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Sato A, Tanaka Y, Ishiwada T, Arai Y, Takei T, Maehara T. Comparative Analysis of Patients Undergoing Microvascular Decompression for Trigeminal Neuralgia Caused by Solely Arterial or Solely Venous Compression. World Neurosurg 2024; 189:e1034-e1039. [PMID: 39013499 DOI: 10.1016/j.wneu.2024.07.071] [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: 05/25/2024] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) due to venous compression is far less common than that due to arterial compression, and its pathogenesis is less clear. We investigated the clinical and imaging features of TN caused by solely venous compression by measuring the morphologies of the posterior cranial fossa (PCF) and the trigeminal nerve. METHODS We retrospectively reviewed records of TN patients who underwent microvascular decompression at our institution and extracted cases with solely arterial or solely venous compression. Preoperative magnetic resonance imaging was used to find the length (Y), width (X), height (Z), and volume (V) of the PCF, the angle between the trigeminal nerve and pons, and the distance between Meckel's cave and the root entry zone of the trigeminal nerve. RESULTS Of 152 patients, 24 had TN caused solely by venous compression. The value of Y was significantly smaller in the venous group than the arterial group (P < 0.01). The trigeminal nerve and pons was significantly smaller in the venous group (P < 0.01). We hypothesized that TN patients with solely venous compression had a characteristic PCF morphology with a short anteroposterior diameter (Y), such that age-related changes in brain morphology could alter the course of the trigeminal nerve and cause compression by a vein. CONCLUSIONS The morphological features of the PCF differed between patients with TN of venous and those with TN of arterial etiology. Age-related changes in brain morphology and changes of course of the trigeminal nerve may also add to the possibility of developing TN, especially of venous etiology.
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Affiliation(s)
- Akihito Sato
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Tadahiro Ishiwada
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yukika Arai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takamaro Takei
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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Huang Y, Huang Y, Xiao C, Huang Q, Chai X. Preoperative Evaluation of Neurovascular Relationship in Primary Trigeminal Neuralgia(PTN) by Magnetic Resonance Virtual Endoscopy(MRVE) Combined with 3D-FIESTA-c and 3D-TOF-MRA. J Pain Res 2024; 17:2561-2570. [PMID: 39132295 PMCID: PMC11313606 DOI: 10.2147/jpr.s465956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/30/2024] [Indexed: 08/13/2024] Open
Abstract
Objective This study aims to evaluate the effectiveness of Magnetic Resonance Virtual Endoscopy combined with 3D-FIESTA-c and 3D-TOF-MRA in preoperative assessment of MVD for PTN, with a focus on accurately detecting neuromuscular contact. Methods We retrospectively analyzed clinical and imaging data from 240 patients with unilateral primary trigeminal neuralgia undergoing MVD surgery between April 2016 and July 2023. Preoperative scans with 3D-FIESTA-c and 3D-TOF-MRA were performed, and MRVE images were obtained to analyze the relationship between the trigeminal nerve and adjacent vessels. Using the findings during microvascular decompression (MVD) surgery as the gold standard, the diagnostic results of 3D-TOF-MRA + 3D-FIESTA-c were considered as group I, while the combined use of MRVE, 3D-TOF-MRA + 3D-FIESTA-c was considered as group II. Results In 240 cases, group I had a positive rate of 96.25% and an accuracy rate of 86.25% for identifying responsible blood vessels, while group II had a positive rate of 98.3% and an accuracy rate of 94.17%. There were no statistically significant differences in positive rates between group I and group II, group I and MVD, or group II and MVD (P > 0.05). However, there were statistically significant differences in accuracy rates (P < 0.05). The accuracy for single and multiple arteries with group I was 99.38% and 80.0%, respectively, while with group II, it was 100% and 95.0%. No statistically significant difference was found in accuracy for single or multiple arteries (P>0.05). The accuracy of evaluating responsibility veins with or without other vessels was 52.73% and 80.0%, respectively, with a statistically significant difference (P<0.05). Conclusion MRVE combined with 3D-TOF-MRA + 3D-FIESTA-c significantly improves the accuracy of identifying responsibility vessels, especially veins, in preoperative assessment for MVD. This has important clinical implications for preoperative decision-making and surgical planning.
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Affiliation(s)
- Yu Huang
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Ying Huang
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Chaoyong Xiao
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Qingling Huang
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Xue Chai
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
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Ashina S, Robertson CE, Srikiatkhachorn A, Di Stefano G, Donnet A, Hodaie M, Obermann M, Romero-Reyes M, Park YS, Cruccu G, Bendtsen L. Trigeminal neuralgia. Nat Rev Dis Primers 2024; 10:39. [PMID: 38816415 DOI: 10.1038/s41572-024-00523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 06/01/2024]
Abstract
Trigeminal neuralgia (TN) is a facial pain disorder characterized by intense and paroxysmal pain that profoundly affects quality of life and presents complex challenges in diagnosis and treatment. TN can be categorized as classical, secondary and idiopathic. Epidemiological studies show variable incidence rates and an increased prevalence in women and in the elderly, with familial cases suggesting genetic factors. The pathophysiology of TN is multifactorial and involves genetic predisposition, anatomical changes, and neurophysiological factors, leading to hyperexcitable neuronal states, central sensitization and widespread neural plasticity changes. Neurovascular compression of the trigeminal root, which undergoes major morphological changes, and focal demyelination of primary trigeminal afferents are key aetiological factors in TN. Structural and functional brain imaging studies in patients with TN demonstrated abnormalities in brain regions responsible for pain modulation and emotional processing of pain. Treatment of TN involves a multifaceted approach that considers patient-specific factors, including the type of TN, with initial pharmacotherapy followed by surgical options if necessary. First-line pharmacological treatments include carbamazepine and oxcarbazepine. Surgical interventions, including microvascular decompression and percutaneous neuroablative procedures, can be considered at an early stage if pharmacotherapy is not sufficient for pain control or has intolerable adverse effects or contraindications.
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Affiliation(s)
- Sait Ashina
- BIDMC Comprehensive Headache Center, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- BIDMC Comprehensive Headache Center, Department of Anaesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Anan Srikiatkhachorn
- Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Giulia Di Stefano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Anne Donnet
- Department of Evaluation and Treatment of Pain, FHU INOVPAIN, Centre Hospitalier Universitaire de Marseille, Hopital de la Timone, Assistance Publique-Hopitaux de Marseille, Marseille, France
| | - Mojgan Hodaie
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontairo, Canada
| | - Mark Obermann
- Department of Neurology, Hospital Weser-Egge, Hoexter, Germany
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Marcela Romero-Reyes
- Department of Pain and Neural Sciences, Brotman Facial Pain Clinic, University of Maryland, School of Dentistry, Baltimore, MD, USA
| | - Young Seok Park
- Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
- Department of Neurosurgery, Gamma Knife Icon Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Lars Bendtsen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, University of Copenhagen, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Glostrup, Copenhagen, Denmark
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Izumi S, Takezaki T, Takeshima Y, Hamasaki T, Mukasa A. A Case of Trigeminal Neuralgia in an Adult Patient With Lambdoid Synostosis. Cureus 2024; 16:e56918. [PMID: 38665710 PMCID: PMC11043020 DOI: 10.7759/cureus.56918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Trigeminal neuralgia (TN) is characterized by sudden, brief intense pain in the distribution of the unilateral trigeminal nerve (TGN). Neurovascular compression (NVC) of the TGN is the most common cause of TN. Recent studies have suggested that a structural anomaly of the posterior cranial fossa might be involved in the development of TN, and several studies have documented the association between NVC-related TN and congenital posterior cranial deformities in adults. We present the case of a 56-year-old woman with NVC-related TN and unilateral lambdoid synostosis (ULS), along with a literature review, to investigate the relationship between TN and structural anomalies of the posterior fossa. This is the first report of TN in an adult with ULS. Mild and asymptomatic cases of lambdoid synostosis might have a higher incidence of NVC-related TN in association with posterior cranial fossa deformities.
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Affiliation(s)
- Shunsuke Izumi
- Neurosurgery, Kumamoto University Hospital, Kumamoto, JPN
| | | | - Yuki Takeshima
- Neurosurgery, Kumamoto University Hospital, Kumamoto, JPN
| | | | - Akitake Mukasa
- Neurosurgery, Kumamoto University Hospital, Kumamoto, JPN
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Comert A, Dogan I, Cavdar Yilmaz NP, Gungor Y, Bekdemir Y, Kubat G, Gurpinar S, Basarmak MB, Asan B, Gul D, Gokmen D. Investigating the Effects of Trigeminal Impression and Internal Acoustic Opening Morphology Differences for Possible Surgical Applications. World Neurosurg 2024; 181:e84-e93. [PMID: 37562683 DOI: 10.1016/j.wneu.2023.08.004] [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: 06/10/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE The exhaustive information regarding the types of trigeminal pore (TP) or trigeminal impression (TI), internal acoustic opening (IAO), and related surgical approaches is lacking in the literature. Therefore, this study is performed to further elucidate the types of TP or TI, IAO, and the relationships with critical surgical landmarks in the skull base. METHODS Trigeminal impression (TI) and internal acoustic opening (IAO) found in 11 dry skulls, 24 right temporal bones, and 25 left temporal bones were examined on both sides to define their relationship to each other and nearby structures. The age and sex of these bones were not identified. Besides these, 77 skulls were examined by radiologic imaging methods. These skulls were identified by gender. RESULTS According to test results, there was a significant difference between the left and right internal acoustic opening in the case of horizontal dimension (HD). The left HD-IAO is bigger than the right one. In addition, right HD-IAO, vertical dimension (VD) of right internal acoustic opening, left HD-IAO, and left VD-IAO values differed significantly in male and female patients. CONCLUSIONS Investigating the relationship of TI and IAO with relevant structures suggests that surgical approaches involving the TP and IAO indicated that surgical approaches considering the TI and IAO variations may be used in the development of surgical processes and primary surgical interventions.
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Affiliation(s)
- Ayhan Comert
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey.
| | - Ihsan Dogan
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey; Department of Anatomy, Ankara University Graduate School of Health Science, Ankara, Turkey
| | | | - Yigit Gungor
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey
| | | | - Goktug Kubat
- School of Medicine, Ankara University, Ankara, Turkey
| | | | | | - Batuhan Asan
- School of Medicine, Ankara University, Ankara, Turkey
| | - Dicle Gul
- School of Medicine, Ankara University, Ankara, Turkey
| | - Derya Gokmen
- Department of Biostatistics, School of Medicine, Ankara University, Ankara, Turkey
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Sun T, Huang Q, Li C, Yang W, Wang W, He L, Liu J, Yang C. Correlation study between multiplanar reconstruction trigeminal nerve angulation and trigeminal neuralgia. BMC Neurol 2022; 22:384. [PMID: 36224533 PMCID: PMC9555177 DOI: 10.1186/s12883-022-02906-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 12/08/2022] Open
Abstract
OBJECTIVES Neurovascular compression (NVC) produces morphological changes on the trigeminal nerve root is considered the cause of trigeminal neuralgia (TN), but there were some patients with TN found no NVC, and also NVC was found in asymptomatic individuals. Many studies found tight relationships of TN and morphological structures of trigeminal nerve. We designed this study to explore the correlation between multiplanar reconstruction (MPR) trigeminal nerve angulation (TNA) and TN. METHODS Patients with classical symptoms of TN were recruited as observation group (OG) in this study, 50 healthy controls were enrolled as control group (CG), the OG was further subtyped into young patients (YP), middle-aged patients (MP) and old patients (OP) based to the onset age of symptoms, and also divided into patients with or without trigger maneuvers (TM) based on the presence of TM or not. All the participants underwent magnetic resonance (MR) examinations in same device, bilateral TNA measurements were carried out in OG and CG, then TNA was compared between different groups or subgroups. All images were interpreted by two radiologists who were blinded to the study, diagnosis of TN was made by two senior neurosurgery professors. RESULT Ultimately, 95 patients with primary TN were recruited in OG, aged from 25 to 84 (61.15 ± 12.70) years with a course of 0.5 to 30 (5.03 ± 5.41) years, their onset age ranged from 24 to 82 (56.13 ± 11.98) years. There were 34 males and 61 females in OG, and 58 cases involved right side. The CG aged from 22 to 85 (61.86 ± 13.03) years. No statistical difference was found between the age of OG and CG(p = 0.76), and also the bilateral TNA of CG (154.92 ± 16.90° vs 155.55 ± 17.03°, p > 0.05), while TNA of OG was significantly smaller than CG (150.78 ± 11.29° vs 155.24 ± 16.88°, p = 0.019). In OG, TNA on the affected side was significantly smaller than the unaffected side (149.29 ± 12.44° vs 152.27 ± 9.85°, p = 0.014). TNA showed a positive correlation with onset age of patients with TN, as TNA on the affected side of YP was significantly smaller than MP and OP (139.00 ± 11.64° vs 148.86 ± 11.54°, 139.00 ± 11.64° vs 152.18 ± 12.61°, p = 0.004 and 0.026). Furthermore, patients with TM showed smaller TNA than those without TM (147.05 ± 11.30° vs 164.75 ± 8.39°, p < 0.001). CONCLUSIONS This study suggested that TNA might play a role in TN, small TNA could be a risk factor of TN. Furthermore, patients with small TNA are more likely to combine with TM, but more studies are needed to explore the exact role of TNA in TN.
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Affiliation(s)
- Tao Sun
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-Sen University, No 58th, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Qinghao Huang
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-Sen University, No 58th, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Chuangfeng Li
- Center of Universal Medical Imaging Diagnostic, No 80th, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Wensheng Yang
- Center of Universal Medical Imaging Diagnostic, No 80th, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Wentao Wang
- Department of Neurosurgery, First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19, Nonglinxia Road, Yuexiu District, Guangzhou, 510080, China
| | - Longshuang He
- Department of Neurosurgery, First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19, Nonglinxia Road, Yuexiu District, Guangzhou, 510080, China
| | - Jinlong Liu
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-Sen University, No 58th, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Chao Yang
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-Sen University, No 58th, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China.
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The practical limits of high-quality magnetic resonance imaging for the diagnosis and classification of trigeminal neuralgia. Clin Neurol Neurosurg 2022; 221:107403. [PMID: 35933966 DOI: 10.1016/j.clineuro.2022.107403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Neurovascular compression (NVC) has been the primary hypothesis for the underlying mechanism of classical trigeminal neuralgia (TN). However, a substantial body of literature has emerged highlighting notable exceptions to this hypothesis. The purpose of this study is to assess the reliability and diagnostic accuracy of high resolution, high contrast MRI-determined neurovascular contact for TN. METHODS We performed a retrospective, randomized, and blinded parallel characterization of neurovascular interaction and diagnosis in a population of TN patients and controls using four expert reviewers. Performance statistics were calculated, as well as assessments for generalizability using shuffled bootstraps. RESULTS Fair to moderate agreement (ICC: 0.32-0.68) about diagnosis between reviewers was observed using MRIs from 47 TN patients and 47 controls. On average reviewers performed no better than chance when diagnosing participants, with an accuracy of 0.57 (95% CI 0.40, 0.59) per patient. CONCLUSION While MRI is useful in determining structural causes in secondary TN, expert reviewers do no better to only slightly better than chance with distinguishing TN with MRI, despite moderate agreement. Further, the causal role of NVC for TN is not clear, limiting the applicability of MRI to diagnose or prognosticate treatment of TN.
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Zhong H, Zhang W, Sun S, Bie Y. MRI Findings in Trigeminal Neuralgia without Neurovascular Compression: Implications of Petrous Ridge and Trigeminal Nerve Angles. Korean J Radiol 2022; 23:821-827. [PMID: 35695314 PMCID: PMC9340232 DOI: 10.3348/kjr.2021.0771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the anatomical characteristics of the petrous ridge and trigeminal nerve in trigeminal neuralgia (TN) without neurovascular compression (NVC). Materials and Methods From May 2017 to March 2021, 66 patients (49 female and 17 male; mean age ± standard deviation [SD], 56.8 ± 13.3 years) with TN without NVC and 57 controls (46 female and 11 male; 52.0 ± 15.6 years) were enrolled. The angle of the petrous ridge (APR) and angle of the trigeminal nerve (ATN) were measured using magnetic resonance imaging with a high-resolution three-dimensional T2 sequence. Data on the symptomatic side were compared with those on the asymptomatic side in patients and with the mean measurements of the bilateral sides in controls. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performance of APR and ATN in distinguishing TN patients from controls. Results In TN patients without NVC, the mean ± standard deviation (SD) of APR on the symptomatic side (98.40° ± 19.75°) was significantly smaller than that of the asymptomatic side (105.59° ± 22.45°, p = 0.019) and controls (108.44° ± 15.98°, p = 0.003). The mean ATN ± SD on the symptomatic side (144.41° ± 8.92°) was significantly smaller than that of the asymptomatic side (149.67° ± 8.09°, p = 0.003) and controls (150.45° ± 8.48°, p = 0.001). The area under the ROC curve for distinguishing TN patients from controls was 0.673 (95% confidence interval [CI]: 0.579–0.758) for APR and 0.700 (CI: 0.607–0.782) for ATN. The sensitivity and specificity using the diagnostic cutoff yielding the highest Youden index were 81.8% (54/66) and 49.1% (28/57), respectively, for APR (with a cutoff score of 94.30°) and 65.2% (43/66) and 66.7% (38/57), respectively, for ATN (cutoff score, 148.25°). Conclusion In patients with TN without NVC, APR and ATN were smaller than those in controls, which may explain the potential cause of TN and provide additional information for diagnosis.
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Affiliation(s)
- Hai Zhong
- Department of Radiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenshuang Zhang
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shicheng Sun
- Department of Neurosurgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Yifan Bie
- Department of Radiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Sun C, Zheng W, Zhu Q, Du Q, Yu W. The Transformation of the Balloon Shape in Percutaneous Balloon Compression for Trigeminal Neuralgia. J Pain Res 2021; 14:3805-3814. [PMID: 34934354 PMCID: PMC8684418 DOI: 10.2147/jpr.s343783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background The pear shape of an inflated balloon is thought to be a gold standard of successful percutaneous balloon compression (PBC). However, neither how nor why it changes in that way (the anatomic basis) has not yet been fully described. Aim In this article, we try to describe how the balloon in Meckel’s cave (MC) should appear and why; and identify which shapes are good pear shapes, which shapes are not good pear shapes, and which shapes are intermediate. Methods Radiographs from over 150 percutaneous balloon compression (PBC) cases were thoroughly evaluated. We proposed a model of changing balloon shape in MC and 70 cases were followed up over two years, in which therapeutic effect was measured. Results We found that the balloon changed stereotypically in MC. The model that we proposed is consistent with the description of MC’s structures and its’ surroundings in the literature. The distinct pear (pear in MC) brought about a far better surgical result than other shapes (p < 0.01). Conclusion Our study showed how and why the balloon shape changed during PBC surgery. The model provides clear guidance for PBC surgery.
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Affiliation(s)
- Chenglong Sun
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Wenhao Zheng
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Qiang Zhu
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Quan Du
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Wenhua Yu
- Department of Neurosurgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Neurosurgery, Hangzhou Ninth People's Hospital, Hangzhou, People's Republic of China
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Inoue T, Shitara S, Goto Y, Prasetya M, Radcliffe L, Fukushima T. Redo surgery for trigeminal neuralgia: reasons for re-exploration and long-term outcomes. Acta Neurochir (Wien) 2021; 163:2407-2416. [PMID: 34232394 DOI: 10.1007/s00701-021-04920-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To investigate the causes of failure and recurrence after microvascular decompression (MVD) for trigeminal neuralgia (TGN) and to analyze the results of redo surgery. METHODS Sixty-three cases of redo surgery were retrospectively reviewed. Reasons for re-exploration were categorized into 4 groups based on the operative findings. Patient characteristics, outcomes of re-exploration, and operative complications were analyzed by Kaplan-Meier and logistic regression analyses. RESULTS Reasons for redo surgery were divided into arterial compression in 13 patients (21%), venous compression in 11 patients (17%), prosthesis-related in 25 patients (40%), and adhesion or negative exploration in 14 patients (22%). Immediate pain relief was obtained in 59 patients (94%) postoperatively with newly developed facial numbness in 17 patients (27%). Of these, 48 patients (76%) maintained pain-free 1 year postoperatively. Overall recurrence was noted in 17 patients (27%) during the median 49-month follow-up period. Most recurrences occurred within 1 year after redo surgery, but the prosthesis-related patients showed a continuous recurrence up to 4 years. Patients having vascular compression showed significantly better pain control than those without vascular contact in Kaplan-Meier analyses (p = 0.0421). No prognostic factor for pain-free 1 year after redo surgery was found. CONCLUSIONS Redo surgery is effective for patients with remaining vascular compression rather than those without vascular contact. Teflon contact onto the nerve root should be avoided because it is a potential risk for recurrence and causes poor prognosis after redo surgery.
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Affiliation(s)
- Takuro Inoue
- Department of Neurosurgery, Koto Memorial Hospital, Shiga, Japan.
| | - Satoshi Shitara
- Department of Neurosurgery, Koto Memorial Hospital, Shiga, Japan
| | - Yukihiro Goto
- Department of Neurosurgery, Koto Memorial Hospital, Shiga, Japan
| | - Mustaqim Prasetya
- Department of Neurosurgery, National Brain Center Hospital, Jakarta, Indonesia
| | | | - Takanori Fukushima
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Ogut E, Armagan K, Barut C. Reappraisal of the types of trigeminal porus and importance in surgical applications. Surg Radiol Anat 2021; 43:1169-1178. [DOI: https:/doi.org/10.1007/s00276-020-02651-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/05/2020] [Indexed: 07/22/2023]
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12
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Wang J, Niu H, Zhao K, Shu K, Lei T. Comparative Analysis of Trigeminal Neuralgia Caused by Sole Arterial and Venous Compression: Clinical Features and Surgical Outcomes From 222 Cases. Front Neurol 2021; 12:634945. [PMID: 33995245 PMCID: PMC8113406 DOI: 10.3389/fneur.2021.634945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Compared with trigeminal neuralgia (TN) caused by arterial neurovascular conflict (NVC), the clinical characteristics and managements for TN with venous NVC are not well-established. This study aims to comparatively summarize the clinical features and surgical outcomes of microvascular decompression (MVD) for patients with TN caused by sole arterial and venous compression, with a particular focus on the morphological features of posterior cranial fossa (PCF). Methods: A total of 222 patients with TN caused by sole arterial NVC (188/84.7%) and venous NVC (34/15.3%) underwent MVD in our department from January 2014 to December 2018. The patient data were analyzed retrospectively. Particularly, we focused on the potential impact of PCF on surgical outcomes. Results: Compared with arterial NVC, V3 branch of the trigeminal nerve was more frequently involved in venous NVC (p = 0.009). The most common compression site was root entry zone for arterial NVC (68.6%) and midcisternal segment for venous NVC (76.5%) (p < 0.001). No serious post-operative complication was observed in the two groups. Both short- and long-term outcomes were relatively worse in venous NVC cases compared with arterial NVC cases (p = 0.001 and p = 0.030, respectively); and a dominantly higher rate of delayed cure was demonstrated in venous NVC cases (p < 0.001). TN patients with venous NVC revealed a more flat-shaped PCF than those with arterial NVC. Moreover, flat-shaped PCF morphometry was negatively correlated with surgical outcomes of TN patients with arterial NVC, but not with those of venous NVC cases. Conclusions: MVD is an effective and safe treatment for patients with TN caused by either arterial or venous NVC. Patients with a more flat-shaped PCF might be vulnerable to venous compression. Our study demonstrated that PCF morphometry only affected the surgical outcomes of patients with TN caused by arterial NVC, but not the outcomes of those with venous NVC.
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Affiliation(s)
- Junwen Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongquan Niu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Zhao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Lei
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Sindou M, Brinzeu A, Laurent B. Aspetti clinici e terapeutici della nevralgia dei nervi trigemino e glossofaringeo. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)44502-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Ogut E, Armagan K, Barut C. Reappraisal of the types of trigeminal porus and importance in surgical applications. Surg Radiol Anat 2021; 43:1169-1178. [PMID: 33399922 DOI: 10.1007/s00276-020-02651-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The detailed information regarding the types of trigeminal porus (TP) and related surgical approach is lacking in the literature. Therefore, we performed this study to elucidate further the types of TP and the relationships with critical surgical landmarks in the skull base. METHODS The study was performed on 19 formalin-fixed cadavers of the cranial base (52.6% male, n = 10; 47.4% female, n = 9) on both sides. Calculations were made of the vertical dimension (VD), horizontal dimension (HD), and types of TP, the thickness of the TP, the HD and VD of the internal acoustic meatus, the distance between the TP-IAM, the thickness of the ossifying tissue that forms the TP, the trigeminal nerve (CN V) in both types and the distance between the CN V-VI. RESULTS The elliptical (42.1% left, 36.8% right), oval (52.6% left, 36.8% right) and slit-like (5.3% right) types of TP were detected (X2 = 11.722). The HD of the TP was, on average, 8.02 mm (female) and 9.2 mm (male) on the right side, and 8.26 mm (female) and 8.81 mm (male) on the left side. The VD of the TP was, on average, 1.99 mm (female) and 2.65 mm (male) on the right side, and 2.42 mm (female) and 2.94 mm (male) on the left side. CONCLUSIONS In our study, ellipse and slit-like types of TP are taken into account in order to plan the surgical approaches to remove or prevent the extension of tumors. A combined surgical technique is recommended to reach the TP easily without damaging the nearby surgical structures during surgery. The oval type of TP allows a wide range of movements, so it is more advantageous in skull base surgery.
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Affiliation(s)
- Eren Ogut
- Department of Anatomy, School of Medicine, Bahcesehir University, 34734, Istanbul, Turkey
| | - Kutay Armagan
- Medical Faculty Student, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Cagatay Barut
- Department of Anatomy, School of Medicine, Bahcesehir University, 34734, Istanbul, Turkey.
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Sindou M, Brinzeu A. Topography of the pain in classical trigeminal neuralgia: insights into somatotopic organization. Brain 2020; 143:531-540. [DOI: 10.1093/brain/awz407] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 10/08/2019] [Accepted: 11/11/2019] [Indexed: 11/14/2022] Open
Abstract
AbstractTrigeminal neuralgia is defined by its clinical characteristics of paroxysmal unilateral facial pain in a well-defined territory. Distribution of the pain may be in one or several of the cutaneous and/or mucous territories of the three divisions with V2 pain being the most frequent territory followed by V3 and V1. Factors determining the distribution of pain have not yet been systematically investigated. It is now well recognized that vascular compression factor is a predominant aetiology of classical trigeminal neuralgia. In this study we aimed to find whether there is a relation between the location of the vascular compression and the peripheral distribution of the pain. Patients with classical trigeminal neuralgia in whom microvascular decompression was performed were included. Data recorded pertained to the nature of the conflict, its degree and, most importantly, location around the root: supero-median, supero-lateral or inferior. Equally, clinical data for the distribution of pain were recorded. Most of the patients 318 (89.3%) had the compression coming from above, i.e. 220 (61.7%) had compression from a supero-medial direction and 98 (27.5%) from a supero-lateral direction; inferior compression was present in 38 patients (10.7%). Distribution of the pain was significantly different according to the location of the conflict (P = 0.0005, Fisher Exact test). Odds ratios were computed for each location of compression and painful territory involved. According to the overall distribution of pain, patients with supero-medial compression had an odds ratio of 2.7 [95% confidence interval (CI) 1.66–4.41] of manifesting with V1 pain. Conversely V3 pain was less likely to occur with supero-median compression than the other types of pain (odds ratio 0.53, 95% CI 0.34–0.83). Inferior compression on the other hand was more likely to manifest with V3 pain with an odds ratio of 2.56 (95% CI 1.21–5.45). Overall V2 pain had an odds ratio close to 1 regardless of the type of compression. These findings suggest an association between the location of the neurovascular conflict with its resulting insult and the distribution of pain supporting a somatotopic view of the organization of the trigeminal root and a role of the conflict in the clinical manifestation of trigeminal neuralgia.
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Affiliation(s)
- Marc Sindou
- University of Lyon 1, Faculty of Medicine Lyon-Est – Neurosurgery, Lyon, France
- Groupe Elsan-Clinique Bretéché, Nantes, France
| | - Andrei Brinzeu
- University of Lyon 1, Faculty of Medicine Lyon-Est – Neurosurgery, Lyon, France
- University of Medecine et Pharmacie “Victor Babes” Timisoara, Romania
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Hirata S, Kobayashi M, Kamamoto D, Kosugi K, Yoshida K, Fujimaki T. Trigeminal Neuralgia Due to Petrosal Bone Deformity. World Neurosurg 2019; 126:79-82. [DOI: 10.1016/j.wneu.2019.02.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 01/26/2023]
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Sindou M, Brinzeu A. Nevralgia del trigemino e neurochirurgia. Neurologia 2019. [DOI: 10.1016/s1634-7072(18)41586-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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