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Xie ME, Halbert-Elliott K, Nair SK, Huang J, Yedavalli VS, Bettegowda C, Xu R. Application of Sequential Thresholding-Based Automated Reconstruction of the Trigeminal Nerve in Trigeminal Neuralgia. World Neurosurg 2024; 181:e567-e577. [PMID: 37890771 PMCID: PMC11055639 DOI: 10.1016/j.wneu.2023.10.095] [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: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE High-resolution magnetic resonance imaging (MRI) of the trigeminal nerve is indispensable for workup of trigeminal neuralgia (TN) before microvascular decompression; however, the evaluation is often subjective and prone to variability. We aim to develop and assess sequential thresholding-based automated reconstruction of the trigeminal nerve (STAR-TN) as an algorithm for segmenting the trigeminal nerve and contacting structures that will allow for a structured method for assessing neurovascular conflict. METHODS A total of 42 patients with TN who underwent high-resolution MRI before microvascular decompression in 2022 were included in our study. Segmentation of the trigeminal nerve and contacting structures was performed on preoperative MRI scans using STAR-TN. The segmentations were then evaluated for neurovascular conflict and compared to the preoperative radiology and operative notes. Geometric features, including the area of contact and distance to conflict, were extracted. RESULTS Of the 42 patients, 32 (76.2%) were found to show neurovascular conflict based solely on their STAR-TN segmentations and 10 (23.8%) were found to not show neurovascular conflict. Compared with the intraoperative findings, this resulted in a sensitivity of 78.0% and specificity of 100%. In contrast, assessments of neurovascular conflict by radiologists using only 2-dimensional MRI views had a sensitivity of 68.3% and specificity of 100%. Of the 32 patients with neurovascular conflict, 29 (90.9%) had conflict within the root entry zone. Overall, the patients had a median area of contact of 10.66 mm2. CONCLUSIONS STAR-TN allows for 3-dimensional visualization and identification of neurovascular conflict with improved sensitivity compared with neuroradiologist assessments from MRI slices.
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Affiliation(s)
- Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kyra Halbert-Elliott
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vivek S Yedavalli
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Qi X, He Y, Wang Q, Ren S, Yao H, Cao W, Guan L. Diffusion tensor and kurtosis imaging reveal microstructural changes in the trigeminal nerves of patients with trigeminal neuralgia. Eur Radiol 2023; 33:8046-8054. [PMID: 37256350 DOI: 10.1007/s00330-023-09762-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/19/2023] [Accepted: 04/11/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate the use of diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) for detection of microstructural changes in the trigeminal nerves of trigeminal neuralgia (TN) patients. METHODS Forty TN patients and 40 healthy controls were examined using 3 T magnetic resonance imaging (MRI) to evaluate DTI and DKI parameters in trigeminal nerves. One-way ANOVA was used to test the differences in age, sex, and DTI and DKI parameters between the TN-affected sides, TN-unaffected sides, and controls. For parameters with inter-group differences, pairwise comparisons were performed. Then, the difference ratios (DRs) of the parameters with statistical differences were calculated and used for the receiver operating characteristic (ROC) analysis to assess their diagnostic performance. In addition, for the DTI and DKI parameter values with differences, we used pure DTI and DKI values to perform the ROC analysis. RESULTS Compared to the unaffected sides and controls, the FA, MK, and Kr of the affected sides of TN patients were significantly reduced, while ADC was significantly increased (p < 0.05). The diagnostic efficiency of the FA DRs (AUC: 0.974; cutoff value: 0.038; sensitivity: 100%; specificity: 95.0%) was the highest among all DTI and DKI parameters. The DRs of FA and MK more efficiently diagnosed TN than pure FA and MK values. CONCLUSIONS DTI and DKI allowed detection of microstructural changes in TN-affected trigeminal nerves. FA DR was the best independent predictor of microstructural changes in TN. CLINICAL RELEVANCE STATEMENT Both DTI and DKI can be used for noninvasive quantitative evaluation of the changes in the microstructure of the cisternal segment of the cranial nerves in clinical practice. KEY POINTS • Diffusion tensor imaging (DTI) can be used to evaluate the in vivo integrity of white matter and nerve fiber pathway. • Diffusion kurtosis imaging (DKI) has been shown to be considerable sensitive to microstructural changes. • DTI combined with DKI can comprehensively evaluate the status of the TN-affected trigeminal nerve.
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Affiliation(s)
- Xixun Qi
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Yunyun He
- Department of Radiology, Jingzhou Central Hospital, Jingzhou, 434020, China
| | - Qiushi Wang
- Department of Pain, First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Sixie Ren
- Department of Radiology, Chengdu Second People's Hospital, Chengdu, 610000, China
| | - Haibo Yao
- Medical Records Office, Chengdu Women'S and Children'S Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Wanyu Cao
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Liming Guan
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
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Lerner A, Sheikh-Bahaei N, Go JL. Utility of Neuroimaging in the Management of Chronic and Acute Headache. Otolaryngol Clin North Am 2022; 55:559-577. [PMID: 35490044 DOI: 10.1016/j.otc.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Imaging plays an important role in identifying the cause of the much less common secondary headaches. Such headaches may be caused by a variety of pathologic conditions which can be categorized as intracranial and extracranial. Idiopathic intracranial hypertension imaging findings include "empty sella," orbital changes, and dural venous sinus narrowing. Intracranial hypotension (ICH) is frequently caused by CSF leaks. Imaging findings include loss of the CSF spaces, downward displacement of the brain, as well as dural thickening and enhancement. Severe cases of ICH may result in subdural hematomas. A variety of intracranial and skull base tumors may cause headaches due to dural involvement. Extracranial tumors and lesions that frequently present with headaches include a variety of sinonasal tumors as well as mucoceles. Neurovascular compression disorders causing headaches include trigeminal and glossopharyngeal neuralgia. Imaging findings include displacement and atrophy of the cranial nerve caused by an adjacent arterial or venous structure.
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Affiliation(s)
- Alexander Lerner
- Keck Medical Center of USCD, Department of Radiology, 1500 San Pablo Street, 2nd Floor, Imaging, Los Angeles, CA 90033, USA.
| | - Nasim Sheikh-Bahaei
- Keck Medical Center of USCD, Department of Radiology, 1500 San Pablo Street, 2nd Floor, Imaging, Los Angeles, CA 90033, USA
| | - John L Go
- Keck Medical Center of USCD, Department of Radiology, 1500 San Pablo Street, 2nd Floor, Imaging, Los Angeles, CA 90033, USA
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Pham HD, Dang TH, Duong TK, Dinh TT, Bui VG, Nguyen TV, Huynh QH. Predictability of Fused 3D-T2-SPACE and 3D-TOF-MRA Images in Identifying Conflict in Trigeminal Neuralgia. J Pain Res 2021; 14:3421-3428. [PMID: 34754235 PMCID: PMC8570429 DOI: 10.2147/jpr.s331054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy of fused three-dimensional T2 sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) and three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) sequences for detecting neurovascular compression (NVC) in patients presenting with trigeminal neuralgia (TN). Methods A prospective study was carried in 33 consecutive patients (m/f: 17/16; mean age, 56.3 ± 10.4 years) with unilateral TN confirmed NVC and consensus by two experienced radiologists on fused 3D-SPACE and 3D-TOF-MRA sequences of 3-tesla (3-T) MRI. All patients underwent microvascular decompression (MVD), using photos and video in surgery as documents compared with MRI. Both the MRI and MVD were reported for three grades (contact, compression, distortion), vessel types (artery or vein), identification of offending vessel, site (juxtapontine, cisternal, and juxtapetrous), and location (cranial, caudal, medial, lateral). Agreement between preoperative MRI visualization and surgical findings was assessed using the kappa (K) statistic. Results The k-values for the agreement were excellent for the grade of NVC (k=0.82), vessel types (k=0.78), and location of conflict (k=0.74), and good for identification of the offending vessel (0.65) and the site-affected vessel (k=0.69). Conclusion The fused D3-SPACE and 3D-TOF-MRA images are highly effective tools for the evaluation and treatment planning of NVC in TN patients.
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Affiliation(s)
- Hong Duc Pham
- Radiology Department, Saint Paul Hospital of Hanoi, Hanoi City, Vietnam.,Radiology Department, Hanoi Medical University, Hanoi City, Vietnam
| | - Thu Ha Dang
- Radiology Department, Saint Paul Hospital of Hanoi, Hanoi City, Vietnam.,Radiology Department, Hanoi Medical University, Hanoi City, Vietnam
| | - Trung Kien Duong
- Neurosurgery Department, Saint Paul Hospital of Hanoi, Hanoi City, Vietnam
| | - Trung Thanh Dinh
- Radiology Department, Saint Paul Hospital of Hanoi, Hanoi City, Vietnam
| | - Van Giang Bui
- Radiology Department, Hanoi Medical University, Hanoi City, Vietnam.,Radiology Centre, National Cancer Hospital, Hanoi City, Vietnam
| | - Tuan Vu Nguyen
- Cardiology Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Quang Huy Huynh
- Radiology Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Radiology Department, Trưng Vương Hospital, Ho Chi Minh City, Vietnam
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Trigeminal Neuralgia Due to Compression of Primitive Trigeminal Artery Variant: Usefulness of Fusion Images of Constructive Interference in Steady-State Magnetic Resonance Imaging and Computed Tomography Angiography. World Neurosurg 2020; 138:257-260. [PMID: 32151772 DOI: 10.1016/j.wneu.2020.02.168] [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: 01/15/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is one of the neuropathic pain syndromes, most commonly caused by vascular compression in the root entry zone of the trigeminal nerve in the cerebellopontine angle. It was rare as offending artery that primitive trigeminal artery and primitive trigeminal artery variant (PTAv) as an anomaly that occurs carotid-basilar anastomosis. We report a case of TN caused by the PTAv, and usefulness of fusion images of magnetic resonance imaging (MRI) and computed tomography angiography (CTA). CASE DESCRIPTION A 65-year-old man presented with a 2-year history of left paroxysmal facial pain in the second division of the trigeminal nerve. We diagnosed left TN due to PTAv using constructive interference in steady state magnetic resonance imaging (CISS MRI) and CTA. Microvascular decompression surgery disclosed trigeminal nerve compressed by PTAv consisted with findings from preoperative neuroimaging. We report a case of TN caused by PTAv, and usefulness of fusion images of CISS MRI and CTA to understand the neurovascular and bony structure during the perioperative period. CONCLUSIONS The fusion image created by CISS MRI and 3-dimensional CTA was useful to identify the offending vessel and to clearly understand the neurovascular structure preoperatively.
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Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, Eide PK, Leal PRL, Maarbjerg S, May A, Nurmikko T, Obermann M, Jensen TS, Cruccu G. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol 2019; 26:831-849. [DOI: 10.1111/ene.13950] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/08/2019] [Indexed: 12/19/2022]
Affiliation(s)
- L. Bendtsen
- Department of Neurology Faculty of Health and Medical Sciences Danish Headache Center Rigshospitalet‐Glostrup University of Copenhagen Glostrup Denmark
| | - J. M. Zakrzewska
- Pain Management Centre National Hospital for Neurology and Neurosurgery London UK
- Eastman Dental Hospital UCLH NHS Foundation Trust London UK
| | - J. Abbott
- Trigeminal Neuralgia Association UK Oxted Surrey UK
| | | | - G. Di Stefano
- Department of Human Neuroscience Sapienza University Rome Italy
| | - A. Donnet
- Headache and Pain Department CHU La Timone APHM Marseille France
| | - P. K. Eide
- Department of Neurosurgery Oslo University Hospital‐Rikshospitalet Oslo Norway
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
| | - P. R. L. Leal
- Department of Neurosurgery Faculty of Medicine of Sobral Federal University of Ceará Sobral Brazil
- University of Lyon 1 Lyon France
| | - S. Maarbjerg
- Department of Neurology Faculty of Health and Medical Sciences Danish Headache Center Rigshospitalet‐Glostrup University of Copenhagen Glostrup Denmark
| | - A. May
- Department of Systems Neuroscience Universitäts‐Krankenhaus Eppendorf Hamburg Germany
| | - T. Nurmikko
- Neuroscience Research Centre Walton Centre NHS Foundation Trust Liverpool UK
| | - M. Obermann
- Center for Neurology Asklepios Hospitals Schildautal Seesen Germany
| | - T. S. Jensen
- Department of Neurology and Danish Pain Research Center Aarhus University Hospital University of Aarhus Aarhus C Denmark
| | - G. Cruccu
- Department of Human Neuroscience Sapienza University Rome Italy
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Satoh T, Yagi T, Onoda K, Kameda M, Sasaki T, Ichikawa T, Date I. Hemodynamic features of offending vessels at neurovascular contact in patients with trigeminal neuralgia and hemifacial spasm. J Neurosurg 2018; 130:1870-1876. [PMID: 29979116 DOI: 10.3171/2018.1.jns172544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 01/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Offending vessels at the site of neurovascular contact (NVC) in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS) may have specific hemodynamic features. The purpose of this study was to investigate the wall shear stress (WSS) of offending vessels at NVCs by conducting a computational fluid dynamics (CFD) analysis. METHODS The authors retrospectively analyzed the cases of 20 patients (10 with TN and 10 with HFS) evaluated by 3D CT angiography and used the imaging findings for analysis of the hemodynamic parameters. The 3D CFD images were directly compared with the NVCs determined by simulated multifusion images of CT angiogram and MR cisternogram, and operative photos. The magnitudes of the WSS (WSSm) at the proximal (WSSm-p), just-beginning (WSSm-j), contact site (WSSm-s), and distal (WSSm-d) areas of each NVC were analyzed. The ratios of the WSSm-j, WSSm-s, and WSSm-d areas to the WSSm-p area were calculated individually. The direction of the WSS (WSSv) and its temporal variation (WSSvV) were depicted and morphologically compared with the NVC confirmed by simulated images and operative findings. RESULTS The ratios of WSSm at the just-beginning and the contact site to the proximal area of the NVCs (WSSm-j/WSSm-p and WSSm-s/WSSm-p) were both significantly higher than that at the distal area (WSSm-d/WSSm-p) (p < 0.05). The WSSv and WSSvV at the NVCs showed small variation in a single cardiac cycle, especially along the areas that were in contact with the affected nerve. CONCLUSIONS Areas of relatively high WSSm and temporal variation of WSSm (WSSmV) were observed at the NVCs. Less mobility of the WSSv and WSSvV was detected along the side of the vessels in contact with the nerves. These findings may be consistent with the actual area of the NVC. Hemodynamic features of the site of NVC can be added to the preoperative simulation for MVD surgery, which may be useful for the diagnosis and treatment planning of TN and HFS.
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Affiliation(s)
- Toru Satoh
- 1Department of Neurological Surgery, Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima
| | - Takanobu Yagi
- 2Center for Advanced Biomedical Sciences, Waseda University, Tokyo
| | - Keisuke Onoda
- 3Department of Neurological Surgery, Okayama Red Cross General Hospital; and
| | - Masahiro Kameda
- 4Department of Neurological Surgery, Okayama University Postgraduate Medical School, Okayama, Japan
| | - Tatsuya Sasaki
- 4Department of Neurological Surgery, Okayama University Postgraduate Medical School, Okayama, Japan
| | - Tomotsugu Ichikawa
- 4Department of Neurological Surgery, Okayama University Postgraduate Medical School, Okayama, Japan
| | - Isao Date
- 4Department of Neurological Surgery, Okayama University Postgraduate Medical School, Okayama, Japan
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8
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Brînzeu A, Drogba L, Sindou M. Reliability of MRI for predicting characteristics of neurovascular conflicts in trigeminal neuralgia: implications for surgical decision making. J Neurosurg 2018; 130:611-621. [PMID: 29624148 DOI: 10.3171/2017.8.jns171222] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/01/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The choice of microvascular decompression (MVD), among the several other surgical options, for treating refractory classical trigeminal neuralgia (TN) relies mostly on preoperative imaging, but the degree of reliability of MRI remains a matter of debate. The authors approached the question of predictability of neurovascular conflict (NVC) in a series of 100 protocolized MRI studies from patients with TN who underwent MVD, by reexamination of MR images, blinded to the clinical data and surgical findings, including the side of the neuralgia. METHODS Patients included in the study were those who underwent MVD after surgical indication had been determined based on a protocolized imagery workup (3D high-resolution T2-weighted cisternography centered on the trigeminal nerve, 3D time-of-flight angiography, and 3D gadolinium-enhanced T1-weighted imaging) performed at our institution. All MR images were blindly reexamined, and neurovascular relationships were described on both sides, noting the existence of compression, vessels involved, situation along the root, and degree of compression. The results of MRI evaluation were then compared with actual surgical findings. The extent of agreement and quality of the prediction were expressed with Cohen's kappa coefficient (κ) and receiver operating characteristic (ROC) statistics. RESULTS A conflict had actually been found during surgery in 94 of 100 patients. The sensitivity of MRI to detect a conflict was 97% and the specificity was 50%. Vessel type was identified with high reliability (κ = 0.80), while the grade of the conflict and its situation along the root showed poor to average reliability (κ = 0.38 and κ = 0.40, respectively). The area under the ROC curve for predicting the presence of a conflict according to the grades of conflict seen on MRI was 0.93, which is considered very good. The positive predictive value was differentiated according to the grade of conflict, with a very high value for high grades of vascular conflict. CONCLUSIONS This study shows an overall good reliability of MRI to predict the existence of an NVC. The prediction value is excellent for high grades of compression. Some apparent low-grade compressions on MRI may be revealed as false positives in surgical exploration. This raises the question of what other imaging methods might be used to determine not only the existence of a conflict but also its degree of compression. The degree of compression is of paramount importance to predict the probability of long-term pain relief, and therefore in the decision to propose MVD as the first choice of surgical treatment.
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Affiliation(s)
- Andrei Brînzeu
- 1Department of Neurosurgery, University of Lyon 1, Lyon, France
- 2Department of Neurosciences, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania; and
| | - Landry Drogba
- 1Department of Neurosurgery, University of Lyon 1, Lyon, France
- 3University of Medicine Abidjan, Yopougon, Abidjan, Côte d'Ivoire
| | - Marc Sindou
- 1Department of Neurosurgery, University of Lyon 1, Lyon, France
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9
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Wang Y, Zu C, Hu G, Luo Y, Ma Z, He K, Wu X, Zhou J. Automatic Tumor Segmentation with Deep Convolutional Neural Networks for Radiotherapy Applications. Neural Process Lett 2018. [DOI: 10.1007/s11063-017-9759-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Abstract
Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.
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Affiliation(s)
- Yad Ram Yadav
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Yadav Nishtha
- Department of Radio Diagnosis and Imaging, All India Institute of Medical Science, New Delhi, India
| | - Pande Sonjjay
- Department of Radio Diagnosis and Imaging, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Parihar Vijay
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Ratre Shailendra
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Khare Yatin
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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11
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Feng B, Zheng X, Wang X, Wang X, Ying T, Li S. Management of different kinds of veins during microvascular decompression for trigeminal neuralgia: technique notes. Neurol Res 2016; 37:1090-5. [PMID: 26923579 DOI: 10.1080/01616412.2015.1115588] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE During microvascular decompression surgery for trigeminal neuralgia, surgeons will encounter various kinds of veins that block the approach to or compress the trigeminal nerve. The aim of this study was to present our experience in managing different kinds of veins. METHODS This was a retrospective study of 21 patients with trigeminal neuralgia, in whom one or more veins were encountered during surgery. The techniques used in treating 4 types of veins during microvascular decompression were assessed, and the surgical outcomes and operative complications were analysed. RESULTS For the first type, large veins blocking the approach towards the root entry zone (REZ) of the trigeminal nerve were bypassed via cerebellar fissure approach. Second, veins lying on the brainstem surface and compressing the REZ were detached using a gelatin-assisted dissecting technique and then interposed. Third, veins rising from the surface of the brainstem and crossing the cisternal portion of the trigeminal nerve were interposed. Fourth, intraneural veins, which were generally small, were coagulated and cut. In this series, there was no intentional sacrifice or unintentional rupture of large veins, and the sacrifice rate of medium and small veins was only 19.0%. Thirteen patients (61.9%) gained complete pain relief immediately after surgery (i.e. "excellent" result), while the remaining eight patients (38.1%) achieved "good" pain relief. CONCLUSION Different surgical techniques were used based on the different kinds of veins encountered. This allowed preservation of almost all the large veins. There were no serious complications postoperatively.
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Affiliation(s)
- Baohui Feng
- a Department of Neurosurgery, XinHua Hospital, Affiliated to Shanghai JiaoTong University School of Medicine , Shanghai, China
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12
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DeSouza DD, Hodaie M, Davis KD. Structural Magnetic Resonance Imaging Can Identify Trigeminal System Abnormalities in Classical Trigeminal Neuralgia. Front Neuroanat 2016; 10:95. [PMID: 27807409 PMCID: PMC5070392 DOI: 10.3389/fnana.2016.00095] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/27/2016] [Indexed: 01/28/2023] Open
Abstract
Classical trigeminal neuralgia (TN) is a chronic pain disorder that has been described as one of the most severe pains one can suffer. The most prevalent theory of TN etiology is that the trigeminal nerve is compressed at the root entry zone (REZ) by blood vessels. However, there is significant evidence showing a lack of neurovascular compression (NVC) for many cases of classical TN. Furthermore, a considerable number of patients who are asymptomatic have MR evidence of NVC. Since there is no validated animal model that reproduces the clinical features of TN, our understanding of TN pathology mainly comes from biopsy studies that have limitations. Sophisticated structural MRI techniques including diffusion tensor imaging provide new opportunities to assess the trigeminal nerves and CNS to provide insight into TN etiology and pathogenesis. Specifically, studies have used high-resolution structural MRI methods to visualize patterns of trigeminal nerve-vessel relationships and to detect subtle pathological features at the trigeminal REZ. Structural MRI has also identified CNS abnormalities in cortical and subcortical gray matter and white matter and demonstrated that effective neurosurgical treatment for TN is associated with a reversal of specific nerve and brain abnormalities. In conclusion, this review highlights the advanced structural neuroimaging methods that are valuable tools to assess the trigeminal system in TN and may inform our current understanding of TN pathology. These methods may in the future have clinical utility for the development of neuroimaging-based biomarkers of TN.
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Affiliation(s)
- Danielle D DeSouza
- Department of Neurology and Neurological Sciences, Stanford University Stanford, CA, USA
| | - Mojgan Hodaie
- Division of Brain, Imaging and Behavior-Systems Neuroscience, Krembil Research Institute, University Health NetworkToronto, ON, Canada; Institute of Medical Science, University of TorontoToronto, ON, Canada; Division of Neurosurgery, Toronto Western Hospital and Department of Surgery, University of TorontoToronto, ON, Canada
| | - Karen D Davis
- Division of Brain, Imaging and Behavior-Systems Neuroscience, Krembil Research Institute, University Health NetworkToronto, ON, Canada; Institute of Medical Science, University of TorontoToronto, ON, Canada; Division of Neurosurgery, Toronto Western Hospital and Department of Surgery, University of TorontoToronto, ON, Canada
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13
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Docampo J, Gonzalez N, Muñoz A, Bravo F, Sarroca D, Morales C. Neurovascular study of the trigeminal nerve at 3 t MRI. Neuroradiol J 2015; 28:28-35. [PMID: 25924169 DOI: 10.15274/nrj-2014-10116] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study aimed to show a novel visualization method to investigate neurovascular compression of the trigeminal nerve (TN) using a volume-rendering fusion imaging technique of 3D fast imaging employing steady-state acquisition (3D FIESTA) and coregistered 3D time of flight MR angiography (3D TOF MRA) sequences, which we called "neurovascular study of the trigeminal nerve". We prospectively studied 30 patients with unilateral trigeminal neuralgia (TN) and 50 subjects without symptoms of TN (control group), on a 3 Tesla scanner. All patients were assessed using 3D FIESTA and 3D TOF MRA sequences centered on the pons, as well as a standard brain protocol including axial T1, T2, FLAIR and GRE sequences to exclude other pathologies that could cause TN. Post-contrast T1-weighted sequences were also performed. All cases showing arterial imprinting on the trigeminal nerve (n = 11) were identified on the ipsilateral side of the pain. No significant relationship was found between the presence of an artery in contact with the trigeminal nerve and TN. Eight cases were found showing arterial contact on the ipsilateral side of the pain and five cases of arterial contact on the contralateral side. The fusion imaging technique of 3D FIESTA and 3D TOF MRA sequences, combining the high anatomical detail provided by the 3D FIESTA sequence with the 3D TOF MRA sequence and its capacity to depict arterial structures, results in a tool that enables quick and efficient visualization and assessment of the relationship between the trigeminal nerve and the neighboring vascular structures.
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Affiliation(s)
- Jorge Docampo
- Magnetic Resonance Department, Fundación Científica del Sur; Lomas de Zamora, Argentina
| | - Nadia Gonzalez
- Magnetic Resonance Department, Fundación Científica del Sur; Lomas de Zamora, Argentina
| | - Alexandra Muñoz
- Magnetic Resonance Department, Fundación Científica del Sur; Lomas de Zamora, Argentina
| | - Fernando Bravo
- Dresden Music Cognition Laboratory, TU-Dresden, Dresden, Germany
| | - Daniel Sarroca
- Magnetic Resonance Department, Fundación Científica del Sur; Lomas de Zamora, Argentina
| | - Carlos Morales
- Magnetic Resonance Department, Fundación Científica del Sur; Lomas de Zamora, Argentina
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Masuda Y, Yamamoto T, Akutsu H, Shiigai M, Masumoto T, Ishikawa E, Matsuda M, Matsumura A. Usefulness of subtraction of 3D T2WI-DRIVE from contrast-enhanced 3D T1WI: preoperative evaluations of the neurovascular anatomy of patients with neurovascular compression syndrome. AJNR Am J Neuroradiol 2014; 36:317-22. [PMID: 25300986 DOI: 10.3174/ajnr.a4130] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution 3D MR cisternography techniques such as 3D T2WI-driven equilibrium radiofrequency reset pulse (DRIVE) are used preoperatively to assess neurovascular anatomy in patients with neurovascular compression syndrome, but contrast between vessels and cranial nerves at the point of neurovascular contact is limited. The postprocessing technique subtraction of 3D T2WI-driven equilibrium radiofrequency reset pulse from contrast-enhanced 3D T1WI (sDRICE) provides both high spatial resolution and excellent contrast in depicting the neurovascular contact. We evaluated the usefulness of sDRICE compared with 3D T2WI-DRIVE. MATERIALS AND METHODS Twelve patients who underwent microvascular decompression for hemifacial spasm or trigeminal neuralgia were examined preoperatively with 3D T2WI-DRIVE and sDRICE. Two neuroradiologists retrospectively analyzed and scored lesion conspicuity, defined as the ease of discrimination between offending vessels and compressed nerves or the brain stem at the neurovascular contact. They also quantitatively analyzed the contrast and contrast-to-noise ratio at the neurovascular contact. RESULTS The lesion conspicuity scores of sDRICE images were significantly higher than those of 3D T2WI-DRIVE for all 12 patients (P = .006) and the 6 cases of hemifacial spasm (P = .023) but were not significantly higher in the 6 trigeminal neuralgia cases alone (P = .102). For all 12 patients, the contrast-to-noise ratio between the offending vessels and the brain stem and between the vessels and nerves on sDRICE images was significantly higher than that on 3D T2WI-DRIVE (P = .003 and P = .007, respectively). Among these structures, the contrast values were also significantly higher on the sDRICE than on the 3D T2WI-DRIVE (P < .001) images. CONCLUSIONS The postprocessing technique sDRICE is useful to evaluate neurovascular anatomy and to improve contrast and the contrast-to-noise ratio in patients with neurovascular compression syndrome.
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Affiliation(s)
- Y Masuda
- From the Departments of Neurosurgery (Y.M., T.Y., H.A., E.I., M.M., A.M.)
| | - T Yamamoto
- From the Departments of Neurosurgery (Y.M., T.Y., H.A., E.I., M.M., A.M.)
| | - H Akutsu
- From the Departments of Neurosurgery (Y.M., T.Y., H.A., E.I., M.M., A.M.)
| | - M Shiigai
- Radiology (M.S., T.M.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Masumoto
- Radiology (M.S., T.M.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - E Ishikawa
- From the Departments of Neurosurgery (Y.M., T.Y., H.A., E.I., M.M., A.M.)
| | - M Matsuda
- From the Departments of Neurosurgery (Y.M., T.Y., H.A., E.I., M.M., A.M.)
| | - A Matsumura
- From the Departments of Neurosurgery (Y.M., T.Y., H.A., E.I., M.M., A.M.)
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Amagasaki K, Abe S, Watanabe S, Naemura K, Nakaguchi H. Trigeminal neuralgia caused by a trigeminocerebellar artery. J Neurosurg 2014; 121:940-3. [DOI: 10.3171/2014.6.jns132292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This 31-year-old woman presented with typical right trigeminal neuralgia caused by a trigeminocerebellar artery, manifesting as pain uncontrollable with medical treatment. Preoperative neuroimaging studies demonstrated that the offending artery had almost encircled the right trigeminal nerve. This finding was confirmed intraoperatively, and decompression was completed. The neuralgia resolved after the surgery; the patient had slight transient hypesthesia, which fully resolved within the 1st month after surgery. The neuroimaging and intraoperative findings showed that the offending artery directly branched from the upper part of the basilar artery and, after encircling and supplying tiny branches to the nerve root, maintained its diameter and coursed toward the rostral direction of the cerebellum, which indicated that the artery supplied both the trigeminal nerve and the cerebellum. The offending artery was identified as the trigeminocerebellar artery. This case of trigeminal neuralgia caused by a trigeminocerebellar artery indicates that this variant is important for a better understanding of the vasculature of the trigeminal nerve root.
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Affiliation(s)
| | - Shoko Abe
- 2Radiology, Mitsui Memorial Hospital, Tokyo, Japan
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Magnetic resonance imaging contribution for diagnosing symptomatic neurovascular contact in classical trigeminal neuralgia: A blinded case-control study and meta-analysis. Pain 2014; 155:1464-1471. [DOI: 10.1016/j.pain.2014.04.020] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/26/2014] [Accepted: 04/14/2014] [Indexed: 11/19/2022]
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Kawano Y, Maehara T, Ohno K. Validation and evaluation of the volumetric measurement of cerebellopontine angle cistern as a prognostic factor of microvascular decompression for primary trigeminal neuralgia. Acta Neurochir (Wien) 2014; 156:1173-9. [PMID: 24663436 DOI: 10.1007/s00701-014-2064-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to analyze the prognostic factors of trigeminal neuralgia (TN) after microvascular decompression (MVD), and to evaluate the volumetric parameters of the cerebellopontine angle (CPA) cistern as a pathogenic factor and imaging predictor. METHODS This retrospective study included 70 patients with primary TN treated with pure MVD, followed up for at least 1 year and evaluated by high-resolution MR imaging. The volume of the CPA cistern was calculated bilaterally, and the "Cistern Deviation Index" was defined to represent degree of deviation of the CPA cistern. Clinical data and volumetric parameters were compared between patients with TN and age- and sex-matched controls without TN, and between the recurrent and non-recurrent patients. RESULTS The transposition procedure had a better outcome than the interposition procedure (P < 0.001). There was a significant difference in the volume of CPA cistern between the affected and unaffected side (152.1 ± 50.1 vs. 179.9 ± 63.7 mm(3), P < 0.001) in patients with TN, while no significant difference between the right and left side (158.7 ± 44.6 vs. 163.1 ± 49.8 mm(3), P = 0.162) in controls. The Cistern Deviation Index was significantly larger in controls than in patients with TN (P = 0.048), and in the non-recurrent patients than in recurrent patients (P = 0.040). CONCLUSION We demonstrated that the volumetric parameters of the CPA cistern are a marker for understanding the pathogenesis of TN and useful for predicting the recurrence after MVD. The Cistern Deviation Index might contribute to deciding the surgical approach.
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Affiliation(s)
- Yoshihisa Kawano
- Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan,
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Etiologic exploration of magnetic resonance tomographic angiography negative trigeminal neuralgia. J Clin Neurosci 2014; 21:1349-54. [PMID: 24758727 DOI: 10.1016/j.jocn.2013.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 10/30/2013] [Accepted: 11/02/2013] [Indexed: 11/22/2022]
Abstract
Our objective was to explore the etiologic factors involved in trigeminal neuralgia with negative magnetic resonance tomographic angiography (MRTA) results. Clinical data from 341 patients with idiopathic trigeminal neuralgia who were treated with neurovascular decompression between March 2003 and December 2011 were retrospectively analyzed. The etiologic causes of preoperative MRTA-negative trigeminal neuralgia were categorized based on comparisons between preoperative MRTA and intraoperative endoscopic images. MRTA was highly sensitive (92.4%, 291/315) to neurovascular compression, whereas its specificity was 65.4% (17/26). Among the 24 false-negative cases, there were nine patients with petrosal vein compression, 12 with superior cerebellar artery compression, two with superior cerebellar arterial branch compression, and one patient with anterior inferior cerebellar artery compression. Among the 17 true-negative cases, three patients had arachnoid adhesions, one had a protruding temporal eminence, five had micro-cholesteatomas, and eight patients exhibited no compression. The factors responsible for the MRTA-negative results included small-diameter arterial vessels, veins with slow blood flow, arachnoid adhesions, protruding temporal eminences, micro-cholesteatomas, and other pathologies such as multiple sclerosis. Preoperative diagnoses of MRTA-negative patients need to integrate the MRI results from multiple sequences to discriminate between arteriolar compression, venous compression, and small compressive lesions. When narrow cerebellopontine angles are shown in MRTA, arachnoid adhesion and temporal eminence compression should be considered.
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Jo KW, Kong DS, Hong KS, Lee JA, Park K. Long-term prognostic factors for microvascular decompression for trigeminal neuralgia. J Clin Neurosci 2013; 20:440-5. [DOI: 10.1016/j.jocn.2012.03.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 03/06/2012] [Accepted: 03/10/2012] [Indexed: 10/27/2022]
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Focal deformity of the cranial nerves observed on multislice motion-sensitized driven equilibrium (MSDE) in patients with neurovascular compression. J Comput Assist Tomogr 2012; 36:121-4. [PMID: 22261781 DOI: 10.1097/rct.0b013e3182416f3b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Our purpose is to demonstrate the deformity of the cranial nerves by arterial compression using a novel technique, multislice motion-sensitized driven equilibrium (MSDE). METHODS Subjects were 10 patients with neurovascular compression (5 patients with trigeminal neuralgia and 5 patients with hemifacial spasm). We observed the existence and extent of deformity of nerves by MSDE. Afterward, we compared operative findings with preoperative imaging findings and evaluated the validity of the latter. RESULTS All compressing, blood vessels could be correctly identified through preoperative evaluation. Of all patients, 7 showed deformity of the cranial nerves, which was consistent with operative findings except in one case. In postoperative evaluation, patients' neurological symptoms improved and the deformity disappeared. Three patients did not show deformity on preoperative MSDE images. In these patients, neural compression was also not observed during the operation. CONCLUSIONS The deformity of cranial nerves in patients with neurovascular compression was clearly shown using MSDE.
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Trigeminal neuralgia: Assessment with T2 VISTA and FLAIR VISTA fusion imaging. Eur Radiol 2011; 21:2633-9. [DOI: 10.1007/s00330-011-2216-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 06/01/2011] [Accepted: 06/22/2011] [Indexed: 10/17/2022]
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Grasso G, Meli F, Maugeri R, Certo F, Costantino G, Giambartino F, Iacopino DG. Unusual recurrence of trigeminal neuralgia after microvascular decompression by muscle interposal. Med Sci Monit 2011; 17:CS43-6. [PMID: 21455112 PMCID: PMC3539511 DOI: 10.12659/msm.881703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression (MVD) typically undergo less invasive procedures in the hope of providing pain relief. However, re-operation should be considered in selected patients. CASE REPORT A 48-year-old woman presented with recurrent trigeminal neuralgia (TN) 3 years following microvascular decompression (MVD). The patient underwent brain magnetic resonance angiography (MRA), which did not reveal neurovascular compression; therefore surgical re-exploration was carried out. During the operation, the fifth cranial nerve was seen without impingement from any blood vessels; however, a very firm tissue was observed and identified as the muscle fragment from the previous MVD procedure. The fifth cranial nerve was carefully separated from the muscle. Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura. CONCLUSIONS Our findings, along with similar cases reported in the literature, support the development of new inert materials and alternative surgical strategies that can limit TN recurrence.
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Affiliation(s)
- Giovanni Grasso
- Neurosurgical Clinic, Department of Clinic Neurosciences, University of Palermo, Palermo, Italy.
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Du ZY, Gao X, Zhang XL, Wang ZQ, Tang WJ. Preoperative evaluation of neurovascular relationships for microvascular decompression in the cerebellopontine angle in a virtual reality environment. J Neurosurg 2010; 113:479-85. [DOI: 10.3171/2009.9.jns091012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this paper the authors' goal was to evaluate the feasibility and efficacy of a virtual reality (VR) system in preoperative planning for microvascular decompression (MVD) procedures treating idiopathic trigeminal neuralgia and hemifacial spasm. The system's role in surgical simulation and training was also assessed.
Methods
Between May 2008 and April 2009, the authors used the Dextroscope system to visualize the neurovascular complex and simulate MVD in the cerebellopontine angle in a VR environment in 16 patients (6 patients had trigeminal neuralgia and 10 had hemifacial spasm). Reconstructions were carried out 2–3 days before MVD. Images were printed in a red-blue stereoscopic format for teaching and discussion and were brought into the operating room to be compared with real-time intraoperative findings.
Results
The VR environment was a powerful aid for spatial understanding of the neurovascular relationship in MVD for operating surgeons and trainees. Through an initial series of comparison/confirmation experiences, the senior neurosurgeon became accustomed to the system. He could predict intraoperative problems and simulate surgical maneuvering, which increased his confidence in performing the procedure.
Conclusions
The Dextroscope system is an easy and rapid method to create a stereoscopic neurovascular model for MVD that is highly concordant with intraoperative findings. It effectively shortens the learning curve and adds to the surgeon's confidence.
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Affiliation(s)
| | | | | | | | - Wei-Jun Tang
- 2Radiology, Huashan Hospital of Fudan University, Shanghai, China
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El-Ghandour NM. Microvascular Decompression in the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Ectasia. Neurosurgery 2010; 67:330-7. [DOI: 10.1227/01.neu.0000371978.86528.60] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Vertebrobasilar ectasia (VBE) is a rare cause of trigeminal neuralgia (TN). It occurs in about 2% of all patients.
OBJECTIVE
This study reviewed the clinical features, radiological concomitants, and surgical findings of VBE and evaluate the microsurgical decompression procedure as a surgical line of treatment of the associated TN.
METHODS
Ten patients with TN caused by VBE and treated by microvascular decompression are the subject of this study. The study consisted of 6 men and 4 women with a mean age of 54 years. The mean duration of symptoms was 4.5 years. TN was the only symptom in 6 patients; it was associated with hemifacial spasm in 4. Arterial hypertension was present in 6 patients. Multiplanar high-resolution magnetic resonance imaging showed the accurate location and course of the ectatic vessel. Magnetic resonance angiography and digital subtraction angiography confirmed the diagnosis. Surgery demonstrated fifth nerve compression by an ectatic and tortuous vertebrobasilar artery in all cases and seventh nerve compression in 4 cases. Teflon felt was placed between the ectatic artery and compressed nerves.
RESULTS
There was complete resolution of TN in 8 patients (80%) and hemifacial spasm in 3 (75%) without medication. Four of 6 hypertensive patients (66.7%) achieved normotension without medication. There was no recurrence of symptoms in the mean follow-up period of 7.8 years.
CONCLUSION
Microvascular decompression is recommended for the treatment of TN caused by VBE if medical treatment has failed, if the patient is suitable for general anesthesia, and if there is evidence of vascular compression of the trigeminal nerve on magnetic resonance imaging.
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Süssmuth J, Protogerakis WD, Piazza A, Enders F, Naraghi R, Greiner G, Hastreiter P. Color-encoded distance visualization of cranial nerve-vessel contacts. Int J Comput Assist Radiol Surg 2010; 5:647-54. [PMID: 20383598 DOI: 10.1007/s11548-010-0410-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Visualization of pathological contact between cranial nerves and vascular structures at the surface of the brainstem is important for diagnosis and treatment of neurovascular compression (NVC) syndromes. We developed a method for improved visualization of this abnormality. METHODS Distance fields were computed using preoperative MRI scans of individuals with NVC syndromes to support the topological representation of brainstem surface structures with quantitative information. Polygonal models of arteries, cranial nerves and the brainstem were generated using segmented T2 weighted MR data. After color-coding the polygonal models with the respective distances, enhanced color visualization of vessel-nerve locations with possible contacts was achieved. RESULTS The proposed method was implemented and applied to surgical planning in a dozen cases of NVC syndrome. Two selected cases were chosen to demonstrate the feasibility and subjective improvement provided by our visualization technique. Expert neurosurgeons found the improvement valuable and useful for these cases. CONCLUSION Color-encoded distance information significantly improves the perceptibility of potential nerve-vessel contacts. This method contributes to a better understanding of the complex anatomical situation at the surface of the brainstem and assists in planning of surgery.
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