.neu.0000327022.79171.d6] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Microvascular decompression, although a well-established procedure for treating primary trigeminal neuralgia, still has no standardized protocol. The practical consequences of having the implant keep the conflicting vessels apart, whether or not in contact with the root, is still in debate. The present work was undertaken to answer this question. METHODS Patients were segregated into 2 groups: Group I (260 patients) had a Teflon prosthesis implanted without contact to the root, and Group II (70 patients) had a similar implant with contact to the root. Cure rates in the 2 groups were compared at the latest follow-up (</=15 yr; average, 8.2 yr) using Kaplan-Meier analysis. RESULTS In Group I, the cure rate was 82% (214 of 260 patients), whereas in Group II, the cure rate was 67% (47 of 70 patients) (P = 0.01). Kaplan-Meier analysis of the follow-up period up to 15 years also shows a significant difference (P = 0.05). CONCLUSION These results strongly support the goal of performing the procedure without the implant in contact with the root. This is easier with the superior cerebellar artery, because of its laxity and small number of perforating branches, than with the anteroinferior cerebellar artery, which has perforators to the brainstem and labyrinthine artery arising from its cisternal portion. The significantly better long-term cure rate when the implant is not in contact with the root favors the "pure" decompressive effect of the microvascular decompression procedure, rather than a conduction block mechanism.
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Affiliation(s)
- Marc Sindou
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Claude Bernard University, Lyon, France.
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Alberione F, Arena A, Matera R. Descompresiva microvascular en la neuralgia del trigémino: factores pronósticos. Neurocirugia (Astur) 2008. [DOI: 10.1016/s1130-1473(08)70227-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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