Is There a Safe and Effective Way to Treat Trigeminal Neuralgia Associated with Vertebrobasilar Dolichoectasia? Presentation of 8 Cases and Literature Review

Vanaclocha, Vicente; Herrera, Juan Manuel; Martínez-Gómez, Deborah; Rivera-Paz, Marlon; Calabuig-Bayo, Cristina; Vanaclocha, Leyre

doi:10.1016/j.wneu.2016.08.085

Cited by 26 publications

(21 citation statements)

References 56 publications

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“…VBD, a rare arterial disease caused by vertebrobasilar tortuosity and expansion, can lead to obvious compression for the trigeminal nerve, which brings about the occurrence of TN. Some studies have reported that VBD-TN is more common in elderly male patients, usually on the left side, and tends to suffer from arterial hypertension [15,25,29,40,43]. In our study, the clinical baseline characteristics in the MVD and GKRS groups were consistent with those ndings.…”

Section: Discussionsupporting

confidence: 90%

Comparison of microvascular decompression and two isocenters gamma knife for the treatment of trigeminal neuralgia caused by vertebrobasilar compression

Zhao

Chai

Wang

et al. 2021

Preprint

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Objective: Vertebrobasilar dolichoectasia (VBD) is one of the uncommon causes of trigeminal neuralgia (TN). The main surgical treatments for TN caused by VBD (VBD-TN) are invasive microvascular decompression (MVD) and mini-invasive Gamma Knife radiosurgery (GKRS). However, the therapeutic effects of the two methods have not been clinically reported, so this study evaluated the outcomes of MVD and GKRS for patients with VBD-TN.Methods: The retrospective study of patients diagnosed with VBD-TN in Wuhan Union Hospital was performed from March 2011 to March 2019. A total of 80 patients were included in this study, and they were divided into the MVD group (n = 46) and GKRS group (n = 34) according to the surgical methods. Among patients in the GKRS group, all performed by two isocenters gamma knife. The imaging data, intraoperative findings, outcomes, and complications of the two groups were analyzed and compared.Results: Patients who underwent MVD were younger than patients who underwent GKRS (median ages were 61.1 and 65.4 years old, p=0.03). The average follow-up was 61.1 months for the MVD group and was 56.8 months for the GKRS group. The favorable outcomes (BNI score I-II) occurred in 97.8% of patients treated with MVD and in 78.9% of patients treated with GKRS (P=0.009). The favorable outcomes in the percentage of patients after MVD 1,3,5 and 7 years were 95.7%, 85.1%, 74.2%, and 74.2%. The corresponding percentages after GKRS were 76.5%, 66.2%, 56.6% and 47.2%, respectively (P=0.031). The postoperative complications (except facial numbness) in the MVD group were higher than those in the GKRS group (P=0.036), but the incidence of new and worsening facial numbness was higher in the GKRS group (P<0.001).Conclusions: For VBD-TN, MVD is superior to GKRS in obtaining and maintaining favorable outcomes, but it also comes with more complications other than facial sensation. Treatment choice can be tailored to a patient’s unique condition and wishes.

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Section: Discussionsupporting

confidence: 90%

Comparison of microvascular decompression and two isocenters gamma knife for the treatment of trigeminal neuralgia caused by vertebrobasilar compression

Zhao

Chai

Wang

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…VBD, a rare arterial disease caused by vertebrobasilar tortuosity and expansion, can lead to obvious compression for the trigeminal nerve, which brings about the occurrence of TN. Some studies have reported that VBD-TN is more common in elderly male patients, usually on the left side, and tends to suffer from arterial hypertension ( 13 , 19 – 22 ). In our study, the clinical characteristics in the MVD and GKRS groups were consistent with those findings.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Microvascular Decompression and Two Isocenters Gamma Knife for the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Dolichoectasia

et al. 2021

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Background: Vertebrobasilar dolichoectasia (VBD) is one of the rare causes of trigeminal neuralgia (TN). The common surgical treatments for patients with TN caused by VBD (VBD-TN) are microvascular decompression (MVD) and Gamma Knife radiosurgery (GKRS). However, the therapeutic effects of the two methods have not been clinically compared, so this study was performed to evaluate the treatment outcomes of MVD and GKRS for patients with VBD-TN.Methods: The retrospective study was performed from March 2011 to March 2019 in Wuhan Union Hospital. A total of 80 patients diagnosed with VBD-TN were included in this study, and they were divided into the MVD group (n = 46) and GKRS group (n = 34) according to the surgical methods. The imaging data, intraoperative findings, treatment outcomes, and complications of the two groups were analyzed and compared. Meanwhile, the influencing factors of the treatment effect are also explored on the two groups.Results: Patients who underwent MVD were younger than patients who underwent GKRS (median ages were 61.1 and 65.4 years old, respectively, p = 0.03). The median follow-up was 61.1 months for the MVD group and 56.8 months for the GKRS group. The favorable outcomes [Barrow Neurological Institute (BNI) pain score, BNI scores I–II] occurred in 97.8% of patients treated with MVD and in 78.9% of patients treated with GKRS (p = 0.009). The favorable outcomes in the percentage of patients after MVD 1, 3, 5, and 7 years were 95.7, 85.1, 74.2, and 74.2%, respectively, whereas the corresponding percentages after GKRS were 76.5, 66.2, 56.6, and 47.2%, respectively (p = 0.031). The postoperative complications (except facial numbness) in the MVD group were higher than those in the GKRS group (p = 0.036), but the incidence of new and worsening facial numbness was lower in the GKRS group (p < 0.001).Conclusions: MVD is superior to GKRS in obtaining and maintaining favorable outcomes for patients with VBD-TN, but it also comes with more complications other than facial numbness. Thus, the treatment program can be tailored to a patient's unique condition and wishes.

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“…The increased vascular tortuosity in elderly patients is more likely to develop stroke of lacunar infarction pattern or small vessel occlusive disease, carrying a high risk of neurologic decline [9,[17][18][19]. Compressive symptoms manifest when dolichoectatic vertebrobasilar arteries exert pressure on cranial nerve roots and deforms the brainstem [20][21][22][23][24]. Cranial neuropathies include ophthalmoplegia, nystagmus, hemifacial spasm, facial palsy, dizziness, tinnitus, hearing loss, dysarthria, trigeminal neuralgia [20][21][22] and/or diplopia [23].…”

Section: Introductionmentioning

confidence: 99%

“…Compressive symptoms manifest when dolichoectatic vertebrobasilar arteries exert pressure on cranial nerve roots and deforms the brainstem [20][21][22][23][24]. Cranial neuropathies include ophthalmoplegia, nystagmus, hemifacial spasm, facial palsy, dizziness, tinnitus, hearing loss, dysarthria, trigeminal neuralgia [20][21][22] and/or diplopia [23]. Cerebrospinal fluid (CSF) flow obstruction and hydrocephalus may occur when the basilar artery impinges on the third ventricle above the sellar diaphragm [25].…”

Section: Introductionmentioning

confidence: 99%

Melittin-loaded Iron Oxide Nanoparticles Prevent Intracranial Arterial Dolichoectasia Development through Inhibition of Macrophage-mediated Inflammation

Vu¹,

Huynh²,

Ryu³

et al. 2021

Int. J. Biol. Sci.

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Rationale: In intracranial arterial dolichoectasia (IADE) development, the feedback loop between inflammatory cytokines and macrophages involves TNF-α and NF-κB signaling pathways and leads to subsequent MMP-9 activation and extracellular matrix (ECM) degeneration. In this proof-of-concept study, melittin-loaded L-arginine-coated iron oxide nanoparticle (MeLioN) was proposed as the protective measure of IADE formation for this macrophage-mediated inflammation and ECM degeneration. Methods: IADE was created in 8-week-old C57BL/6J male mice by inducing hypertension and elastase injection into a basal cistern. Melittin was loaded on the surface of ION as a core-shell structure (hydrodynamic size, 202.4 nm; polydispersity index, 0.158). Treatment of MeLioN (2.5 mg/kg, five doses) started after the IADE induction, and the brain was harvested in the third week. In the healthy control, disease control, and MeLioN-treated group, the morphologic changes of the cerebral arterial wall were measured by diameter, thickness, and ECM composition. The expression level of MMP-9, CD68, MCP-1, TNF-α, and NF-κB was assessed from immunohistochemistry, polymerase chain reaction, and Western blot assay. Results: MeLioN prevented morphologic changes of cerebral arterial wall related to IADE formation by restoring ECM alterations and suppressing MMP-9 expression. MeLioN inhibited MCP-1 expression and reduced CD68-positive macrophage recruitments into cerebral arterial walls. MeLioN blocked TNF-α activation and NF-κB signaling pathway. In the Sylvian cistern, co-localization was found between the CD68-positive macrophage infiltrations and the MeLioN distributions detected on Prussian Blue and T2* gradient-echo MRI, suggesting the role of macrophage harboring MeLioN. Conclusions:The macrophage infiltration into the arterial wall plays a critical role in the MMP-9 secretion. MeLioN, designed for ION-mediated melittin delivery, effectively prevents IADE formation by suppressing macrophage-mediated inflammations and MMP activity. MeLioN can be a promising strategy preventing IADE development in high-risk populations.

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Is There a Safe and Effective Way to Treat Trigeminal Neuralgia Associated with Vertebrobasilar Dolichoectasia? Presentation of 8 Cases and Literature Review

Cited by 26 publications

References 56 publications

Comparison of microvascular decompression and two isocenters gamma knife for the treatment of trigeminal neuralgia caused by vertebrobasilar compression

Comparison of microvascular decompression and two isocenters gamma knife for the treatment of trigeminal neuralgia caused by vertebrobasilar compression

Comparison of Microvascular Decompression and Two Isocenters Gamma Knife for the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Dolichoectasia

Melittin-loaded Iron Oxide Nanoparticles Prevent Intracranial Arterial Dolichoectasia Development through Inhibition of Macrophage-mediated Inflammation

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