Diagnosis and management for trigeminal neuralgia caused solely by venous compression

Inoue, Tan; Hirai, Hisao; Shima, Ayako; Suzuki, Fumio; Fukushima, Takanori; Matsuda, Masayuki

doi:10.1007/s00701-017-3085-4

Cited by 44 publications

(58 citation statements)

References 18 publications

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“…4,8,10,11,15,17 This venous compression has been observed in 4.3%-25.7% of the patients with trigeminal neuralgia who underwent microvascular decompression surgery. 4,8,10,15,17 The surgical outcome was good or excellent in 70.6%-100% of these patients, 4,8,10,11,15 and recurrence was observed in 0%-36.4% of them. 4,8,10,14 Compared to those with arterial compression, the patients with venous compression may have relatively less pain improvement and higher recurrence rates, although some have reported excellent outcomes in those with venous compression.…”

Section: Discussionmentioning

confidence: 99%

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Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Toda

Iwasaki

Yoshimoto

et al. 2018

Neurosurgical Focus

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OBJECTIVEIn microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm, the bridging veins are dissected to provide the surgical corridors, and the veins of the brainstem may be mobilized in cases of venous compression. Strategy and technique in dissecting these veins may affect the surgical outcome. The authors investigated solutions for minimizing venous complications and reviewed the outcome for venous decompression.METHODSThe authors retrospectively reviewed their surgical series of microvascular decompression for trigeminal neuralgia and hemifacial spasm in patients treated between 2005 and 2017. Surgical strategies included preservation of the superior petrosal vein and its tributaries, thorough dissection of the arachnoid sleeve that enveloped these veins, cutting of the inferior petrosal vein over the lower cranial nerves, and mobilization or cutting of the veins of the brainstem that compressed the nerve roots. The authors summarized the patient characteristics, operative findings, and postoperative outcomes according to the vascular compression types as follows: artery alone, artery and vein, and vein alone. They analyzed the data using chi-square and 1-way ANOVA tests.RESULTSThe cohort was composed of 121 patients with trigeminal neuralgia and 205 patients with hemifacial spasm. The superior petrosal vein and its tributaries were preserved with no serious complications in all patients with trigeminal neuralgia. Venous compression alone and arterial and venous compressions were observed in 4% and 22%, respectively, of the patients with trigeminal neuralgia, and in 1% and 2%, respectively, of those with hemifacial spasm (p < 0.0001). In patients with trigeminal neuralgia, 35% of those with artery and venous compressions and 80% of those with venous compression alone had atypical neuralgia (p = 0.015). The surgical cure and recurrence rates of trigeminal neuralgias with venous compression were 60% and 20%, respectively, and with arterial and venous compressions the rates were 92% and 12%, respectively (p < 0.0001, p = 0.04). In patients with hemifacial spasm who had arterial and venous compressions, their recurrence rate was 60%, and that was significantly higher compared to other compression types (p = 0.0008).CONCLUSIONSDissection of the arachnoid sleeve that envelops the superior petrosal vein may help to reduce venous complications in surgery for trigeminal neuralgia. Venous compression may correlate with worse prognosis even with thorough decompression, in both trigeminal neuralgia and hemifacial spasm.

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Section: Discussionmentioning

confidence: 99%

“…This arachnoid dissection enables further dissection around the trigeminal nerve root to be performed safely. We also focus on the clinical importance of venous compression to the trigeminal 4,8,10,11,15,17 and facial nerve roots. 2,6,7 We summarize the cases with venous compression and their long-term outcomes after microvascular decompression surgery.…”

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confidence: 99%

Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Toda

Iwasaki

Yoshimoto

et al. 2018

Neurosurgical Focus

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“…Microvascular decompression is the most common surgical treatment of TN 6 this surgery has the characteristic of small trauma, quick recovery, so it has been widely accepted by people worldwide. 7 With the promotion of MVD for a long time, more and more specialist hospitals have mastered the advanced treatment technology of TN, and more and more cases have been treated. In the early days of the MVD application, people were shocked by the subversive therapeutic effects of this technology.…”

Section: Discussionmentioning

confidence: 99%

A Study on the Recurrence Rate of Trigeminal Neuralgia after MVD and the Related Factors

Zheng

Sun

Zhang

et al. 2019

J Neurol Surg B Skull Base

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The aim of this article is to investigate the related factors affecting the recurrence of microvascular decompression (MVD) after trigeminal neuralgia. We selected 400 cases of patients who met the diagnostic criteria of primary trigeminal neuralgia. The recurrence rate of patients and their statistical data related factors such as age, gender, disease duration, pain branches, vascular compression, patients, and complications (urban and rural), were collected. Of the 400 cases, 36 had recurrence after 2 years. In female group, the recurrence rate was (9.4%) higher than the recurrence rate in male group (8%); no recurrence rate of vascular compression group (40%) was higher than that of vascular compression group recurrence rate (8.6%); the recurrence rate of each branch in pain group from high to low was V2–3 (13.4%), V2 (12.5%), V1 (9.1%), V3 (7.5%), V1–2-3 (4.4%), V1–2 (4.3%), V1–3 (0%); and the difference was statistically significant (p < 0.05).Gender of the patient, the presence of vascular pressure, and the branch of pain could significantly affect the postoperative recurrence rate of trigeminal neuralgia in patients treated with simple MVD (p < 0.05).

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“…Clinical outcomes can range from mild inconvenience to severe life disturbance due to pain and disfiguring from frequent muscle contractions (Yaltho & Jankovic, ). Treatments for HFS include analgesics, anticonvulsants, botulinum toxin injection to paralyze the facial muscles, and microvascular decompression (MVD) surgery to relieve the pressures on the facial nerve (Barker, Jannetta, Bissonette, Larkins, & Jho, ; Inoue et al, ; Li et al, ; Sindou, Leston, Decullier, & Chapuis, ).…”

Section: Introductionmentioning

confidence: 99%

“…Treatments for HFS include analgesics, anticonvulsants, botulinum toxin injection to paralyze the facial muscles, and microvascular decompression (MVD) surgery to relieve the pressures on the facial nerve (Barker, Jannetta, Bissonette, Larkins, & Jho, 1996;Inoue et al, 2017;Li et al, 2016;Sindou, Leston, Decullier, & Chapuis, 2007).…”

Section: Introductionmentioning

confidence: 99%

Microvascular decompression in patients with hemifacial spasm

et al. 2019

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PurposeTo study blood pressure alterations after microvascular decompression (MVD) surgery in patients with hemifacial spasm (HFS).MethodsA retrospective study was performed to review HFS patients who received MVD surgery between January 2014 and December 2016. Vessels that were considered to be responsible for HFS were determined by reviewing the brain magnetic resonance imaging, magnetic resonance angiography, and surgical video. Blood pressure measurements were performed 1 day before (preoperative) and 7 days after (postoperative) the MVD surgery. Pre‐ and postoperative blood pressure measurements were compared.ResultsA total of 374 patients were included in the study, with 118 (31.6%) male patients, age 53.8 ± 9.9 years old, and 141 (37.7%) patients with hypertension. Systolic blood pressure had statistically significant decrease in patients with (134.5 ± 8.2–132.6 ± 9.1 mmHg, p = .01) or without (125.6 ± 9.1–123.8 ± 10.0 mmHg, p = .01) hypertension. Diastolic blood pressure only had statistically significant decrease in patients with hypertension (83.0 ± 5.8–82.0 ± 6.5 mmHg, p = .04). Analyses in all the study patients and in the subgroup of patients with hypertension showed that more statistically significant blood pressure reductions were observed when left‐side vessel or vertebrobasilar artery was involved.ConclusionIn patients with HFS, MVD not only decreased blood pressure in patients with hypertension but also affected blood pressure in patients without hypertension. Blood pressure reductions were more prominent when left‐side vessel or vertebrobasilar artery was involved.

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Diagnosis and management for trigeminal neuralgia caused solely by venous compression

Abstract: Contrast-enhanced T1 SPGR imaging is crucial to detect small veins in the preoperative diagnosis. Division of the culprit veins is recommended if the diameter is smaller than the VCPF as it provides a better outcome and lower recurrence rate than transposition.

Cited by 44 publications

References 18 publications

Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

A Study on the Recurrence Rate of Trigeminal Neuralgia after MVD and the Related Factors

Microvascular decompression in patients with hemifacial spasm

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