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

Abstract

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.

Magnetic resonance imaging evaluation of masticatory muscle changes in patients with primary trigeminal neuralgia before microvascular decompression

“…The results demonstrated a marked increase in masticatory muscle atrophy in patients with PTN. Previous studies have reported that some patients with TN having signi cant pain on chewing have disuse atrophy of the muscles of mastication, which is consistent with the ndings of this study [3]. Furthermore, the number of patients with muscle edema in the PTN group was higher than that in the control group in this study, especially for the number of patients with edema of the lateral pterygoid muscle.…”

“…Three types of trigeminal neuralgia have been delineated: classical, secondary, and idiopathic. The classical type, which is the most common, is caused by neurovascular con ict (NVC) in the trigeminal nerve root entry zone (REZ) [1,3]. Unilateral masticatory muscle atrophy and edema tend to occur; these should be considered in the clinical assessment of the motor root of the trigeminal nerve [4].…”

Keyhole supraorbital eyebrow approach for fully endoscopic resection of tuberculum sellae meningioma

“…This method can adjust the depth and angle of the endoscope as the surgeon operates, and the assistant can achieve a better endoscope flexibly by handling the endoscope with both hands compared to the mechanical arm ( 30 , 31 ). Moreover, unlike the fixation arm, endoscopy can achieve “dynamic magnification” ( 32 , 33 ). The fulcrum of the assistant handling the endoscope.…”

Using RNA-Seq to Explore the Hub Genes in the Trigeminal Root Entry Zone of Rats by Compression Injury

“…At present, most people believe that primary TN is mainly caused by microvascular compression. Microvascular decompression and microballoon compression are commonly used in clinical treatment for primary TN (15,16); however, surgical strategy for TN patients also exhibited treatment failure or recurrence (17). Therefore, it is necessary to uncover the pathogenesis of TN at different levels to better treat this disease, including at the transcriptome level.…”