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Hou X, Xu RX, Tang J, Yin C. A novel 3D multimodal fusion imaging surgical guidance in microvascular decompression for primary trigeminal neuralgia and hemifacial spasm. Head Face Med 2024; 20:56. [PMID: 39390456 DOI: 10.1186/s13005-024-00442-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/31/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Neurovascular compression (NVC) is a primary etiology of trigeminal neuralgia (TN) and hemifacial spasm (HFS). Despite Magnetic Resonance Tomographic Angiography (MRTA) being a useful tool for 3D multimodal fusion imaging (MFI) in microvascular decompression (MVD) surgery planning, it may not visualize smaller arterial vessels and veins effectively. We validate a novel computed tomography angiography and venography (CTA/V) - diffusion tensor tractography (DTT) -3D-MFI to enhance the MVD surgical guidance. METHODS In this prospective study, 80 patients with unilateral primary TN or HFS who underwent MVD surgery were included. Imaging was conducted using CTA/V-DTT-3D-MFI compared with CT-MRTA-3D-MFI in predicting the responsible vessel and assessing the severity of NVC. Surgical outcomes were subsequently analyzed. Neurosurgery residents were provided with questionnaires to evaluate and compare the two approaches. RESULTS CTA/V-DTT-3D-MFI significantly improved accuracy in identifying the responsible vessel (kappa = 0.954) and NVC (kappa = 0.969) compared to CT-MRTA-3D-MFI, aligning well with surgical findings. CTA/V-DTT-3D-MFI also exhibited higher sensitivity in identifying responsible vessels (98.0%) and NVC (98.7%) than CT-MRTA-3D-MFI. Additionally, CTA/V-DTT-3D-MFI showed fewer complications, shorter operation times, and lower recurrence after one year (all p < 0.05). Resident neurosurgeons emphasized that CTA/V-DTT-3D-MFI greatly assisted in formulating precise surgical strategies for more accurate identification and protection of responsible vessels and nerves (all p < 0.001). CONCLUSION CTA/V-DTT-3D-MFI enhances MVD surgery guidance, improving accuracy in identifying responsible vessels and NVC for better outcomes. This advanced imaging plays a crucial role in safer and more effective MVD surgery, as well as in training neurosurgeons.
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Affiliation(s)
- Xiaolin Hou
- The Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610031, China
| | - Ru Xiang Xu
- The Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610031, China
| | - Jing Tang
- The Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610031, China
| | - Cheng Yin
- The Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610031, China.
- The Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610031, China.
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Hou X, Xu RX, Tang J, Li D, Yin C. Comparative study of CTA/CTV and MRTA for preoperative simulation of microvascular decompression in neurovascular compression syndromes. Neurosurg Rev 2024; 47:591. [PMID: 39259374 DOI: 10.1007/s10143-024-02663-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 09/13/2024]
Abstract
Neurovascular compression syndrome (NVCS), characterized by cranial nerve compression due to adjacent blood vessels at the root entry zone, frequently presents as trigeminal neuralgia (TN), hemifacial spasm (HFS), or glossopharyngeal neuralgia (GN). Despite its prevalence in NVCS assessment, Magnetic Resonance Tomographic Angiography (MRTA)'s limited sensitivity to small vessels and veins poses challenges. This study aims to refine vessel localization and surgical planning for NVCS patients using a novel 3D multimodal fusion imaging (MFI) technique incorporating computed tomography angiography and venography (CTA/CTV). A retrospective analysis was conducted on 76 patients who underwent MVD surgery and were diagnosed with single-site primary TN, HFS, or GN. Imaging was obtained from MRTA and CTA/CTV sequences, followed by image processing and 3D-MFI using FastSurfer and 3DSlicer. The CTA/CTV-3D-MFI showed higher sensitivity than MRTA-3D-MFI in predicting responsible vessels (98.6% vs. 94.6%) and NVC severity (98.6% vs. 90.8%). Kappa coefficients revealed strong agreement with MRTA-3D-MFI (0.855 for vessels, 0.835 for NVC severity) and excellent agreement with CTA/CTV-3D-MFI (0.951 for vessels, 0.952 for NVC). Resident neurosurgeons significantly preferred CTA/CTV-3D-MFI due to its better correlation with surgical reality, clearer depiction of surgical anatomy, and optimized visualization of approaches (p < 0.001). Implementing CTA/CTV-3D-MFI significantly enhanced diagnostic accuracy and surgical planning for NVCS, outperforming MRTA-3D-MFI in identifying responsible vessels and assessing NVC severity. This innovative imaging modality can potentially improve outcomes by guiding safer and more targeted surgeries, particularly in cases where MRTA may not adequately visualize crucial neurovascular structures.
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Affiliation(s)
- Xiaolin Hou
- The Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 61173, China
| | - Ru Xiang Xu
- The Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 61173, China
| | - Jing Tang
- The Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 61173, China
| | - Dingjun Li
- The Department of Neurosurgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Cheng Yin
- The Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 61173, China.
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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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Cao C, Li M, Wu M, Jiang X. Hemifacial Spasm Associated With the Specific Offending Vein. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01251. [PMID: 38995027 DOI: 10.1227/ons.0000000000001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/29/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Hemifacial spasm (HFS) caused by venous compression is a rare occurrence. Currently, there is no relevant research on the venous characteristics and potential pathogenic mechanisms causing venous HFS. Exploring the venous characteristics in venous-type HFS may reduce the likelihood of repeated surgery. METHODS The authors presented 4 cases of HFS caused by veins of middle cerebellar peduncle (V. of Mid.Cer.Ped) successfully treated with microvascular decompression. RESULTS Based on intraoperative observations and abnormal muscle response (AMR) monitoring, it was determined that V. of Mid.Cer.Ped were offending vessels in these patients. Moreover, veins crossed between the facial and vestibulocochlear nerves, and then surrounded the ventral aspect of the facial nerve root. Microvascular decompression for the offending vessel was successfully performed, and AMR disappeared for each patient. These patients were discharged without any complications and involuntary contractions or twitching of facial muscles. CONCLUSION The study demonstrated that veins can indeed induce HFS. The characteristic of the V. of Mid.Cer.Ped that leads to HFS is that these veins traverse between the facial nerve and the vestibulocochlear nerve, and then surround the ventral aspect of the facial nerve root. The dynamic influence of cerebrospinal fluid leads to pulsatile impingement of the facial nerve on the vein, resulting in facial nerve bending and deformation at the location of the vein. Significantly, in the context of surgery, if it is noticed that the V. of Mid.Cer.Ped surrounds the ventral aspect of the facial nerve root and the facial nerve is compressed and deformed, when AMR disappears after decompression of the artery, it may be necessary to perform vein decompression.
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Affiliation(s)
- Chenglong Cao
- Department of Neurosurgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui Province, People's Republic of China
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Chen K, Shen L, Yang J, Zhao J, Wu J, Cai Y, Mei Z, Chai S, Xu D, Jiang P, Xiong N. A nomogram based on clinical multivariate factors predicts delayed cure after microvascular decompression for hemifacial spasm. Neurosurg Rev 2024; 47:44. [PMID: 38216699 DOI: 10.1007/s10143-024-02284-5] [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: 11/15/2023] [Revised: 12/06/2023] [Accepted: 01/06/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND The course of disease after microvascular decompression (MVD) in patients with hemifacial spasm (HFS) is variable. The purpose of this study was to develop and validate a nomogram to predict the probability of delayed cure after microvascular decompression in patients with hemifacial spasms based on clinical multivariate factors. METHODS A retrospective data collection was performed on 290 patients with HFS undergoing MVD at our center from January 2017 to January 2022. The patients were randomly assigned to the training cohort (n = 232) and validation cohort (n = 58) at a ratio of 8:2. Retrospective analysis was performed of information on clinical, radiological, and intraoperative findings and clinical outcomes. Univariate and multivariate analyses were performed in the training cohort, and a nomogram was constructed using a stepwise logistic regression approach. The receiver operating characteristic (ROC) was calculated to evaluate the reliability of the nomogram model. Decision curve analysis (DCA) was used to assess the clinical application value of the nomogram model. RESULTS In the training cohorts, 73 patients (73/232) had a delayed cure. In the validation cohorts, 18 patients (18/58) had a delayed cure. We developed a novel nomogram model to predict the risk of delayed cure after MVD in HFS patients based on the presence of vertebral artery compression, venous compression, absence of LSR, degree of facial nerve indentation, degree of neurovascular compression, and internal auditory canal vascular looThe area under the curve (AUC) of the nomogram model was 0.9483 in the training cohort and 0.9382 in the validation cohort. The calibration curve showed good correspondence between the predicted and actual probabilities in the training and validation groups. The decision curve showed that the nomogram model had good performance in clinical applications. CONCLUSIONS We developed and validated a preoperative and intraoperative multivariate factors nomogram to predict the possibility of delayed cure after MVD in HFS patients, which may help clinicians in the comprehensive management of HFS.
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Affiliation(s)
- Keyu Chen
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Lei Shen
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Jingyi Yang
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Jingwei Zhao
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Ji Wu
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Yuankun Cai
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Zhimin Mei
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Songshan Chai
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Dongyuan Xu
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Pucha Jiang
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China
| | - Nanxiang Xiong
- Department of Neurosurgery, Wuhan University Zhongnan Hospital, Wuhan, 430071, China.
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Jeon C, Kim M, Lee HS, Kong DS, Park K. Outcomes after Microvascular Decompression for Hemifacial Spasm without Definite Radiological Neurovascular Compression at the Root Exit Zone. Life (Basel) 2023; 13:2064. [PMID: 37895445 PMCID: PMC10608077 DOI: 10.3390/life13102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/24/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
The purpose of this study was to investigate the outcome of microvascular decompression (MVD) in patients with hemifacial spasm (HFS) who have no definite radiological neurovascular compression (NVC). Sixteen HFS patients without radiological NVC on preoperative MRI underwent MVD surgery. The symptoms were left-sided in fourteen (87.5%) and right-sided in two patients (12.5%). Intraoperatively, the most common vessel compressing the facial nerve was the AICA (8, 44.4%), followed by arterioles (5, 27.8%), veins (4, 22.2%), and the PICA (1, 5.6%). The most common compression site was the cisternal portion (13, 76.5%) of the facial nerve, followed by the REZ (4, 23.5%). One patient (6.3%) was found to have multiple NVC sites. Arachnoid type (7, 50%) was the most common compressive pattern, followed by perforator type (4, 28.6%), sandwich type (2, 14.3%), and loop type (1, 7.1%). A pure venous compression was seen in two patients, while a combined venous-arterial "sandwich" compression was detected in two patients. Symptom improvement was observed in all of the patients. Only one patient experienced recurrence after improvement. Based on our experience, MVD surgery can be effective for primary HFS patients with no definite radiological NVC. MVD can be considered if the patient shows typical HFS features, although NVC is not evident on MRI.
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Affiliation(s)
- Chiman Jeon
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan 15355, Republic of Korea;
| | - Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Republic of Korea;
| | - Hyun-Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
- Department of Neurosurgery, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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Basamh M, Sinning N, Ajabnoor W, Illies T, Kehler U. Preoperative assessment of the individual anatomy of the superior petrosal vein complex using balanced fast field echo magnetic resonance imaging. Surg Radiol Anat 2023; 45:1273-1285. [PMID: 37548655 DOI: 10.1007/s00276-023-03220-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Here, we sought to examine the validity and reproducibility of balanced fast field echo (bFFE) for assessing superior petrosal vein (SPV) complex (SPVC) anatomy. METHODS Preoperative bFFE or equivalent scans and operative videos were studied and directly compared with regard to the individual anatomical features of SPVCs and their relation to the operative field. The anatomical details of the bFFE findings of the non-operated side (group 2) of all 50 patients were then reviewed, including the presence of petrosal-galenic anastomosis, and finally compared to the operated SPVCs (group 1). RESULTS A complete correlation between bFFE and intraoperative findings was observed in 62% of cases and had a significant correlation with 3 Tesla magnet strength and higher pixel bandwidth (rbis = - 0.47; p = 0.005). The sensitivity and specificity of bFFE magnetic resonance imaging were 93.7 and 95.2%, respectively, for detecting an SPV disturbing the operative field, and 97.3% and 95% for a disturbing tributary, respectively. Each group had 50 SPVCs, with a total of 70 and 64 SPVs, 10 and 11 general SPVC configurations, as well as 29 and 28 different individual anatomical variations in groups 1 and 2, respectively. Both groups had 1-3 SPVs with a similar distribution of frequencies [Chi-square (4) = 27.56; p = 0.0145 (Fisher's exact test)]. The similarity of the general configurations was not statistically significant. The same four predominant configurations constituted 80% of the SPVCs in each group. The vein of the cerebellopontine fissure was most frequently found in 86% and 88% of cases, and a petrosal-galenic anastomosis was seen in 38% and 40% of groups 1 and 2, respectively. CONCLUSIONS Individual SPVC variations are extensive. Good quality bFFE or equivalents are feasible for preoperative SPVC assessments. However, methods improving vascular visualization are recommended.
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Affiliation(s)
- Mohammed Basamh
- Division of Neurosurgery, King Abdul-Aziz University Hospital, P. O. Box 80125, 21589, Jeddah, Saudi Arabia.
| | - Nico Sinning
- Department of Neurosurgery, Asklepios Klinik Altona, Hamburg, Germany
| | - Waleed Ajabnoor
- Department of Radiology, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia
| | - Till Illies
- Department of Neuroradiology, Asklepios Klinik Altona, Hamburg, Germany
| | - Uwe Kehler
- Department of Neurosurgery, Asklepios Klinik Altona, Hamburg, Germany
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Yokosako S, Kikuchi A, Ohbuchi H, Kubota Y, Kasuya H. Venous Flow Conversion Technique for Sacrificing the Superior Petrosal Vein During Microvascular Decompression for Trigeminal Neuralgia. Oper Neurosurg (Hagerstown) 2022; 23:e232-e236. [PMID: 36001758 PMCID: PMC9439690 DOI: 10.1227/ons.0000000000000333] [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: 12/24/2021] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Microvascular decompression for trigeminal neuralgia (TN) may require sacrifice of the superior petrosal vein (SPV), with potential risks of ischemia and hemorrhagic complications due to impaired venous return. OBJECTIVE To investigate methods for safely sacrificing the SPV. METHODS We retrospectively reviewed 21 cases in 346 consecutive microvascular decompression surgeries for TN. They were intraoperatively identified as SPV and its tributaries being the offending vessels causing TN and were intentionally sacrificed. RESULTS The transverse pontine vein (TPV) was sacrificed in 10 patients. The main trunk of the SPV was sacrificed using the TPV as a collateral flow pathway in 10 patients. No complications occurred related to impaired venous return. CONCLUSION The venous flow conversion technique can be applied to safely sacrificing the SPV and its tributaries with the TPV acting as a collateral blood flow pathway to prevent postoperative impaired venous return.
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Affiliation(s)
- Suguru Yokosako
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan;
| | - Asami Kikuchi
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan;
| | - Hidenori Ohbuchi
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan;
| | - Yuichi Kubota
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan;
| | - Hidetoshi Kasuya
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan;,Neuro Machida Clinic, Tokyo, Japan
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Lee JA, Kong DS, Lee S, Park SK, Park K. Chronological Patterns of Long-Term Outcomes After Microvascular Decompression for Hemifacial Spasm Over 5 Years. World Neurosurg 2022; 166:e313-e318. [PMID: 35817354 DOI: 10.1016/j.wneu.2022.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The postoperative course of hemifacial spasm (HFS) varies. We analyzed the clinical outcomes from 1 to ≥5 years after microvascular decompression (MVD) in patients with HFS. METHODS Between July 2004 and January 2015, 528 patients who were followed up for ≥5 years after MVD for HFS were included. We evaluated chronological patterns of clinical outcomes from 1 to ≥5 years. The outcomes at 2, 3, 4, and ≥5 years postoperatively were individually compared with those at 1 year postoperatively, and the relationships between clinical features, surgical findings, and outcomes over time were analyzed. RESULTS Eight groups were created according to the similarity in the pattern of clinical outcomes from 1 to ≥5 years postoperatively. Individual postoperative outcomes at 2-4 years were consistent with those at 1 year postoperatively, whereas postoperative outcomes at ≥5 years were not (P = 0.020). There was substantial to moderate agreement between the outcomes at 1 year and at 2-4 years postoperatively, but the agreement decreased over time. Patients without diabetes (P = 0.015), an intraoperative offending vessel without a vein (P = 0.005), and intraoperative discoloration of the facial nerve (P = 0.036) showed better outcomes at ≥5 years postoperatively. CONCLUSIONS Long-term outcomes from 1 to ≥5 years after MVD in patients with HFS were diverse. Nondiabetes, intraoperative offending vessel without a vein, and intraoperative discoloration of the facial nerve were better prognostic factors for outcomes at ≥5 years postoperatively. It is advisable to consider these results when evaluating the long-term outcomes of this surgery.
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Affiliation(s)
- Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea.
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Wang M, Wang J, Zhang X, Chai S, Cai Y, Dai X, Yang B, Liu W, Lu T, Mei Z, Zheng Z, Zhou Y, Yang J, Shen L, Zhao J, Ho J, Cai M, Chen J, Xiong N. Intraoperative Findings of Inferior Petrosal Vein During Microvascular Decompression for Hemifacial Spasm: A Single-Surgeon Experience. Front Surg 2022; 9:921589. [PMID: 35756473 PMCID: PMC9226572 DOI: 10.3389/fsurg.2022.921589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to evaluate the impact of the inferior petrosal veins (IPVs) on operational exploration and to analyze related anatomic features. Methods A total of 317 patients were retrospectively studied. Surgical outcomes and postoperative complications were analyzed, and patients were divided into two groups according to whether the IPV was sacrificed or preserved. The diameter of the IPV was also recorded during operation. Furthermore, the position where the IPV drained into the jugular bulb was recorded in each patient, and the influence of different injection points on the operation was analyzed. Results IPVs were conclusively identified in 242/317 (76.3%) of patients, with 110/242 (45.5%) of patients categorized as “IPV sacrifice” versus 132/242 (54.5%) categorized as “IPV preservation.” IPV diameter was observed to be <0.5 mm in 58 cases (23.9%), 0.5 mm–1.0 mm (≥0.5 mm and ≤1.0 mm) in 145 cases (59.9%), and >1 mm in 39 cases (16.2%). The position of IPV drainage into the jugular bulb was at the level of the accessory nerve in 163 cases (67.3%), the level of the vagus nerve in 42 cases (17.4%), and the level of the glossopharyngeal nerve or above in 37 cases (15.3%). The diameters of IPV in the sacrifice group were mainly less than 1 mm (94.5% vs. 75%, P < 0.01), and the cases with draining points near the glossopharyngeal nerve were more than that in the preservation group (27.3% vs. 5.3%, P < 0.01). Conclusion IPV is an obstructive structure in MVD for HFS, with considerable variations in diameters and draining points. IPV near the glossopharyngeal nerve significantly impacts surgical exposure and is often sacrificed for a better view of the operation field. Meanwhile, it is feasible to maintain IPVs with a diameter >1 mm.
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Affiliation(s)
- Mengyang Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiajing Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuling Zhang
- Department of Neurology, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, China
| | - Songshan Chai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuankun Cai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuan Dai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bangkun Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Taojunjin Lu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhimin Mei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhixin Zheng
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - YiXuan Zhou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jingyi Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lei Shen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jingwei Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Joshua Ho
- School of Biomedical Sciences, LKS Faculty of Medicine, Hongkong University, Hongkong, China
| | - Meng Cai
- iRegene Therapeutics Ltd., Wuhan, Hongkong, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Correspondence: Jincao Chen Nanxiang Xiong
| | - Nanxiang Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Correspondence: Jincao Chen Nanxiang Xiong
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11
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Cerebral venous thrombosis: an unexpected Brissaud-Sicard syndrome mimicker. Neurol Sci 2022; 43:3439-3441. [PMID: 35286541 PMCID: PMC8919905 DOI: 10.1007/s10072-022-05977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 11/23/2022]
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12
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Huang CW, Yang MY, Cheng WY, Pan SY, Wang CL, Lai WY, Lin TW, Liu SY, Huang YF, Lai CM, Shen CC. Predictive and prognostic factors for outcome of microvascular decompression in trigeminal neuralgia. J Chin Med Assoc 2022; 85:198-203. [PMID: 35175243 DOI: 10.1097/jcma.0000000000000667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a disease characterized by recurring, short-lived, electric shock-like pain experienced on one side of the face. Microvascular decompression (MVD) is one of the most effective surgical interventions for resolving TN caused by neurovascular compression. This study aimed to determine the predictive and prognostic factors of surgical outcomes. METHODS This retrospective cohort study enrolled patients diagnosed with TN who underwent MVD at our hospital during 2013-2019. The demographic information, pain character, peri-operative Barrow Neurological Institute (BNI) scale, medication, operative finding were recorded. And the outcome was Outcomes were divided into drug-free and drug-dependent group. Predisposing factors for each outcome were analyzed by one-way analysis of variance, followed by a Mann-Whitney U test or Kruskal-Wallis test. RESULTS A total of 104 consecutive patients received MVD to treat TN, and 88 patients were enrolled in this study. The overall postoperative drug-free outcome was 72.7%. A significant difference in drug-free outcomes was observed for patients with typical TN (80.8%) compared with patients with atypical TN (33.33%, p = 0001). When severe venous compression was encountered during MVD, the drug-free outcome fell to 50% (10/20, p = 0.009). The Mann-Whitney U test indicated typical TN as a positive predictive factor of a drug-free outcome, whereas severe venous compression was a negative predictive factor. The patients with preoperative BNI score of 4 had better improvement than others (p = 0.045). Age, onset duration, and arterial loop had no specific difference in this study. CONCLUSION In our study, atypical TN and severe venous compression were associated with poor outcomes. Regrouping atypical TN into precise diagnosis represents an immediate priority according to our result. The preoperative BNI score could be used as an effective predictive tool for the outcome of MVD surgery.
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Affiliation(s)
- Chih-Wei Huang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Meng-Yin Yang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Neurosurgery, Da-Li Jan-Ai Hospital, Taichung, Taiwan, ROC
- Department of Surgery/Neurosurgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- College of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
| | - Wen-Yu Cheng
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan, ROC
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Szu-Yen Pan
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chia-Lin Wang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Yi Lai
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Wei Lin
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Szu-Yuan Liu
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Yu-Fen Huang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chin-Ming Lai
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chiung-Chyi Shen
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan, ROC
- Basic Medical Education Center, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
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Villalonga JF, Baldoncini M, Pailler JI, Saenz A, Lucifero AG, Luzzi S, Pipolo DO, Campero A. Classification and Management of Pontecerebellar-Petrosal Bridging Veins. World Neurosurg 2022; 160:e481-e486. [PMID: 35074544 DOI: 10.1016/j.wneu.2022.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The risks and benefits of coagulating intradural venous elements during a retrosigmoid approach for trigeminal neurovascular decompression has not been accurately established. The objectives of this study are to identify the veins that drain into the superior petrosal sinus, classify them in relation to the suprameatal tubercle and determine the implication of their coagulation. MATERIAL AND METHODS A retrospective study of 3D surgical videos of retrosigmoid approaches for trigeminal neurovascular decompression from the LINT (Laboratory of Neurosurgical Innovations of Tucumán) digital archive was carried out. The veins encountered were classified into 3 groups: retromeatal, meatal and premeatal. The neurosurgical postoperative complication scale proposed by Landriel et al. was utilized to assess complications from venous coagulation. A Grade 0 was added for patients without complications. The STATA 14 program was utilized for statistical analysis. RESULTS The pontocerebellar-petrosal veins of 28 patients who underwent trigeminal decompressive surgery were analyzed. In 7 cases these were found in the retromeatal region; 100% were sacrificed. 11 cases revealed veins within the meatal region; 90,91% were coagulated. Veins in the premeatal region were found in 14 cases; 57,14% were sacrificed. In the postoperative follow-up, 27 patients were grade 0 and 1 patient developed postoperative meningitis (grade Ib complication). No patient suffered vascular complications. CONCLUSION The venous elements identified in trigeminal neurovascular decompressive surgery are variable. We propose classifying them into retromeatal, metal and premeatal groups. Retromeatal and meatal veins can be safely sacrificed for appropriate visualization of the neurovascular conflict. The premeatal venous elements should be coagulated only in justified cases.
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Affiliation(s)
- Juan F Villalonga
- Laboratory of Neurosurgical Innovations of Tucumán, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina; Department of Neurological Surgery, Hospital Padilla, Tucumán, Argentina
| | - Matías Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, Argentina.
| | - José I Pailler
- Laboratory of Neurosurgical Innovations of Tucumán, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Amparo Saenz
- Laboratory of Neurosurgical Innovations of Tucumán, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Derek O Pipolo
- Laboratory of Neurosurgical Innovations of Tucumán, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Alvaro Campero
- Laboratory of Neurosurgical Innovations of Tucumán, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina; Department of Neurological Surgery, Hospital Padilla, Tucumán, Argentina
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Sabourin V, Lavergne P, Mazza J, Head J, Al-Saiegh F, Stefanelli T, Karsy M, Evans JJ. Internal Neurolysis for the Treatment of Trigeminal Neuralgia: A Systematic Review. World Neurosurg 2021; 158:e829-e842. [PMID: 34823039 DOI: 10.1016/j.wneu.2021.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Trigeminal neuralgia (TN) remains a challenging disease with debilitating symptoms and variable efficacy in terms of treatment options. Microvascular decompression (MVD) with internal neurolysis (IN) is an alternative treatment that might benefit patients but has limited understanding. We performed a systematic review of IN for the treatment of TN. METHODS Studies from 2000 to 2021 that had assessed IN for TN were aggregated and independently reviewed. RESULTS A total of 520 patients in 12 studies were identified, with 384 who had undergone IN (mean age, 53.8 years; range, 46-61.4 years; mean follow-up, 36.5 months). Preoperative symptoms had been present for ∼55.0 months before treatment, and pain was predominantly in V2 and V3 (26.8%), followed by other distributions. Of the patients, 83.7% (range, 72%-93.8%) had had an excellent to good outcome (Barrow Neurological Institute pain scale score [BNI-PS], I-II). The pain outcomes at 1 year were excellent for 58%-78.4%, good or better for 77%-93.75%, and fair or better for 80%-93.75% of the patients. On average, facial numbness after IN was experienced by 96% of the patients. However, at follow-up, facial numbness remained in only 1.75%-10%. Most of the remaining numbness was not significantly distressing to the patients. Subgroup comparisons of IN versus recurrent MVD, IN versus radiofrequency ablation, the effects of IN in the absence of vascular compression, and IN with and without MVD were also evaluated. CONCLUSIONS IN represents a promising surgical intervention for TN in the absence of vascular compression and for potential cases of recurrence. Complications were limited in general but require further study.
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Affiliation(s)
- Victor Sabourin
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Lavergne
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jacob Mazza
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jeffrey Head
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Fadi Al-Saiegh
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Tony Stefanelli
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michael Karsy
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - James J Evans
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
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15
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Wang B, Chen Y, Mo J, Gai S, Wang S, Ou C, Xing R, Chen Z, Xu D. Preoperative evaluation of neurovascular relationships for microvascular decompression: Visualization using Brainvis in patients with idiopathic trigeminal neuralgia. Clin Neurol Neurosurg 2021; 210:106957. [PMID: 34583277 DOI: 10.1016/j.clineuro.2021.106957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/11/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A precise and accurate evaluation of neurovascular relationships in patients with idiopathic trigeminal neuralgia (ITN) scheduled for microvascular decompression is necessary. Thus, we constructed and evaluated a fusion imaging technique combining multi-source heterogeneous imaging data from three-dimensional magnetic resonance (MR) and computerized tomography venoangiography (CTV), which enabled use of virtual reality to preoperatively assess the neurovascular relationships, in patients with ITN scheduled for microvascular decompression. METHODS A single-center observational study. In total, eight patients with ITN scheduled for microvascular decompression were included. Patients underwent three-dimensional MR imaging with time-of-flight (TOF) and fast imaging employing steady state acquisition (FIESTA) sequences and CTV before microvascular decompression. A fusion imaging technique, combining MR-TOF, MR-FIESTA, and CTV images, was used to construct a three-dimensional model with information regarding the facial and auditory nerves, brain tissue, skull, arteries and veins. The positions of the trigeminal nerve and the responsible vessels were observed. The agreement between intraoperative neurovascular compression findings and preoperative evaluation results, and the duration required to determine the neurovascular relationships, were evaluated. RESULTS The neurovascular relationships as determined with the fusion imaging technique were consistent with intraoperative neurovascular compression findings in all patients. Moreover, the assessment duration was significantly shorter with the fusion imaging technique than with the three-dimensional MR (P<0.05). The rate of an accurate assessment was significantly higher with the fusion imaging technique than with three-dimensional MR (P<0.05). CONCLUSIONS The fusion imaging technique is a useful tool for the diagnosis and decision-making process based on neurovascular relationships in patients with ITN scheduled for microvascular decompression.
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Affiliation(s)
- Bo Wang
- Department of Neurosurgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322022, China
| | - Yili Chen
- Department of Neurosurgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322022, China.
| | - Jun Mo
- Department of Neurosurgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322022, China
| | - Shiying Gai
- Department of Neurosurgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322022, China
| | - Shenghu Wang
- Department of Neurosurgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322022, China
| | - Changjiang Ou
- Department of Neurosurgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322022, China
| | - Ruxin Xing
- Department of Neurosurgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322022, China
| | - Zhenghao Chen
- Department of Neurosurgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322022, China
| | - Dan Xu
- Department of Neurosurgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322022, China
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16
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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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Hanakita S, Oya S, Matsui T. Trigeminal neuralgia caused by an arachnoid cyst in Meckel's cave: A case report and literature review. Surg Neurol Int 2021; 12:45. [PMID: 33654548 PMCID: PMC7911133 DOI: 10.25259/sni_734_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background: We present a rare case of trigeminal neuralgia (TN) caused by an arachnoid cyst (AC) in Meckel’s cave (MC). Case Description: A 35-year-old man presented with facial pain in the left maxillary and mandibular regions. Since the initial magnetic resonance (MR) imaging showed no apparent offending vessels or tumors, the patient was diagnosed with idiopathic TN, for which carbamazepine was initially effective. When his pain worsened, he was referred to our hospital. A slightly asymmetric shape of MC and distorted course of the trigeminal nerve was confirmed on the initial and repeat MR images. His pain was characterized as electric-shock-like pain, which was triggered by touching the face. Under the tentative diagnosis of an AC confined to MC compressing the trigeminal nerve, the exploration of MC through suboccipital craniotomy was performed. Intraoperatively, the AC was identified in the rostral portion of MC. The indentation of the trigeminal nerve was also observed at the orifice of MC, indicating severe compression by the AC. The wall of the AC was fenestrated. The patient’s pain was relieved immediately after surgery. Postoperative MR images showed that the course of the trigeminal nerve was straightened. Although our literature review found five similar cases, the size of the AC was the smallest in our case. Conclusion: Although it is rare, the AC confined to MC can cause TN. The findings of this study emphasize the importance of evaluating subtle radiological findings of compression on the trigeminal nerve in cases of TN seemingly without neurovascular compression.
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Affiliation(s)
- Shunya Hanakita
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Toru Matsui
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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Kasuya H, Tani S, Kubota Y, Yokosako S, Ohbuchi H, Arai N, Inazuka M, Chernov M. Characteristics and management of the offending veins in microvascular decompression surgery for trigeminal neuralgia. Neurosurg Rev 2020; 44:2337-2347. [PMID: 33111206 PMCID: PMC8338833 DOI: 10.1007/s10143-020-01411-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022]
Abstract
The optimal technique of microvascular decompression (MVD) for trigeminal neuralgia (TN) caused by venous conflict remains unclear. The objectives of this study are to characterize the offending veins identified during MVD for TN and to evaluate intraoperative technique applied for their management. From 2007 till 2019, 308 MVD surgeries were performed in 288 consecutive patients with TN, and in 58 of them, pure venous conflict was identified. In 44 patients, the offending vein was interrupted, as was done for small veins arising from the cisternal trigeminal nerve (CN V) or its root entry zone (REZ) causing their stretching (19 cases), small veins on the surface of REZ (9 cases), transverse pontine vein (TPV) compressing REZ or distal CN V (12 cases), and superior petrosal vein (SPV) using flow conversion technique (4 cases). In 14 other cases, the offending vein was relocated, as was done for the SPV or the vein of cerebellopontine fissure (8 cases), TPV (3 cases), and the vein of middle cerebellar peduncle (3 cases). Complete pain relief after surgery was noted in 49 patients (84%). No one patient experienced major neurological deterioration. Postoperative facial numbness developed in 14 patients (24%), and in 8 of them, it was permanent. In 14 patients, MRI demonstrated venous infarction of the middle cerebellar peduncle, which was associated with the presence of any (P = 0.0180) and permanent (P = 0.0002) facial numbness. Ten patients experienced pain recurrence. Thus, 39 patients (67%) sustained complete pain relief at the last follow-up (median, 48 months), which was significantly associated with the presence of any (P = 0.0228) and permanent (P = 0.0427) postoperative facial numbness. In conclusion, in cases of TN, small offending veins arising from REZ and/or distal CN V and causing their stretching may be coagulated and cut. In many cases, TPV can be also interrupted safely or considered as collateral way for blood outflow. The main complication of such procedures is facial numbness, which is associated with the venous infarction of middle cerebellar peduncle and long-term complete pain relief.
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Affiliation(s)
- Hidetoshi Kasuya
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
| | - Shigeru Tani
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Yuichi Kubota
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Suguru Yokosako
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Hidenori Ohbuchi
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Naoyuki Arai
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Mayuko Inazuka
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Mikhail Chernov
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
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Soni P, Potter T, Soni PP, Estemalik E, Recinos PF, Kshettry VR. Outcomes of microvascular decompression for trigeminal neuralgia with purely venous compression: A systematic review and meta-analysis. Clin Neurol Neurosurg 2020; 198:106230. [PMID: 32949856 DOI: 10.1016/j.clineuro.2020.106230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Microvascular decompression (MVD) is a commonly-used treatment option for medically-refractory trigeminal neuralgia (TN) with arterial neurovascular compression. Pain control and recurrence rates after MVD in patients with purely venous compression are not well understood. In this systematic review and meta-analysis, we studied outcomes after MVD in patients with purely venous compression and reviewed the operative management in these patients. METHODS We performed a systematic review and meta-analysis following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. We searched PubMed, Google Scholar, and Scopus databases for studies reporting surgical outcomes after MVD for purely venous compression. Pain control and recurrence rates were extracted and summarized. Studies that reported outcomes after mobilization/decompression compared with coagulation/transection of compressive veins were reviewed. RESULTS We identified and included 24 studies with a total of 330 patients in this study. 75.6 % of patients achieved a Barrow Neurological Institute (BNI) I pain score with a mean follow-up of 38.0 months. Pain recurred in 23.1 % of patients at a mean follow-up of 51.4 months. There was no significant difference in pain control outcomes between patients with mobilization/decompression and patients with coagulation/transection of compressive veins. CONCLUSION After MVD in patients with venous compression alone, pain control rates were similar to those reported for arterial compression, though recurrence rates were higher. There was no difference between vein coagulation/transection compared to mobilization/decompression. Further studies are needed to determine the optimal treatment paradigm for patients with purely venous compression.
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Affiliation(s)
- Pranay Soni
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Tamia Potter
- Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Payal P Soni
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emad Estemalik
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Psychiatry, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Pablo F Recinos
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Varun R Kshettry
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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20
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Holste K, Sahyouni R, Teton Z, Chan AY, Englot DJ, Rolston JD. Spasm Freedom Following Microvascular Decompression for Hemifacial Spasm: Systematic Review and Meta-Analysis. World Neurosurg 2020; 139:e383-e390. [PMID: 32305605 PMCID: PMC7899163 DOI: 10.1016/j.wneu.2020.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS) is a debilitating disorder characterized by intermittent involuntary movement of muscles innervated by the facial nerve. HFS is caused by neurovascular compression along the facial nerve root exit zone and can be treated by microvascular decompression (MVD). The goal was to determine rates and predictors of spasm freedom after MVD for HFS. METHODS A literature search using the key terms "microvascular decompression" and "hemifacial spasm" was performed. The primary outcome variable was spasm freedom at last follow-up. Analysis was completed to evaluate for variables associated with spasm-free outcome. RESULTS A total of 39 studies including 6249 patients were analyzed. Overall spasm freedom rate was 90.5% (5652/6249) at a follow-up of 1.25 ± 0.04 years. There was no significant relationship between spasm freedom versus persistent spasm and age at surgery, timing of follow-up, gender, disease duration, side of disease, or vessel type. Spasm freedom was more likely after an initial surgery versus a redo MVD (odds ratio 4.16, 95% confidence interval 1.99-8.68; P < 0.01). CONCLUSIONS MVD works well for HFS with cure rates >90% at 1-year follow-up in 6249 patients from 39 studies. A significant predictor of long-term spasm freedom at 1 year was an initial MVD as compared to repeat MVD. The majority of published manuscripts on MVD for HFS are heterogeneous single-institutional retrospective studies. As such, a large-scale meta-analysis reporting outcome rates and evaluating significant predictors of spasm freedom provides utility in the absence of randomized controlled studies.
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Affiliation(s)
- Katherine Holste
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Zoe Teton
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Alvin Y Chan
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
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21
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Grigoryan G, Sitnikov A, Grigoryan Y. Hemifacial spasm caused by the brainstem developmental venous anomaly: A case report and review of the literature. Surg Neurol Int 2020; 11:141. [PMID: 32547828 PMCID: PMC7294170 DOI: 10.25259/sni_56_2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/16/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Hemifacial spasm (HFS) is usually caused by vascular compression of the root exit zone (REZ) of the facial nerve. Dual compression of the REZ by veins and arteries is also associated with HFS, but venous origin alone is rarely reported. We present a rare case of HFS caused by the brainstem developmental venous anomaly (DVA) treated with microvascular decompression (MVD). Case Description: A 30-year-old women presented with the left-sided HFS since the age of 18 years. The brainstem DVA was diagnosed by magnetic resonance imaging (MRI) and followed by two attempts of MVD at some other clinics without any improvement. At our hospital, MVD was performed through a left retromastoid craniotomy. Intraoperatively, after detaching the strong adhesions between the cerebellar hemisphere, petrosal dura and lower cranial nerves, and removing the Teflon sponge inserted during the previous operations, the compressing large vein was found, separated from facial nerve REZ and MVD was completed. The postoperative computed tomography angiography and MRI showed the thrombosis of the main trunk of DVA and decompression of the facial nerve REZ. Complete cessation of HFS with hearing preservation was observed with only slight weakness of mimic muscles which disappeared within 3 months after surgery. Conclusion: HFS associated with brainstem DVA is a very rare condition. MVD of the facial nerve REZ with transposition of the large draining vein should be considered as an effective treatment option.
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Affiliation(s)
- George Grigoryan
- Department of Neurosurgery, Treatment and Rehabilitation Center, Moscow, Russian Federation
| | - Andrey Sitnikov
- Department of Neurosurgery, Treatment and Rehabilitation Center, Moscow, Russian Federation
| | - Yuri Grigoryan
- Department of Neurosurgery, Treatment and Rehabilitation Center, Moscow, Russian Federation
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22
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The petrosal vein mutilation affects the SOD activity, MDA levels and AQP4 level in cerebellum and brain stem in rabbit. J Chem Neuroanat 2020; 106:101791. [PMID: 32339652 DOI: 10.1016/j.jchemneu.2020.101791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 11/24/2022]
Abstract
Cerebral edema after brain surgery remains a life-threatening complication in the clinic. For a better operating field view, superior petrosal vein (SPV) can be easily damaged during neurosurgery. SPV sacrifice may sometimes be inevitable in clinic. However, the safety of SPV sacrifice is still a controversial question. Whether petrosal vein injury has an effect on cerebral edema after brain surgery is still unknown. In this study, rabbits were divided into two groups. The rabbits in the surgery group underwent petrosal vein sacrifice. The control group was subjected to sham surgery. Cerebellum and brain stem tissues were collected at 4 h, 8 h, 12 h, 24 h, 48 h and 72 h post-surgery. The superoxidase dismutase (SOD) activity and expression of malondialdehyde (MDA) were tested in the collected samples. Quantitiative real time polymerase chain reaction and immunohistochemistry were used to detect the mRNA and protein levels, respectively, of aquaporin 4 (AQP4) in the tissue samples. Compared to the control sham group, the activity of SOD and MDA expression in cerebellum was decreased and increased, respectively, at 4 h, 8 h, 12 h and 24 h post-, surgery The SOD activity and expression of MDA in brain stem was decreased and increased, respectively, only in 4 h after surgery, compared with control group. The mRNA and protein levels of AQP4 were increased in cerebellum at 4 h, 8 h, 12 h and 24 h after surgery, but in the brain stem, the levels were increased only at 4 h after surgery compared with sham group. Our results thus show that SPV sacrifice influences oxidative stress and the expression of AQP4 in cerebellum and brain stem of rabbits; highlighting the importance of protecting the petrosal vein during neurosurgery.
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23
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Basamh M, Sinning N, Kehler U. Individual variations of the superior petrosal vein complex and their microsurgical relevance in 50 cases of trigeminal microvascular decompression. Acta Neurochir (Wien) 2020; 162:197-209. [PMID: 31768757 PMCID: PMC6942005 DOI: 10.1007/s00701-019-04109-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/14/2019] [Indexed: 11/24/2022]
Abstract
Background We investigated the understudied anatomical variations of the superior petrosal vein (SPV) complex (SPVC), which may play some role in dictating the individual complication risk following SPVC injury. Methods Microvascular decompressions of the trigeminal nerve between September 2012 and July 2016. All operations utilized an SPVC preserving technique. Preoperative balanced fast field echo (bFFE) magnetic resonance imaging, or equivalent sequences, and operative videos were studied for individual SPVC anatomical features. Results Applied imaging and operative SPVC anatomy were described for fifty patients (mean age, 67.18 years; female sex and right-sided operations, 58% each). An SPVC component was sacrificed intentionally in 6 and unintentionally in only 7 cases. Twenty-nine different individual variations were observed; 80% of SPVCs had either 2 SPVs with 3 or 1 SPV with 2, 3, or 4 direct tributaries. Most SPVCs had 1 SPV (64%) and 2 SPVs (32%). The SPV drainage point into the superior petrosal sinus was predominantly between the internal auditory meatus and Meckel cave (85.7% of cases). The vein of the cerebellopontine fissure was the most frequent direct tributary (86%), followed by the pontotrigeminal vein in 80% of SPVCs. Petrosal-galenic anastomosis was detected in at least 38% of cases. At least 1 SPV in 54% of the cases and at least 1 direct tributary in 90% disturbed the operative field. The tributaries were more commonly sacrificed. Conclusions The extensive anatomical variation of SPVC is depicted. Most SPVCs fall into 4 common general configurations and can usually be preserved. BFFE or equivalent sequences remarkably facilitated the intraoperative understanding of the individual SPVC in most cases.
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Affiliation(s)
- Mohammed Basamh
- Department of Neurosurgery, Asklepios Klinik Altona, Paul-Ehrlich Strasse 1, 22763, Hamburg, Germany.
- Division of Neurosurgery, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.
| | - Nico Sinning
- Department of Neurosurgery, Asklepios Klinik Altona, Paul-Ehrlich Strasse 1, 22763, Hamburg, Germany
| | - Uwe Kehler
- Department of Neurosurgery, Asklepios Klinik Altona, Paul-Ehrlich Strasse 1, 22763, Hamburg, Germany
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24
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Yanagawa T, Hatayama T, Harada Y, Sato E, Yamashita K, Tanaka M, Torii M, Kiyomoto M, Imai H, Ehara T, Kono T. Preoperative risk assessment for predicting the opening of mastoid air cells in lateral suboccipital craniotomy for microvascular decompression. Clin Neurol Neurosurg 2019; 189:105624. [PMID: 31809889 DOI: 10.1016/j.clineuro.2019.105624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Opening of mastoid air cells (MACs), a complication of lateral suboccipital craniotomy for microvascular decompression (MVD), might cause cerebrospinal fluid (CSF) leakage and meningitis. Only a few studies have investigated the association of degree of MAC development and actual opening of MACs. The present study focused on preoperative risk assessment for predicting the opening of MACs. PATIENTS AND METHODS The study included 204 consecutive patients who underwent MVD at our hospital between January 2014 and December 2018. We retrospectively collected clinical and neuroimaging data from electronic medical charts and discharge summaries. MACs were classified into four types according to neuroimaging data. Postoperative computed tomography (CT) was used to assess patients with and without CSF leakage into MACs. RESULTS No CSF leakage was observed into types 1 and 2 MACs, but it was noted in 14 of 46 patients (30 %) with type 3 and 44 of 58 patients (76 %) with type 4 MACs. Opening of MACs during surgery could not be recognized in 33 (57 %). CSF rhinorrhea was noted in 1 of the 58 patients with CSF leakage into MACs and meningitis was not noted. CONCLUSION Patients with types 3 and 4 MACs have a high risk of CSF leakage. Complete prevention of mild symptoms, such as ear obstruction, is challenging even if opened MACs are sealed, but serious complications, such as CSF rhinorrhea and meningitis, can be avoided. For cases in which preoperative CT reveals a high risk of opening of MACs, preventive closure should be performed.
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Affiliation(s)
- Taro Yanagawa
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan.
| | - Toru Hatayama
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
| | - Yoichi Harada
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
| | - Eishi Sato
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
| | - Keiichi Yamashita
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
| | - Masaki Tanaka
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
| | - Masataka Torii
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
| | - Masaru Kiyomoto
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
| | - Hiroya Imai
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
| | - Takuro Ehara
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
| | - Takuji Kono
- Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan
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25
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Lee JA, Park K. Short-term versus long-term outcomes of microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 2019; 161:2027-2033. [PMID: 31392569 DOI: 10.1007/s00701-019-04032-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Microvascular decompression (MVD) is a useful treatment for hemifacial spasm (HFS), but the postoperative course is extremely diverse. The purpose of this study was to compare short- and long-term outcomes, find the earliest optimal time for determining the long-term outcomes, and investigate the prognostic factors involved in the outcomes over time. METHODS From July 2004 to January 2015, 1341 patients who underwent MVD for HFS were enrolled. Information on clinical features, operative findings, and surgical outcomes over time were collected by performing a review of electronic medical records, and their relationships were analyzed. The outcomes of MVD at 1, 3, 6, and 9 months were individually compared against those at > 12 months after surgery. RESULTS The mean follow-up period after surgery was 44.9 months (median, 36.8 months; range, 12.0-156.6 months). The overall improvement rate for the 1341 patients was 89.0%. Individual postoperative outcomes at 6 and 9 months showed no differences with those at > 12 months after surgery. Furthermore, in the uni- and multi-variable analyses, patients in whom the offending vessels were intraoperatively determined to be veins showed bad outcomes at 6, 9, and > 12 months (p = 0.048, p = 0.004, and p = 0.003, respectively). Patients with intraoperative indentation on the facial nerve showed good outcomes at 6, 9, and > 12 months (p = 0.005, p = 0.039, and p = 0.020, respectively). Patients with delayed facial palsy after surgery showed better outcomes at 6, 9, and > 12 months (p = 0.002, p = 0.003, and p = 0.028, respectively). CONCLUSIONS Short- and long-term outcomes of MVD in patients with HFS manifested differently, but the outcomes at 6 and 9 months showed similarities with those at > 12 months. In patients in whom the intraoperatively detected offending vessel was not a vein, and in patients with intraoperative indentation on the facial nerve and postoperative delayed facial palsy, good outcomes could be predicted after 6 months of surgery.
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Affiliation(s)
- Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro Gangnam-gu, Seoul, 06351, South Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro Gangnam-gu, Seoul, 06351, South Korea.
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Brzegowy K, Pękala PA, Zarzecki MP, Pękala JR, Roy J, Aziz HM, Tubbs RS, Walocha JA, Tomaszewski KA, Mikos M. Prevalence and Clinical Implications of the Primitive Trigeminal Artery and its Variants: A Meta-Analysis. World Neurosurg 2019; 133:e401-e411. [PMID: 31536812 DOI: 10.1016/j.wneu.2019.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The primitive trigeminal artery (PTA) is the most common and the largest persistent carotid-basilar anastomosis. Primitive trigeminal artery variants (PTAVs) are anastomoses between the internal carotid artery and cerebellar arteries. These vessels pose a risk of hemorrhagic or ischemic complications during neurosurgical procedures in the parasellar and intrasellar regions. The aim of this study was to determine the prevalence of both PTA and PTAVs and their clinically important anatomic features. METHODS Major electronic databases were thoroughly searched for studies on PTA and PTAV. References in the included articles were also evaluated. Data regarding prevalence, laterality, origin, course patterns, and associated anomalies were extracted and pooled into a meta-analysis. RESULTS A total of 39 studies (110,866 patients) were included in the meta-analysis. The total pooled prevalence estimate of PTA and PTAVs combined was 0.4% (95% confidence interval [CI], 0.3-0.5). Individually, PTA was present in 0.3% of patients and PTAV in 0.2%. Both arteries most often originated from the C4 internal carotid artery and took a course lateral to the dorsum sellae. The anterior inferior cerebellar artery type was the predominant PTAV (72.1%). Basilar artery hypoplasia was found in 42.5% of patients with a PTA. CONCLUSIONS PTA and PTAVs are rare vessels, but they are clinically important because they can contribute to trigeminal neuralgia. Knowledge of the potential course of these arteries is essential in neuroradiology and neurosurgery, especially in minimally invasive procedures such as the endoscopic endonasal transsphenoidal approach to the pituitary gland and the percutaneous gasserian ganglion procedure.
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Affiliation(s)
- Karolina Brzegowy
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Przemysław A Pękala
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Michał P Zarzecki
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Jakub R Pękala
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Joyeeta Roy
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Hasina M Aziz
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA
| | - Jerzy A Walocha
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Krzysztof A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland; International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.
| | - Marcin Mikos
- International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
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27
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Nervus Intermedius Section to Mobilize the Anterior Inferior Cerebellar Artery in Microvascular Decompression Surgery for Hemifacial Spasm: A Technical Case Report. World Neurosurg 2019; 122:491-494. [DOI: 10.1016/j.wneu.2018.11.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022]
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