Endoscopic vascular decompression in trigeminal neuralgia

Kher, Yatin; Yadav, Nishtha; Yadav, Yad Ram; Parihar, Vijay; Ratre, Shailendra; Bajaj, Jitin

doi:10.5137/1019-5149.jtn.17046-16.1

Cited by 9 publications

(7 citation statements)

References 42 publications

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“…[ 217 223 ] New nerve-vessel conflicts can be identified which may be missed by microscope in 7.5%–33% of patients. [ 225 226 227 228 ] It is safe,[ 218 229 230 231 232 ] requires less brain retraction[ 217 225 233 234 235 ] and associated with improved pain relief with lower complications as compared to MVD. [ 236 ] The vascular conflict is mostly distributed in the medial side on second division while it is in lateral area for third division in TN.…”

Section: Endoscopic Vascular Decompressionmentioning

confidence: 99%

Trigeminal neuralgia

Yadav

Pande

et al. 2017

Asian J Neurosurg

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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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Section: Endoscopic Vascular Decompressionmentioning

confidence: 99%

Trigeminal neuralgia

Yadav

Pande

et al. 2017

Asian J Neurosurg

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“…There was no mortality in our series; similar observations were made in other reported series as well. 17 The use of the endoscope in the posterior fossa, however, offers additional benefits to skull base surgeons. Once the surgeon becomes accustomed to the technique of operating with the endoscope using the view from the monitor, it opens up the possibility of operating with angled scopes, which may allow safe access to structures not previously seen using the standard operative microscope.…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of microscopic vascular decompression and endoscopic vascular decompression for trigeminal neuralgia: A clinical study

Khanuja¹,

Shekhawat²,

Sinha³

et al. 2020

IJN

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Aim: was to compare and evaluate microscopic vascular decompression and endoscopic vascular decompression for trigeminal neuralgia. Setting and Design: It is an observational study Materials and Methods: The present study was conducted in Department of Neurosurgery at SMS Medical College during November 2017-December 2019 among the patients with the diagnosis of medically refractory trigeminal neuralgia. Thirty three patients were recruited for the study, out of which 22 and 11 underwent MVD and EMVD respectively. Before the surgery parameters like age, gender, chief complaints, duration of symptom, side and number of involved branches were recorded. Patients with trigeminal neuralgia were managed by surgical exploration using a standard retrosigmoid approach. Patients were followed up at one and three months post-surgery. Outcomes were categorized into four groups: excellent, good, fair, and poor. Various complications and relive of symptoms were also recorded. Statistics: Difference between two groups was determined using chi square test and the level of significance was set at p < 0.05. Results: Excellent outcome was reported among 81.82% of the subjects in EMVD while it was found only in 59.09% of the subjects in MVD group. Poor outcome was revealed only in 4.55% of the subjects in MVD group with statistically insignificant difference. Conclusion: It can be concluded from the results of present study that endoscopic microvascular decompression is a safe, feasible and effective procedure for cure of trigeminal neuralgia.

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“…Thirumala et al [22] reported on 93 TN patients with different types of neuralgias and revealed the percentage of hearing loss accounted 30.84%. Kher et al [23] conducted a study on 178 patients with TN who underwent endoscopic microvascular decompression and found that only 11/178 of patients their pain relief was less than 75% and required pain medications, there was no death, temporary complications included trigeminal dysesthesia [3.9%], CSF leak, facial paresis, decreased hearing and vertigo in 5, 7, 3, 6 patients respectively. El-Garem et al [24] A study was done on 42 TN cases to evaluate the use of endoscopy in TN cases.…”

Section: Farid and Elkheshinmentioning

confidence: 99%

Evaluation of Endoscopic Microvascular Decompression for Trigeminal Neuralgia

Atiah

Ayad

Rabea

2022

International Journal of Medical Arts

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Article informationBackground: A severe, intermittent pain in the trigeminal nerve distribution area on one side of the face is known as trigeminal neuralgia. The primary pathophysiological cause of trigeminal neuralgia is neurovascular compression, which results in demyelination of the trigeminal nerve root in the cerebellopontine angle area. Endoscopes offer 360-degree views and bright lighting, making it much easier to spot and treat vascular conflicts than with conventional techniques. The Aim of the work:To evaluate the effectiveness of endoscopic microvascular decompression in patients with primary trigeminal neuralgia regarding pain control, recurrence rate and procedure-related complications. Patients and methods:The current study was applied on 12 patients with 1ry trigeminal neuralgia whom afforded to endoscopic micro-vascular decompression with mean age 59.1±9.54 years. All were submitted to clinical assessment through full history, clinical neurological examination, laboratory and imaging studies. The outcome was assessed by different scales, like visual analogue scale [VAS], pain intensity score of Barrow Neurological Institute [BNI], general and facial function scores. The follow up visits were scheduled directly after surgery, and at 3 and 6 months postoperatively. Results: The commonest affected vessel in the present study was superior cerebellar artery [SCA] [41.75%] then anterior inferior cerebellar artery [AICA] [16.7%]. Majority of patients use carbamazepine [66.7%], followed by gabapentin [58.3%]; 33% of the patients were on monotherapy and 66.7% were on combined therapy. There was significant progressive improvement of pain, general and facial function directly after surgery and till the end of follow up duration. The most common reported complication was transient unsteadiness [16.7%], with recurrence rate of 8.3% after 6 months. Conclusion: Endoscopic microvascular decompression for trigeminal neuralgia can have a promising result as regard relieving of pain with subsequent improvement of general and facial function scores with low frequency of complications and recurrence.

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Endoscopic vascular decompression in trigeminal neuralgia

Abstract: Endoscopic vascular decompression is a safe and effective technique for vascular decompression with advantages of better visualization of the entire course of the nerve and vascular conflict without brain retraction. It also helps in better detection of the completeness of surgery.

Cited by 9 publications

References 42 publications

Trigeminal neuralgia

Trigeminal neuralgia

Comparative evaluation of microscopic vascular decompression and endoscopic vascular decompression for trigeminal neuralgia: A clinical study

Evaluation of Endoscopic Microvascular Decompression for Trigeminal Neuralgia

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