Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve

Hardy, David G.; Rhoton, Albert L.

doi:10.3171/jns.1978.49.5.0669

Cited by 225 publications

(86 citation statements)

References 4 publications

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“…Moreover, NVC is a common finding in asymptomatic patients [59], in some TN patients it is contralateral to the pain [60] and, finally, many nerve roots are physiologically in contact with arteries and veins in the skull [61]. In order to make clear the concept of NVC and to study its pathogenetic role, the papers of Hardy and Rhoton [59] and Haines et al [58] are quoted. Hardy and Rhoton bilaterally examined the trigeminal roots in 25 corpses of subjects who never had TN.…”

Section: Is Mvd the Etiologic Treatment For Tn?mentioning

confidence: 99%

Choice of open or percutaneous procedures in the surgical treatment of trigeminal neuralgia

Orlandini¹

2002

J Headache Pain

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IntroductionTrigeminal neuralgia (TN) can be managed by medical and surgical treatment. Half of the patients are cured by drugs (particularly carbamazepine) without side effects, 25% are cured but have intolerable side effects and 25% are not cured [1]. Then, half of the patients require surgical treatment. When drugs become ineffective or not tolerated, the question of which intervention (percutaneous or open) is appropriate becomes an important issue. Among modern operations, three are percutaneous (trigeminal percutaneous Guido OrlandiniAbstract The aim of this study was to define criteria for the selection of patients for percutaneous or open operations for the cure of drug-resistant trigeminal neuralgia (TN). Trigeminal percutaneous radiofrequency thermorhizotomy (TPRT) has an established place because of its safety in elderly patients, while microvascular decompression (MVD) has appeal in younger patients because of its non-destructive nature and because it attacks what is believed to be the primary etiology of tic douloureux. Nevertheless, MVD is a successful operation only when true neurovascular conflict (NVC) is ascertained, rather than a simple arterial loop and neurovascular contact. Probably, many immediate failures and early relapses are the consequence of the inadequate patient selection for MVD on the presumption that this operation is in any case the ideal cure. The inadequate selection can be explained by the difficult preoperative diagnosis of NVC in the past.Indeed, angiography and computed tomography showed the neurovascular contact but not the size of compression. Fortunately, today magnetic resonance imaging is a reliable instrument to ascertain NVC. So, the diatribe between the supporters of percutaneous techniques and MVD can be concluded with the following: (1) percutaneous techniques are indicated for patients without demonstrated NVC (including patients with TN in multiple sclerosis) and in those with NVC if MVD is contraindicated by ill-health or refused by the informed patient; and (2) MVD is indicated for patients with ascertained NVC who are in good health and who, informed of the surgical risk, favor this operation desiring no sensory deficit.

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Section: Is Mvd the Etiologic Treatment For Tn?mentioning

confidence: 99%

Choice of open or percutaneous procedures in the surgical treatment of trigeminal neuralgia

Orlandini¹

2002

J Headache Pain

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“…The micro vascular compression theory failed to explain the well recognized group of patients in which there was no compressing vessel seen [13]. In addition, autopsy studies [14] showed a large number of previously asymptomatic patients who had blood vessels adjacent to their cranial nerves. There was also evidence on autopsy of bilateral nerve compression in 20% of cases [14] which is high when compared with the clinical incidence of bilateral trigeminal neuralgia in only 2% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, autopsy studies [14] showed a large number of previously asymptomatic patients who had blood vessels adjacent to their cranial nerves. There was also evidence on autopsy of bilateral nerve compression in 20% of cases [14] which is high when compared with the clinical incidence of bilateral trigeminal neuralgia in only 2% of cases. There is also the argument of what is to be considered a significant compression [1,13] and the dubious explanation of recurrence of symptoms by veins which were previously coagulated and divided collaterally [13].…”

Section: Discussionmentioning

confidence: 99%

The Treatment of Trigeminal Neuralgia by Micro Vascular Decompression and Partial Sensory Rhizotomy

1992

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A retrospective study was carried out on 60 cases that had microvascular decompression or partial rhizotomy for trigeminal neuralgia. There were 25 males and 35 females with a mean age of 59.5 years. The mean duration of symptoms prior to surgery was 6.9 years. Thirty seven cases (61.6%) had a previous ablative surgical procedure for the trigeminal neuralgia. In 42 cases (70%), there was evidence of arterial compression of the trigeminal root, venous compression in five cases (8.3%), and compression by a small meningioma in two cases (3.3%). There was no evidence of any compression in 11 cases (18.3%). There was no mortality. Minor morbidity was transient in 11.7%, and permanent in 3.3% of cases. The trigeminal neuralgia recurred within the first year after surgery in 8.3% of cases. 88.3% of the cases were pain-free or had minimal pain which did not require treatment. 11.7% continued to have pain which was controlled on drug therapy. There was a mean follow-up of 23 months. This form of surgical treatment has become the first line treatment in cases of trigeminal neuralgia which failed to respond to medical treatment. Decompression and Partial Sensory Rhizotomy. 1992; 12(1): 16-23 Trigeminal neuralgia (TN) is a painful condition that is treated by a variety of medical and surgical therapies but its etiology and optimum management remain controversial. Over the years, the majority of neurosurgical intervention methods had been ablative in nature and aimed at the distal portion of the trigeminal nerve. Percutaneous procedures at the gasserian ganglion by a radiofrequency lesion (RFL) or injection have been fairly popular. Recently, however, suboccipital micro-vascular decompression (MVD) has become popular as the treatment of choice in the management of TN. There has been a large number of papers reporting favorable results [1][2][3][4][5][6]. Nevertheless, there is still some doubt whether the vascular compression theory, originally proposed by Dandy [7], offers the perfect answer to the cause of TN. But, allowing for the continuing debate between the supporters and opponents of the MVD concept, this method of treatment has proved to be safe and effective. A Jamjoom, H Coakham, M Torrens, The Treatment of Trigeminal Neuralgia by Micro VascularThe technique of MVD for TN was adopted at Frenchay Hospital, United Kingdom in 1984. Prior to 1984 RFL was the most popular method of treatment. Over the next five years MVD became increasingly popular, and sixty cases were treated using this method. The results of surgery in these patients are reviewed in this report. It is appreciated that the number of cases in the series is modest when compared with the very large series reported in the literature [1,3,5,6]. However, the results represent the first experience of a unit in the technique of MVD and must be of interest to others who choose to adopt this operation in the treatment of TN. Recently, this technique has been carried out successfully on two patients at the King Khalid University Hospital in Riyadh, Saudi Ara...

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“…As III, IV, V Cranial nerves are closely related to SCA, variant origin of SCA may cause neurovascular compression syndrome.One of the trunks of duplicated SCA may compress the trigeminal nerve root and may cause neuralgia. Microsurgical relationship of SCA with V cranial nerve is important not only for trigeminal neuralgia, but also in possible injury of vessels during rhizotomy and other surgeries on V cranial nerve [14]. The variant origin of SCA can be explained on the developmental basis.…”

Section: Resultsmentioning

confidence: 99%

A Study of Variations in the Origin of Superior Cerebellar Artery and the Dimensions of Its Proximal Segment

Kalaiyarasi¹,

Chitra²

2018

IJAR

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Background: Since many clinical conditions affecting the brain stem are the results of vascular lesions, profound knowledge of vertebrobasilar circulation is of utmost clinical importance.Variations in the origin of superior cerebellar artery(SCA) are frequently observed and these may play an important role in neurovascular compression syndrome, as III,IV and V cranial nerves are closely related to SCA. Being one of the frequent locations for aneurysms of posterior circulation,variations of SCA should be considered prior to any diagnostic or therapeutic procedures in basilar tip region.

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Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve

Cited by 225 publications

References 4 publications

Choice of open or percutaneous procedures in the surgical treatment of trigeminal neuralgia

Choice of open or percutaneous procedures in the surgical treatment of trigeminal neuralgia

The Treatment of Trigeminal Neuralgia by Micro Vascular Decompression and Partial Sensory Rhizotomy

A Study of Variations in the Origin of Superior Cerebellar Artery and the Dimensions of Its Proximal Segment

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