The neurovascular relationships in the trigeminal root entry zone were studied in 130 trigeminal root entry zones of 65 cadavers. No history of facial or trigeminal pain had been obtained during life in these subjects. The technique of intravascular injection, which allowed good visualization and evaluation of the neurovascular relationships, is described. A total of 42 examples of contact with the root entry zone and 10 examples of compression were identified. In 30 of the examples of contact, the finding could be related to an artery; in the other examples, it appeared to be due to veins. Of the arterial compressions, the superior cerebellar artery was responsible in 53.8%, the anterior inferior cerebellar artery was responsible in 25.6%, and pontine branches of the basilar artery were responsible for the remaining 20.6%. Only one instance of unequivocal compression by a vein was found. Other anatomical observations of interest are reported. The absence of a history of trigeminal neuralgia in the 7% of examined nerves in which root entry zone showed arterial compression is in marked contrast to the finding of 80% or more in the operative series for trigeminal neuralgia. It seems that vascular compressions may be the predominant but not the sole cause of trigeminal neuralgia.
The results of the treatment of trigeminal neuralgia by neurovascular decompression or partial sensory rhizotomy in a personal series of 220 patients are presented. Microvascular decompression was performed in 178 patients and partial sensory rhizotomy in 42. The mean follow-up was 5.2 years. Immediate pain relief was achieved in 94% of all patients, but the rate dropped to 84% during the follow-up period. The recurrence rate in the microvascular decompression group was 6% and in the PSR 49%. Permanent sequelae occurred in 4 patients (loss of hearing, 1; loss of corneal reflex, 1; lesion of the portio minor, 2), but transitory complications (impaired hearing caused by hematotympanum and diplopia) were more frequent, especially in the beginning of the series. Elderly patients tolerated the procedure very well and the percentage of complications was evenly distributed in all age groups. Three patients died. No patient developed painful dysesthesias or anesthesia dolorosa. There were no differences in the outcome, considering sex and age. The duration of symptoms did not influence the prognosis. Patients with severe compression did better than those with a mild one, and patients with an arterial compression did better than those with a venous one. Trigeminal neuralgia in multiple sclerosis is seldom relieved by microvascular decompression. The experience of the surgeon reduces the number of negative findings considerably.
A series of 330 consecutive patients with acute subdural haematomas has been selected to analyze the clinical signs which influence the outcome. To assure a uniformity, the material dates from before the CT era. Four main factors have been selected: age, pupillary changes, dynamics of the clinical development, and the state of consciousness. The importance and the characteristics of different factors are discussed. A simple grading system, which was used as a prognostic orientation guide, is presented. Finally, some prognostic conclusions are made.
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