Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia, with particular attention to venous pathology

Sekula, Raymond F.; Frederickson, Andrew M.; Jannetta, Peter J.; Bhatia, Sanjay; Quigley, Matthew R.; Aziz, Khaled

doi:10.3171/2009.8.focus09156

Cited by 18 publications

(24 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In microvascular decompression for trigeminal neuralgia, these tributaries not only block access to the nerve but also may be the offending compressing vessel. 13,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] The transverse pontine veins have been found to be the most frequently compressing veins in trigeminal neuralgia. The veins of the middle cerebellar peduncle, cerebellopontine fissure, and the pontotrigeminal vein have also been reported to be the compressing vein.…”

Section: Superior Petrosal Veinsmentioning

confidence: 99%

“…The veins of the middle cerebellar peduncle, cerebellopontine fissure, and the pontotrigeminal vein have also been reported to be the compressing vein. 13,26,[30][31][32] It is best to try to preserve the superior petrosal veins before electing to sacrifice them to gain surgical access. In the retrosigmoid approach, the semiopaque outer arachnoidal membrane and the arachnoid trabeculae often obscure the superior petrosal veins and their tributaries during the early stages of the exposure.…”

Section: Superior Petrosal Veinsmentioning

confidence: 99%

See 1 more Smart Citation

Classification of the Superior Petrosal Veins and Sinus Based on Drainage Pattern

Matsushima

Kuga

et al. 2014

Operative Neurosurgery

View full text Add to dashboard Cite

The superior petrosal veins and their largest tributaries, especially the vein of the cerebellopontine fissure, should be preserved if possible. Obliteration of superior petrosal sinuses in which either the lateral or medial portion is absent may result in loss of the drainage pathway of the superior petrosal veins. Preoperative assessment of the superior petrosal sinus should be considered before transpetrosal surgery in which the superior petrosal sinus may be obliterated.

show abstract

Section: Superior Petrosal Veinsmentioning

confidence: 99%

Section: Superior Petrosal Veinsmentioning

confidence: 99%

Classification of the Superior Petrosal Veins and Sinus Based on Drainage Pattern

Matsushima

Kuga

et al. 2014

Operative Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Likewise, the type of vessel compression and the extension of its area of contact along the trigeminal root can also influence symptoms. While arterial compressions, especially at the REZ, are strongly associated with typical-TN, venous compressions usually extend for a larger area and are firmly attached to the trigeminal root (Dandy, 1934); consequently, the latter do not spare any particular group of fibers, and the symptoms are more associated with atypical-TN than with typical-TN (Roski et al, 1982;Sekula et al, 2009). Similar principles apply to the clinical outcome of surgical treatments available for TNP, based on their selective or non-selective harmful effects upon the local groups of trigeminal fibers, sensory and motor.…”

Section: Trigeminal Ganglion and Rootmentioning

confidence: 99%

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

DaSilva

DosSantos

2011

J Dent Res

View full text Add to dashboard Cite

A supplemental appendix to this article is published electronically only at http://jdr.sagepub.com/supplemental. AbstrActIn this study, we systematically investigated fiber demography, based on function and distribution, from the periphery to their destinations in the various central (sub) nuclei in the trigeminal brainstem nuclear sensory complex. Conventional and novel compelling information is provided, demonstrating that the ratio and somatotopy of types A and C sensory fibers at the site of a lesion can elucidate important puzzles in TNP disorders. For instance, we explain how of a major shift in the fibers' direction and ratio at the level of the trigeminal root entry zone (REZ) influences the pathophysiology of preand typical trigeminal neuralgia. As a result, there is a high A/C ratio of oral and peri-oral fibers in the supero-medial region of the REZ, which is mostly susceptible to vascular compression. However, this A/C ratio varies considerably at lower proportions in other areas along the peripheral trigeminal pathway, where an injury (viral, vessel compression, or trauma) can lead to a broader spectrum of fiber involvement and, consequently, pain outcome. In summary, we explain how fiber demography can influence pain quality, location, temporal features, progress, and treatment prognosis of TNP in those patients who develop it.

show abstract

“…11 While some authors argue that only arterial contact can cause the required pulsatile impact, others hypothesize that this phenomenon can also occur in patients with venous contact due to pulsatile flow that is propagated backward by the heart rate in the absence of intravenous valves. 2,34 Some authors even question the essential role of the pulsatile impact at all. 2,15,24,36 From the clinical perspective, TN-related symptoms do not differ between patients with arterial or venous neurovascular conflicts.…”

Section: 37mentioning

confidence: 99%

“…15,16,34 Currently, it is believed that pulsatile and repetitive mechanical irritations due to direct arterial contact are required and drive the morphological and functional alterations that result in TN: histopathological studies have demonstrated large demyelinated axons, 13,25 loss of axon quantity, 9 and abnormal remyelinization processes within the vulnerable sites of the affected nerve. 24,25 In agreement with these histological findings, neurosurgeons often describe the affected trigeminal nerve as flattened and edematous in situ.…”

Section: 37mentioning

confidence: 99%

Microstructural alterations in trigeminal neuralgia determined by diffusion tensor imaging are independent of symptom duration, severity, and type of neurovascular conflict

Lutz¹,

Thon²,

Stahl³

et al. 2016

JNS

View full text Add to dashboard Cite

T rigeminal neuralgia (TN) is characterized by recurrent episodes of intense and lancinating pain localized to the sensory supply areas of the fifth cranial nerve (CN V), which is also known as the trigeminal nerve. 11 The most frequent cause of TN is mechanical irritation of the nerve within a vulnerable zone that extents for about 4 to 5 mm from the point of transition from the peripheral (derived from Schwann cells) to the central myelin (derived from the oligodendroglia) (i.e., transition zone) to the most proximal aspect, where the nerve enters the pons (i.e., root entry zone [REZ]). 24,25,31,32 It is widely believed that direct arterial contact causes pulsatile, repetitive trauma that leads to focal axonal degeneration and demyelination processes within this vulnerable site. 9,13,25 These structural alterations facilitate ephaptic neurotransmissions that cause pain upon common triggers such as chewing or tactile sensations.11 Most frequently, neurovascular compression is caused by a direct anatomical relation with the superior cerebellar artery (SCA) (60%-90%), followed by the anterior inferior cerebellar aBBreViatiONS AD = axial diffusivity; ADC = apparent diffusion coefficient; AICA = anterior inferior cerebellar artery; CE = contrast enhanced; CN = cranial nerve; DTI = diffusion tensor imaging; FA = fractional anisotropy; FIESTA = fast imaging employing steady-state acquisition; MRA = MR angiography; MVD = microsurgical decompression; PICA = posterior inferior cerebellar artery; RD = radial diffusivity; REZ = root entry zone; ROI = region of interest; SCA = superior cerebellar artery; TN = trigeminal neuralgia. OBJectiVe In this prospective study diffusion tensor imaging (DTI) was used to evaluate the influence of clinical and anatomical parameters on structural alterations within the fifth cranial nerve in patients with trigeminal neuralgia (TN) due to neurovascular compression. methOdS Overall, 81 patients (40 men and 41 women; mean age 60 ± 5 years) with typical TN were included who underwent microsurgical decompression. Preoperative 3.0-T high-resolution MRI and DTI were analyzed in a blinded fashion. The respective fractional anisotropy (FA) and apparent diffusion coefficient values were compared with the clinical, imaging, and intraoperative data. This study was approved by the institutional review board, and written informed consent was obtained from all patients. reSultS DTI analyses revealed significantly lower FA values within the vulnerable zone of the affected trigeminal nerve compared with the contralateral side (p = 0.05). The DTI analyses also included 3 patients without clear evidence of neurovascular conflict on preoperative MRI. No differences were seen between arterial and venous compression. Lower FA values were found 5 months after symptom onset; however, no correlation was found with the duration of symptoms or severity of compression. cONcluSiONS DTI analysis allows the quantification of structural alterations, even in those patients without any discernible neurovascular contact o...

show abstract

Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia, with particular attention to venous pathology

Cited by 18 publications

References 24 publications

Classification of the Superior Petrosal Veins and Sinus Based on Drainage Pattern

Classification of the Superior Petrosal Veins and Sinus Based on Drainage Pattern

The Role of Sensory Fiber Demography in Trigeminal and Postherpetic Neuralgias

Microstructural alterations in trigeminal neuralgia determined by diffusion tensor imaging are independent of symptom duration, severity, and type of neurovascular conflict

Contact Info

Product

Resources

About