Operative findings in cases of trigeminal neuralgia without vascular compression: proposal of a different mechanism

Ishikawa, Masatsune; Nishi, Shogo; Aoki, Tomokazu; Takase, Takashi; Wada, Eiki; Ohwaki, Hisasataka; Katsuki, Takatoshi; Fukuda, Hitoshi

doi:10.1054/jocn.2001.0922

Cited by 84 publications

(38 citation statements)

References 7 publications

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“…Patients with severe vascular compression in the REZ region seem to have better results than those with mild compression, and those with venous compression generally had a worse outcome [40] . There are also reports of failure with MVD [11,23,25,31,38,40,45] . The reasons for this remain unclear; there has never been a scientific evaluation of this problem.…”

Section: Discussionmentioning

confidence: 99%

“…Ishikawa et al [23] proposed another explanation for TN without vascular compression. In 9 of 53 patients they found a tethering of the trigeminal nerve which leads to an abnormal stretching at the REZ causing root angulation and or torsion.…”

Section: Discussionmentioning

confidence: 99%

“…The existence of cases without vascular compression who were cured after MVD demonstrates this dilemma. The absence of vascular compression in TN is well known and has been described in the literature in 3-17% of the cases [23,40,41,43] . However, the underlying pathomechanisms as well as the recommended surgical strategies remain unclear.…”

Section: Introductionmentioning

confidence: 98%

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Microvascular Decompression in Trigeminal Neuralgia with No Vascular Compression

Baechli

Gratzl²

2007

Eur Surg Res

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Background: Microvascular decompression (MVD) is a well-known surgical procedure with one of the best long-term results in the therapy of trigeminal neuralgia. But the exact pathophysiology of this disease has not yet been elucidated. Cases with undetectable vascular compression who are cured after MVD make this dilemma clear. Autopsy studies have also shown vascular compression in asymptomatic cases. Methods:Five of 40 cases with TN treated with MVD in our clinic had no visible vascular compression. Diagnosis was made with MRI and MRA. Results: Surprisingly all of these 5 patients were cured with MVD. Two of them needed only one operation to become pain free and 3 a second operation. Conclusion: We think that the therapeutic effect of MVD is due to minimal trauma of the nerve. It seems that MVD is a good alternative strategy with low complication rates in comparison to ablative procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Microvascular Decompression in Trigeminal Neuralgia with No Vascular Compression

Baechli

Gratzl²

2007

Eur Surg Res

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“…The diagnosis of TN is clinical and is based on the patient's history, such as the trigger zone and unilateral lancinating paroxysms followed by refractory periods, and the exclusion of other causes of facial pain. Despite progress in neuroscience, the exact cause of TN has not been fully explained [2][3][4] . Initially, the treatment for TN should be pharmacological, but when this fails or is limited by significant side effects, surgical options are indicated.…”

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confidence: 99%

A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression

Campos

Linhares

2011

Arq. Neuro-Psiquiatr.

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Objective: Trigeminal neuralgia is the most common facial pain. It may be treated with percutaneous balloon compression (PBC), which is considered to be a safe and efficient procedure. The purpose of this study was to review our results with PBC and to assess the factors influencing the outcome. Method: A multivariate analysis was used to study 39 patients during a 50-month postoperative period. Results: There was predominance of the female gender (54%), the right side of the face (84%) and V2V3 roots of trigeminal nerve (33%). The mean age was 62.3 years. No major complications or deaths occurred. Among all variables, postoperative hypoesthesia was the single prognostic factor capable of positively influencing the results (p=0.02). Most patients (80%) were pain-free after 50 months with a 90% satisfaction rate. Conclusion: PBC was a safe procedure with low morbidity, no mortality, high approval ratings, and was an important improving on patients' quality of life. Key words: trigeminal neuralgia, facial hypoesthesia, percutaneous balloon compression, trigeminal nerve, facial neuralgia.Estudo prospectivo de 39 pacientes com neuralgia do trigêmeo tratados com compressão por balão percutâneo RESUMO Objetivo: A neuralgia do trigêmeo é a dor facial mais comum. Ela pode ser tratada através da compressão percutânea com balão, que é considerado procedimento seguro e eficaz. A proposta deste estudo foi avaliar nossos resultados e os fatores que influenciariam o seguimento. Método: Foi utilizada análise multivariada para estudar 39 pacientes submetidos ao procedimento, com seguimento de 50 meses. Resultados: Houve predominância do sexo feminino (54%), lado direito (84%) e dos ramos V2V3 (33%). A idade média foi de 62,3 anos. Não houve complicações maiores ou óbito. Dentre todas as variáveis, a única capaz de influenciar positivamente os resultados foi a hipoestesia pós-operatória (p=0,02). A maioria dos pacientes (80%) estava livre da dor após 50 meses de seguimento, com 90%

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“…This occurrence has been attributed to several causes, including new arterial loop compression, regrowth of new veins, incomplete decompression and problems related to the interposed material [6–8,15–17]. In addition, arachnoid thickening or granulomatous severe adhesion between the nerve and the surrounding structures following the first MVD surgery has been reported [18,19]. In up to 44% of patients no factor explaining the recurrence can be identified [20,21].…”

Section: Discussionmentioning

confidence: 99%

Unusual recurrence of trigeminal neuralgia after microvascular decompression by muscle interposal

et al. 2011

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SummaryBackgroundPatients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression (MVD) typically undergo less invasive procedures in the hope of providing pain relief. However, re-operation should be considered in selected patients.Case ReportA 48-year-old woman presented with recurrent trigeminal neuralgia (TN) 3 years following microvascular decompression (MVD). The patient underwent brain magnetic resonance angiography (MRA), which did not reveal neurovascular compression; therefore surgical re-exploration was carried out. During the operation, the fifth cranial nerve was seen without impingement from any blood vessels; however, a very firm tissue was observed and identified as the muscle fragment from the previous MVD procedure. The fifth cranial nerve was carefully separated from the muscle. Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura.ConclusionsOur findings, along with similar cases reported in the literature, support the development of new inert materials and alternative surgical strategies that can limit TN recurrence.

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Operative findings in cases of trigeminal neuralgia without vascular compression: proposal of a different mechanism

Cited by 84 publications

References 7 publications

Microvascular Decompression in Trigeminal Neuralgia with No Vascular Compression

Microvascular Decompression in Trigeminal Neuralgia with No Vascular Compression

A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression

Unusual recurrence of trigeminal neuralgia after microvascular decompression by muscle interposal

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