Operative Strategies for Minimizing Hearing Loss and Other Major Complications Associated with Microvascular Decompression for Trigeminal Neuralgia

Bond, A.E.; Zada, Gabriel; Gonzalez, Andres A.; Hansen, Christian Fugl; Giannotta, Steven L.

doi:10.1016/j.wneu.2010.05.001

Cited by 50 publications

(30 citation statements)

References 30 publications

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“…All MVDs utilized a key-hole microsurgical approach with the patient in either a supine or a park-bench position (3). An approach centered on the petrotentorial angle was used.…”

Section: Mvd Techniquementioning

confidence: 99%

Microvascular Decompression for Trigeminal Neuralgia in Patients with and without Prior Stereotactic Radiosurgery

Chen

2012

World Neurosurgery

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“…All MVDs utilized a key-hole microsurgical approach with the patient in either a supine or a park-bench position (3). An approach centered on the petrotentorial angle was used.…”

Section: Mvd Techniquementioning

confidence: 99%

Microvascular Decompression for Trigeminal Neuralgia in Patients with and without Prior Stereotactic Radiosurgery

Chen

2012

World Neurosurgery

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“…Experts in the field of MVD have recognized that once surgeons show proficiency in the technique, BAEPs monitoring can be withdrawn from "standard practice." 7,8,42,47 Moreover, IOM would cease after dural closure instead of continuing up to the time of stapling. For bed assignment cost, patients with an age ≤ 65 years, with no cardiorespiratory comorbidities, and with an intact neurological exam in the recovery room were transported directly to the regular ward.…”

Section: Cost-containment and Cost-reduction Initiativesmentioning

confidence: 99%

“…7,47 Masters in the field of MVD have acknowledged that experienced surgeons may revise the need for routine intraoperative BAEPs monitoring in MVD procedures for TN. 7,8,42,47 Bond and colleagues said, "In the future, shifts in the cost-benefit ratio . .…”

Section: Targeting Intraoperative Monitoring Costsmentioning

confidence: 99%

“…may favor evidence-based selected deployment of such techniques rather than rigidly designating them as a surgical 'standard of care.'" 7 Regarding the cost of IOM, detailing the electrode needle cost and actual monitoring cost revealed that the decrease in the average cost of monitoring (base test rates and hourly intraoperative monitoring cost; $1557 to $1263) was offset by the increase in the average electrode needle cost ($729 to $1028) noted from Group 1 to Group 3. This increase in the cost of needles is explained by the increase in the number of muscle groups monitored, an initiative from the IOM team in patients in Group 3.…”

Section: Targeting Intraoperative Monitoring Costsmentioning

confidence: 99%

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Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery

McLaughlin¹,

Upadhyaya²,

Buxey³

et al. 2014

JNS

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H ealtH care expenditures in the US continue to rise annually, faster than the national income. In 2010, health spending exceeded 17% of the nation's gross domestic product. 23,29 Numerous elements of national health reform are aimed at cost containment. Importantly, "bending the cost curve" refers most commonly to the government or insurers' payment to providers. However, reducing reimbursements does not decrease the cost of care delivery. The critical issue is how to deliver improved outcomes at the lowest cost and achieve the highest value of care. 41 Although health care providers have put significant effort into the quality and safety of care delivered in the past decade, little attention has been focused on cost measurement and even less on cost containment. This oversight stems from the fact that health systems, departments, and individual physicians misunderstand the costs related to the care they deliver.Early in 2009, the Department of Neurosurgery at our institution, aiming to improve the delivery of neurosurgical care, launched a Clinical Quality Program.2 Numerous improvement processes aimed at optimizing preoperative, intraoperative, and postoperative patient care were implemented by the third quarter of 2009. Previously, we assessed whether the multidisciplinary and multifaceted efforts instituted in 2009 succeeded in improving our delivery of value-based neurosurgery. 2,32 For that initial case study, patients undergoing microvascular decompression (MVD) performed by one neurosurgeon (N.A.M.) was the proposed model given that the surgical technique was standard, anticipated operative risks were relatively predictable, and perioperative care was relatively similar between cases. We documented a favorable impact from Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaObject. Care providers have put significant effort into optimizing patient safety and quality of care. Value, defined as meaningful outcomes achieved per dollar spent, is emerging as a promising framework to redesign health care. Scarce data exist regarding cost measurement and containment for episodes of neurosurgical care. The authors assessed how cost measurement and strategic containment could be used to optimize the value of delivered care after the implementation and maturation of quality improvement initiatives.Methods. A retrospective study of consecutive patients undergoing microvascular decompression was performed. Group 1 comprised patients treated prior to the implementation of quality improvement interventions, and Group 2 consisted of those treated after the implementation and maturation of quality improvement processes. A third group, Group 3, represented a contemporary group studied after the implementation of cost containment interventions targeting the three most expensive activities: pre-incision time in the operating room (OR) and total OR time, intraoperative neuromonitoring (IOM), and bed assignment (and overall length of stay [LOS]). The value of care was assessed for all...

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“…Microvascular decompression (MVD) surgery is a well established surgical procedure to relieve the compression of arteries or veins that cause trigeminal nerve neuralgia. Although the success rate of surgery was 73% to 86% [1][2][3][4] the incidence of postoperative hearing loss was found to be in the range of 0 to 23% [2,[5][6][7]. The types of post operative auditory morbidities include middle ear infections [8] sensorineural hearing loss [9] and retro cochlear pathology [10,11].…”

Section: Introductionmentioning

confidence: 99%

Auditory Neuropathy Findings Following Microvascular Decompression Surgery for Trigeminal Nerve Neuralgia: A Case Report

Durisala¹

2013

Int. J. Speech Lang. Pathol. Audiol.

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Microvascular decompression is an established surgical remedy in people suffering from trigeminal neuralgia. Hearing loss secondary to decompression surgeries have been reported in the literature but auditory neuropathy type was rare. Here we present an unusual report of a 35 year old female patient who manifested auditory neuropathy type hearing loss following microvascular decompression for trigeminal neuralgia in the right side. Pure tone audiometry revealed a low frequency hearing loss that returned to normal. Brainstem auditory evoked responses and acoustic reflexes were absent and otoacoustic emissions were present. This case study highlights that auditory neuropathy can also be one of the possible auditory morbidities due to microvascular decompression surgery and emphasizes the importance of intra-operative auditory brainstem monitoring.

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Operative Strategies for Minimizing Hearing Loss and Other Major Complications Associated with Microvascular Decompression for Trigeminal Neuralgia

Cited by 50 publications

References 30 publications

Microvascular Decompression for Trigeminal Neuralgia in Patients with and without Prior Stereotactic Radiosurgery

Microvascular Decompression for Trigeminal Neuralgia in Patients with and without Prior Stereotactic Radiosurgery

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery

Auditory Neuropathy Findings Following Microvascular Decompression Surgery for Trigeminal Nerve Neuralgia: A Case Report

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