Full Endoscopic Vascular Decompression in Trigeminal Neuralgia: Experience of 230 Patients

Dubey, Amitesh; Yadav, Nishtha; Ratre, Shailendra; Parihar, Vijay; Yadav, Yad Ram

doi:10.1016/j.wneu.2018.02.108

Cited by 28 publications

(22 citation statements)

References 33 publications

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“…In another study, Dubey et al reported no serious complications; 93.5% and 82.6% of patients had complete pain relief at 3 months and 5 years follow-up, respectively. 19 In the present study, we found that all 20 cases (100%) experienced pain relief. Furthermore, none of the patients experienced a recurrence of pain during a mean of (18 ±4.36) months of follow-up.…”

Section: Resultssupporting

confidence: 55%

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<p>Endoscopic Vascular Decompression for the Treatment of Trigeminal Neuralgia: Clinical Outcomes and Technical Note</p>

Sun

Wang

Cai

et al. 2020

JPR

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Purpose: Microvascular decompression (MVD) surgery is considered as an effective method with which to treat trigeminal neuralgia (TN). However, sometimes MVD surgery fails due to incomplete decompression of the responsible vessels caused by a poor visual field. In this study, we evaluated the benefits of endoscopic visualization and the value of full endoscopic vascular decompression (EVD) by describing the surgical results of 20 patients with TN after EVD. Patients and Methods: This was a retrospective study in a single institution of 20 patients with TN who received EVD between April 2018 and October 2019. All patients underwent EVD via the suboccipital retrosigmoid approach without microscopy at any stage. Abnormal muscle response (AMR) and brainstem auditory evoked potentials (BAEPs) were routinely monitored throughout the procedure. Follow-up was conducted by outpatient and telephone interviews. The degree of facial pain was graded using the Barrow Neurological Institute (BNI) pain intensity score; a BNI of 1 was considered as the best result while a BNI of 2 or 3 was considered as a satisfactory result. Follow-up time ranged from 8 to 24 months, with a mean of 18±4.36 months. Results: All 20 patients with severe preoperative pain (BNI of 5) achieved immediate relief or complete control of pain after surgery (BNI of 1 to 2). Vascular conflicts were observed during surgery in all of the patients. None of the patients experienced hearing loss, facial paralysis, intracranial infection, cerebrospinal fluid leakage, cerebral hemorrhage, or death, following the operation. Conclusion: When carried out by surgeons with endoscopic experience, EVD can provide a clear surgical field of view and reduce the risk of surgical injury. Our findings indicate that EVD is a safe and effective surgical method for the treatment of TN.

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Section: Resultssupporting

confidence: 55%

“…In another study, Dubey et al reported no serious complications; 93.5% and 82.6% of patients had complete pain relief at 3 months and 5 years follow-up, respectively. 19 …”

Section: Resultsmentioning

confidence: 99%

<p>Endoscopic Vascular Decompression for the Treatment of Trigeminal Neuralgia: Clinical Outcomes and Technical Note</p>

Sun

Wang

Cai

et al. 2020

JPR

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“…Coagulation of cerebellar-draining veins should also be avoided to prevent venous congestion and cerebellar edema. If the view through the veins is uncertain, adequate MVD can be controlled by using an endoscope [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Microvascular decompression in trigeminal neuralgia: predictors of pain relief, complication avoidance, and lessons learned

et al. 2021

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Objective To analyze characteristics associated with long-term pain relief after microvascular decompression (MVD) for trigeminal neuralgia (TGN). Description of associated morbidity and complication avoidance. Methods One hundred sixty-five patients with TGN underwent 171 MVD surgeries at the authors’ institution. Patient characteristics and magnetic resonance imaging (MRI) datasets were obtained through the hospital’s archiving system. Patients provided information about pre- and post-operative pain characteristics and neurologic outcome. Favorable outcome was defined as a Barrow Neurological Institute (BNI) pain intensity score of I to III with post-operative improvement of I grade. Results Type of TGN pain with purely paroxysmal pain (p = 0.0202*) and TGN classification with classical TGN (p = 0.0372*) were the only significant predictors for long-term pain relief. Immediate pain relief occurred in 90.6% of patients with a recurrence rate of 39.4% after 3.5 ± 4.6 years. MRI reporting of a neurovascular conflict had a low negative predictive value of 39.6%. Mortality was 0% with major complications observed in 8.2% of patients. Older age was associated with lower complication rates (p = 0.0009***). Re-MVD surgeries showed improved long-term pain relief in four out of five cases. Conclusions MVD is a safe and effective procedure even in the elderly. It has the unique potential to cure TGN if performed on a regular basis, and if key surgical steps are respected. Early MVD should be offered in case of medical treatment failure and paroxysmal pain symptoms. The presence of a neurovascular conflict on MRI is not mandatory. In case of recurrence, re-MVD is a good treatment option that should be discussed with patients. Highlights • Long-term analysis of pain relief after MVD. • Positive predictors for outcome: classical TGN and purely paroxysmal pain. • Presence of neurovascular conflict in MRI is not mandatory for MVD surgery. • Analysis of complications and surgical nuances for avoidance. • MVD is a safe procedure also in the elderly.

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“…Endoscopic procedures are increasingly used in spine and brain surgeries such as in hydrocephalus, 25 craniovertebral lesions, 26 colloid cyst, 27 Arnold Chiari malformation, 28 trigeminal neuralgia, 29,30 lumbar spine, 31,32 cervical spine, 33 deep-seated brain tumors, 34 laboratory training, 35 and spine tumors. 36 Endoscopic evacuation of CSDH was safe and effective in our series.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Chronic Subdural Hematoma

Yadav

Ratre

Parihar

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background Twist drill evacuation, burr hole aspiration, mini-craniotomy, and craniotomy are some of the surgical methods to remove chronic subdural hematoma (CSDH). Endoscopic treatment was also recently found to be useful. Methods We conducted a prospective study of 72 hematomas in 68 patients. Computed tomography was performed in all cases. Endoscopic surgery was performed in all CSDH patients. Surgical procedure A 4-cm skin incision was performed at the most curved part of skull with the CSDH. A mini-craniotomy or enlarged burr hole was made. The inner and outer table of the burr hole margin was drilled to provide a straight trajectory to the hematoma cavity. An endoscope supported by a telescope holder was used. A modified silicone brain retractor was used in five patients. A subgaleal drain was left in all patients for 3 to 5 days. Results There were 42 male and 26 female patients. The age ranged from 45 to 79 years (average: 69 years). All patients had a history of head trauma. Preoperative average Glasgow Coma Scale Score was 14. The procedure was effective in hematoma evacuation and a good visualization of the whole cavity in all patients. The endoscopic technique helped in complete hematoma removal in organized/solid clot, septations, and bridging vessels in 17, 2, and 2 cases, respectively. Duration of surgery ranged from 35 to 80 minutes. One death occurred. There was no recurrence, infection, fresh bleed, or injury to the brain or membrane. Conclusion The endoscopic technique is an effective alternative technique for treating CSDH. Although the study has limitations because of the small number of patients with a short follow-up, the study indicated that thick and vascular membranes, septations, and organized and solid clots can be removed effectively using this technique.

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Full Endoscopic Vascular Decompression in Trigeminal Neuralgia: Experience of 230 Patients

Cited by 28 publications

References 33 publications

<p>Endoscopic Vascular Decompression for the Treatment of Trigeminal Neuralgia: Clinical Outcomes and Technical Note</p>

<p>Endoscopic Vascular Decompression for the Treatment of Trigeminal Neuralgia: Clinical Outcomes and Technical Note</p>

Microvascular decompression in trigeminal neuralgia: predictors of pain relief, complication avoidance, and lessons learned

Endoscopic Management of Chronic Subdural Hematoma

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