Outcomes of microvascular decompression for trigeminal neuralgia with purely venous compression: A systematic review and meta-analysis

Soni, Pranay; Potter, Tamia; Soni, Payal P.; Estemalik, Emad; Recinos, Pablo F.; Kshettry, Varun R.

doi:10.1016/j.clineuro.2020.106230

Cited by 11 publications

(9 citation statements)

References 40 publications

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“…Our data showed that no post-operative complications (cerebellum or brainstem infarction or hemorrhage) were observed in cases with vein division. Literatures ( 24 , 27 ) and our data demonstrated that MVD for TNs caused by arterial NVC displayed better surgical effects in both short-term and long-term evaluations. However, a delayed cure more dominantly occurred in venous NVC cases in comparison with the arterial NVC group, which suggested that it should take a longer period to monitor pain relief in these patients after MVD surgery.…”

Section: Discussionsupporting

confidence: 61%

“…Although the wall of vein is thinner than that of artery, venous compression tends to be a chronic and gradual pathologic process, which usually results in a stronger demyelination damage of the trigeminal nerve ( 8 , 23 ). Therefore, MVD was still highly recommended for treatment of patients with TN caused by venous compression ( 6 , 24 ). As known to all, dissection of nerve root and offending veins is more difficult and likely to cause laceration and hemorrhage ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, coagulation and division of the involved veins provide a more satisfactory and complete decompression, but they may increase local venous pressure causing cerebellum or brainstem infarction or hemorrhage, resulting in fatal complications ( 5 , 7 , 12 , 13 , 26 ). Therefore, some neurosurgeons suggested that small offending veins could be cut off directly without being divided ( 5 , 6 , 24 ). In our series, we would like to emphasize firstly that the SPV complex is covered by the circle of arachnoid membrane, so that a sufficient dissection of arachnoid membrane is the most important.…”

Section: Discussionmentioning

confidence: 99%

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Comparative Analysis of Trigeminal Neuralgia Caused by Sole Arterial and Venous Compression: Clinical Features and Surgical Outcomes From 222 Cases

et al. 2021

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Background: Compared with trigeminal neuralgia (TN) caused by arterial neurovascular conflict (NVC), the clinical characteristics and managements for TN with venous NVC are not well-established. This study aims to comparatively summarize the clinical features and surgical outcomes of microvascular decompression (MVD) for patients with TN caused by sole arterial and venous compression, with a particular focus on the morphological features of posterior cranial fossa (PCF).Methods: A total of 222 patients with TN caused by sole arterial NVC (188/84.7%) and venous NVC (34/15.3%) underwent MVD in our department from January 2014 to December 2018. The patient data were analyzed retrospectively. Particularly, we focused on the potential impact of PCF on surgical outcomes.Results: Compared with arterial NVC, V3 branch of the trigeminal nerve was more frequently involved in venous NVC (p = 0.009). The most common compression site was root entry zone for arterial NVC (68.6%) and midcisternal segment for venous NVC (76.5%) (p < 0.001). No serious post-operative complication was observed in the two groups. Both short- and long-term outcomes were relatively worse in venous NVC cases compared with arterial NVC cases (p = 0.001 and p = 0.030, respectively); and a dominantly higher rate of delayed cure was demonstrated in venous NVC cases (p < 0.001). TN patients with venous NVC revealed a more flat-shaped PCF than those with arterial NVC. Moreover, flat-shaped PCF morphometry was negatively correlated with surgical outcomes of TN patients with arterial NVC, but not with those of venous NVC cases.Conclusions: MVD is an effective and safe treatment for patients with TN caused by either arterial or venous NVC. Patients with a more flat-shaped PCF might be vulnerable to venous compression. Our study demonstrated that PCF morphometry only affected the surgical outcomes of patients with TN caused by arterial NVC, but not the outcomes of those with venous NVC.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparative Analysis of Trigeminal Neuralgia Caused by Sole Arterial and Venous Compression: Clinical Features and Surgical Outcomes From 222 Cases

et al. 2021

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“…Our data support this fact. Pain recurrence rate of 12.2% in our group is little lower compared to the average value of 23.1% of the meta-analysis [18]. Yet, mean FU to pain recurrence is also lower compared to the mentioned study (43 to 51.4 months).…”

Section: Pain Relief and Recurrencecontrasting

confidence: 72%

“…Some studies report full pain resolution on FU of 60%, 67%, 69.6%, and 80% respectively [3,[6][7][8]. A meta-analysis was done by Soni et al about the outcome with purely venous compression [18]. Out of 19 studies they found a total BNI I (excellent) score of 75.6%.…”

Section: Pain Relief and Recurrencementioning

confidence: 99%

Purely venous compression in trigeminal neuralgia—can we predict the outcome of surgery

et al. 2022

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Purpose Controversies regarding venous compression and trigeminal neuralgia (TN) still exist. The study demonstrates our experience for microvascular decompression (MVD) in TN caused by purely venous compression. The goal was to identify prognostic anatomical or surgical factors that may influence the outcome. Methods Between 2004 and 2020, 49 patients were operated with purely venous compression. Average age was 58.4 years. Mean history of TN was 7.8 years. Microsurgical procedures included transposition or separation of the vein, coagulation, and division. Several features have been analyzed with respect to BNI scores. Results Evaluation on discharge revealed a complete pain relief in 39 (80%), partial improvement in 7 (14%), and no benefit in 3 (6%) patients. Facial hypesthesia was reported by 14 (28.6%) patients. Mean follow-up (FU) was 42.1 months. BNI pain intensity score on FU revealed 71.4% excellent to very good scores (score 1: 32 (65.3%); 2: 3 (6.1%)). BNI facial numbness score 2 could be detected in 13 patients (26.5%) during FU. There was no statistical relationship between immediate pain improvement or BNI pain intensity score on FU with respect to surgical procedure, size of trigeminal cistern, type of venous compression, venous caliber, trigeminal nerve indentation, or neurovascular adherence. BNI facial numbness score was dependent on type of venous compression (p < 0.05). Conclusion We did not find typical anatomical features that could either predict or influence the outcome regarding pain improvement or resolution in any form. Neither classic microvascular decompression (interposition/transposition) nor sacrificing the offending vein made any difference in outcome.

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The Principal Surgical Techniques for Microvascular Decompression: Surgical Treatment for Trigeminal Neuralgia

Park

2023

Trigeminal Neuralgia

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Outcomes of microvascular decompression for trigeminal neuralgia with purely venous compression: A systematic review and meta-analysis

Cited by 11 publications

References 40 publications

Comparative Analysis of Trigeminal Neuralgia Caused by Sole Arterial and Venous Compression: Clinical Features and Surgical Outcomes From 222 Cases

Comparative Analysis of Trigeminal Neuralgia Caused by Sole Arterial and Venous Compression: Clinical Features and Surgical Outcomes From 222 Cases

Purely venous compression in trigeminal neuralgia—can we predict the outcome of surgery

The Principal Surgical Techniques for Microvascular Decompression: Surgical Treatment for Trigeminal Neuralgia

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