Microvascular decompression for cochlear symptoms

Okamura, Tomomi; Kurokawa, Yasushi; Ikeda, Norio; Abiko, Seisho; Ideguchi, Makoto; Watanabe, Kousaku; Kido, Toshishige

doi:10.3171/jns.2000.93.3.0421

Cited by 52 publications

(37 citation statements)

References 13 publications

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“…Sixteen patients were males and 14 were females, with an age range between 26 and 79 years and mean age of 57.0 years. Thirty patients (32 sides) underwent MVD by small retromastoid craniectomy [11]. One patient underwent bilateral surgery and one patient underwent reoperation.…”

Section: Surgical Resultsmentioning

confidence: 99%

“…Regarding vertigo, the study by Jannetta et al [2] on DVP is historical. There are several reports on the surgical results microvascular decompression (MVD) [3][4][5][6][7][8][9][10][11][12][13] for CNVC; however, surgical indications remain controversial. Therefore, the aim of the present study is to clarify surgical indications and the timing of surgery for CNVC.…”

Section: Introductionmentioning

confidence: 99%

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Indication and Timing of Surgery for Cochleovestibular Neurovascular Compression Syndrome

Okamura¹,

Takafumi²,

Ikeda³

et al. 2017

J Phonet and Audiol

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Objective: Optimal surgical indications for cochleovestibular neurovascular compression syndrome (CNVC) remain controversial. We examined the surgical indications and timing of surgery for CNVC. Methods: The surgical outcomes of 30 patients (32 sides) with vertigo, tinnitus and hearing loss were evaluated. CNVC was diagnosed according to five items for clinical features with a scoring system of 1 or 0 based on the following features: a history, neurological and otological findings, an ABR evaluation, and vascular contact with the eighth cranial nerve on MR or air CT imaging. Patients with scores of 4-5 were diagnosed with CNVC. In addition, three modulation types of tinnitus using median nerve stimulation were evaluated in CNVC (28 sides) and other diseases (12 sides), and classified as suppression (S-type), no change (N-type), and excitation (E-type). Results: At early time, results of 16 sides evaluated using the modulation test before surgery for CNVC, the relationship between modulation of tinnitus and surgical results was evaluated. The ratio of the tinnitus intensity early after the surgery to that before the surgery was significantly lower for the S-type than for the other two types (P<0.01). At one year follow-up, the results of 32 sides were excellent in 8 sides, good in 19 sides, fair in 2 sides and poor in 3 sides. The duration of preoperative symptoms in the excellent group (1.9 ± 6.7 years) was shorter than that in the good group (5.8 ± 5.8 years). Results of CNVC with a chief complaint of vertigo and the duration of symptoms over 15 years and CNVC with a chief complaint of tinnitus and the duration of symptoms over 3 years was not always satisfactory. Conclusion: Indications for good outcomes are limited and need to consider not only the duration of symptoms, but also the modulation of tinnitus. Our findings suggest that the timing of surgery for CNVC with a complaint of vertigo should be within about 15 years, but that for CNVC with tinnitus should be within 3 years of onset of symptoms. Furthermore, some patients with S-type of less than 6 years are good candidates for surgery.

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Section: Surgical Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Indication and Timing of Surgery for Cochleovestibular Neurovascular Compression Syndrome

Okamura¹,

Takafumi²,

Ikeda³

et al. 2017

J Phonet and Audiol

Self Cite

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“…The flow-related pathomechanism can either be due to increased or decreased flow. In increased flow, a slightly early venous filling can be present, which has been described as ʺmicroshuntsʺ (3,13). In their experience, an increased medullary blush is not considered to be a real shunt, but rather it demonstrates a rapid transit time because medullary veins are enlarged.…”

Section: Introductionmentioning

confidence: 99%

“…The etiology and mechanism of DVAs are unknown, but it is currently accepted that they act like a compensatory system of cerebral parenchyma venous drainage due to either early failure, abnormal development, or an intrauterine occlusion of normal small transcerebral veins (3). They may occur in as many as 2% of individuals (4).…”

Section: Introductionmentioning

confidence: 99%

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Medusa-like Atypical Intracerebral Vein: A Rare Case of Symptomatic Developmental Venous Anomaly

Ligha¹,

Rpbert²

2017

tnd

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Developmental venous anomaly (DVA) is an extreme variation of the normal transmedullary vein, which is necessary for the normal venous drainage of an area of the brain. It occurs in as many as 2% of individuals. In most cases, it is considered to be an incidental finding, however it can be symptomatic under very rare circumstances. The possible pathomechanism of symptomatic DVA is broadly divided into mechanical and flow-related. The flow-related pathomechanism accounts for the majority of cases. Susceptibility weighted magnetic resonance imaging study is the imaging modality of choice in all vascular anomalies because it can detect even very remote vascular abnormalities and its superiority over conventional imaging can never be over emphasized. Irrespective of the pathomechanism of DVA, conservative management remains the treatment of choice. This case of symptomatic DVA is presented to buttress the fact that though most symptomatic venous anomalies are associated with hemorrhage from cavernoma, in rare cases, symptoms may arise from DVAs that are not associated with other vascular malformations.Keywords: Developmental venous anomaly, susceptibility-weighted images, perfusion magnetic resonance imaging Gelişimsel venöz anomali (GVA) beynin bir bölgesinin normal venöz drenajı için gerekli olan normal transmedüller venin sıradışı bir varyasyonudur. Normal popülasyonda %2 oranında görülür. Çoğu olguda bu durum tesadüfi bir bulgu olarak gözlenmiştir, ancak çok nadir durumlarda semptomatik olabilir. Semptomatik GVA'nın muhtemel patomekanizması genel olarak mekanik ve akım ilişkili olarak ayrılmıştır. Olguların çoğunu akım ilişkili patomekanizma oluşturmaktadır. Manyetik rezonans incelemede 'susceptibility weighted imaging' sekansı tüm vasküler anomalilerde tercih edilen görüntüleme yöntemidir, çünkü çok uzak vasküler anormallikleri bile tespit edebilir ve konvansiyonel görüntülemeye göre üstünlüğü asla göz ardı edilemez. GVA'nın patomekanizması ne olursa olsun konservatif yaklaşım halen tercih edilen tedavi durumundadır. Bu semptomatik GVA olgusu, semptomatik venöz anormalliklerin çoğunun kavernoma bağlı kanama ile ilişkili olmasına rağmen, nadir durumlarda, diğer vasküler malformasyonlar ile ilişkili olmayan GVA'lara bağlı semptomların ortaya çıkabileceği gerçeğini desteklemek için sunulmuştur.

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