Microvascular decompression for trigeminal neuralgia

Kolluri, Sastry; Heros, Roberto C.

doi:10.1016/0090-3019(84)90005-3

Cited by 130 publications

(60 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thirty of our 33 patients showed complete relief from their symptoms of neurovascular compression syndrome, a success rate similar to those in previous reports, 3,4,6,10,[13][14][15]29,32) suggesting that the Gore-Tex EPTFE patch is effective as a prosthesis for MVD. This prosthesis may have poor cushioning effects compared to Teflon felt or Ivaron sponge, but the sheets probably do absorb the compression at the exit or entry zone of the cranial nerve (Fig.…”

Section: Discussionsupporting

confidence: 74%

See 1 more Smart Citation

Microvascular Decompression of Cranial Nerves Using Sheets of a Dural Substitute-Technical Note-

Oiwa

Nakai

Takayama

et al. 2004

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Several types of prosthesis are used for microvascular decompression (MVD) surgery for neurovascular compression syndrome. However, most prostheses adhere to the surrounding neuronal structures and occasionally cause granulomas. The present study evaluated a dural substitute made of expanded polytetrafluoroethylene, the Gore-Tex EPTFE patch, as a prosthesis for MVD. Twelve patients with trigeminal neuralgia, 19 patients with hemifacial spasm (HFS), and two patients with glossopharyngeal neuralgia underwent MVD using the dural substitute. In most cases, one or two sheets of the dural substitute were inserted between the offending artery and the compression site covering the cranial nerve and the brainstem. Thirty of the 33 patients experienced complete relief of the symptoms that lasted for at least 10-75 months after the surgery. HFS recurred one month post-surgery in a patient who underwent MVD using two small sheets. Varied grades of hearing disturbance were observed in three patients with HFS. MVD using dural substitute is an easy and efficient method because it is not necessary to move the offending arteries away from the compression site. Large sheets should be positioned over the compression site for sufficient decompression. However, this technique needs to be improved so that the prosthesis does not affect cranial nerve VIII, as three of 19 patients with HFS showed hearing disturbances despite intraoperative monitoring of the auditory brainstem response.

show abstract

Section: Discussionsupporting

confidence: 74%

“…4,6,13,14) We observed no recurrences during follow ups of 13-70 months (mean 42.3 months), suggesting that the dural substitute continues to exert its shock-absorbing effect for a long time with little inflammatory reaction or granuloma formation that is considered to cause recurrence.…”

Section: Discussionmentioning

confidence: 85%

Microvascular Decompression of Cranial Nerves Using Sheets of a Dural Substitute-Technical Note-

Oiwa

Nakai

Takayama

et al. 2004

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

show abstract

“…Second, despite initially effective MVD, there is a steady rate of pain recurrence, which averages 4%-5% per year. [2][3][4]12,19,24,26,34 There is no consensus as to the etiology of pain recurrence in these cases.…”

mentioning

confidence: 99%

“…A review of the literature reveals that a wide range (4%-89%) of TN patients has no demonstrable vascular contact. [2][3][4]12,19,24,26,34 For example, Leal et al 26 reported no NVC in 9% of patients by surgical exploration, and imaging revealed no vessel in relation to the nerve in 12% of patients. There are also reports in which all patients have NVC.…”

mentioning

confidence: 99%

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

Lee¹,

McCartney²,

Burbidge³

et al. 2014

JNS

117

View full text Add to dashboard Cite

Object Vascular compression of the trigeminal nerve is the most common factor associated with the etiology of trigeminal neuralgia (TN). Microvascular decompression (MVD) has proven to be the most successful and durable surgical approach for this disorder. However, not all patients with TN manifest unequivocal neurovascular compression (NVC). Furthermore, over time patients with an initially successful MVD manifest a relentless rate of TN recurrence. Methods The authors performed a retrospective review of cases of TN Type 1 (TN1) or Type 2 (TN2) involving patients 18 years or older who underwent evaluation (and surgery when indicated) at Oregon Health & Science University between July 2006 and February 2013. Surgical and imaging findings were correlated. Results The review identified a total of 257 patients with TN (219 with TN1 and 38 with TN2) who underwent high-resolution MRI and MR angiography with 3D reconstruction of combined images using OsiriX. Imaging data revealed that the occurrence of TN1 and TN2 without NVC was 28.8% and 18.4%, respectively. A subgroup of 184 patients underwent surgical exploration. Imaging findings were highly correlated with surgical findings, with a sensitivity of 96% for TN1 and TN2 and a specificity of 90% for TN1 and 66% for TN2. Conclusions Magnetic resonance imaging detects NVC with a high degree of sensitivity. However, despite a diagnosis of TN1 or TN2, a significant number of patients have no NVC. Trigeminal neuralgia clearly occurs and recurs in the absence of NVC.

show abstract

“…Microvascular decompression (MVD) constitutes a curative treatment and is currerently the only etiologic-based therapy with the best associated outcomes. Although MVD is widely offered to younger patients, some neurosurgeons are reluctant to offer this to more elderly patients, primarily due to fear of complications and concerns over fitness for surgery 15,19) . The purpose of this study was to analyze our elderly population of patients to determine whether microvascular decompression treatment of hemifacial spasm in the elderly is safe and efficacious.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy and Safety of Microvascular Decompression for Hemifacial Spasm in Elderly Patients

Jeon

Kong

Lee

et al. 2010

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Objective : The purpose of this study was to examine the efficacy and safety of microvascular decompression (MVD) for hemifacial spasm (HFS) in elderly patients. Methods : Between 1997 and June 2008, 1,174 patients had undergone MVD for HFS at our institute. Among these, 53 patients were older than 65 years. We retrospectively reviewed and compared the complication and the cure rates of these patients with those of younger patients. Results : There were 38 females and 15 males. The mean duration of symptoms of HFS of these patients was 94.6 months (range, 12-360 months), compared with 67.2 months (range, 3-360 months) in the younger group. The overall cure rate in elderly patients who underwent MVD for HFS during this period was 96.2%. Permanent cranial nerve dysfunctions, such as hearing loss and facial palsy, were seen in 2 patients (3.8%, 2/53) in the elderly group and 19 patients (1.7%, 19/1121) in the younger group. The difference in permanent cranial nerve dysfunction between the two groups was not statistically significant. There was no operative mortality in either group. Conclusion : Microvascular decompression is the most effective surgical modality available for the treatment of HFS. Results of this study indicate that such technique can be performed in the elderly without higher rates of morbidity or mortality. Any patient with HFS, whose general health is acceptable for undergoing general anesthesia, should be considered as a candidate for MVD.

show abstract

Microvascular decompression for trigeminal neuralgia

Cited by 130 publications

References 11 publications

Microvascular Decompression of Cranial Nerves Using Sheets of a Dural Substitute-Technical Note-

Microvascular Decompression of Cranial Nerves Using Sheets of a Dural Substitute-Technical Note-

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

The Efficacy and Safety of Microvascular Decompression for Hemifacial Spasm in Elderly Patients

Contact Info

Product

Resources

About