Resection of the suprameatal tubercle in microvascular decompression for trigeminal neuralgia

Inoue, Tan; Goto, Yukihiro; Prasetya, Mustaqim; Fukushima, Takanori

doi:10.1007/s00701-020-04242-8

Cited by 8 publications

(20 citation statements)

References 11 publications

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“…This is an important consideration, as patients who had NVC in the MRI, in our practice, had a lower recurrence rate. However, it should be noted that even patients without identifiable NVC on the MRI could still appreciate complete resolution of symptomatology after surgical procedures 13,14 . Other negative factors that may influence recurrence are type II TN, disease duration, gender ( female), bilateral involvement and multiple sclerosis 15 .…”

Section: Discussionmentioning

confidence: 98%

“…Although vascular compression of the TN root entry zone is widely accepted as TN etiology, it fails to explain why some patients have TN without an identifiable NVC, as the main believed factor for proper decompression is the correct exposure of the root entrance zone 12,13 . This is an important consideration, as patients who had NVC in the MRI, in our practice, had a lower recurrence rate.…”

Section: Discussionmentioning

confidence: 99%

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Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study

Chaves

Oliveira

Francisco

et al. 2021

Arq. Neuro-Psiquiatr.

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Background: About 50% of patients that suffer from trigeminal neuralgia do not experience sustained benefit from the use of oral medication. For their adequate management, a few surgical procedures are available. Of these, percutaneous balloon compression (PBC) and microvascular decompression (MD) are two of the most performed worldwide. In this retrospective study, we present the outcomes of these techniques through estimation of initial pain relief and subsequent recurrence rate. Methods: Thirty-seven patients with medically refractory trigeminal pain surgically treated at Hospital Cajuru, Curitiba, Brazil, with PBC, MD or both between 2013 and 2018 were enrolled into this retrospective study. The post-procedural rate for pain relief and recurrence and associations between patient demographics and outcomes were analyzed. Results: MD had an earlier recurrence time than balloon compression. Of the 37 patients, the mean age was 61.6 years, approximately one third were male and most had type I neuralgia. The most affected branch was the maxillary (V2). The time for recurrence after surgery was on average 11.8 months for PBC and 9.0 months for MD. Complications were seen only with microsurgery. Conclusions: MD presented with a more precocious recurrence of pain than PBC in this article. Moreover, it had a higher recurrence rate than described in the literature as well, which is possibly explained by the type of graft (muscle) that was used to separate the neurovascular structures.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study

Chaves

Oliveira

Francisco

et al. 2021

Arq. Neuro-Psiquiatr.

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“…Drilling of suprameatal tubercle give access to Meckel's cave and posterior part of middle cranial fossa [ 13 ]. However, drilling of supameatal tubercle maybe necessary in cases of microvascular decompression of trigeminal nerve if heavily calcified and enlarged tubercle encountered to expose the entire length of trigeminal nerve, especially when the offending vessel is not visualized under the enlarged tubercle [ [14] , [15] , [16] ]. Inoue et al reported EST in 48 (10.4%) of 461 patients treated by microvascular decompression for TN and 8 patients had resection of the enlarged tubercle (7 operated via retrosigmoid approach and 1 via anterior transpetrosal approach).…”

Section: Discussionmentioning

confidence: 99%

“…Inoue et al reported EST in 48 (10.4%) of 461 patients treated by microvascular decompression for TN and 8 patients had resection of the enlarged tubercle (7 operated via retrosigmoid approach and 1 via anterior transpetrosal approach). In all of his cases, he encountered a vascular compression or impingement after drilling the EST [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Case report of unusual cause of trigeminal neuralgia: Trigeminal neuralgia secondary to enlarged suprameatal tubercle

Ibrahim

Muhsen

Najera

et al. 2021

Annals of Medicine &Amp; Surgery

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Background Classic trigeminal neuralgia (TN) is caused by vessels compressing the trigeminal nerve root entry zone. The cause is usually impingement of the superior cerebellar artery, anterior inferior cerebellar artery, or a vein. Other rare causes have been reported including aneurysmal compression, skull base tumors, and vascular malformations. An enlarged suprameatal tubercle (EST) as a cause of TN has not yet been described. Case presentation We report the first case of 37 year old female patient presented with severe TN involving the three branches of trigeminal nerve who failed medical treatment and underwent multiple balloon compression for left TN with minimal improvement. The severity of pain was assessed using Barrow Neurological Institute (BNI) pain intensity score. Patient had brain MRI with CISS sequence and CT scan for the brain. After careful revision of her imaging studies, patient found to have prominent and heavily calcified left supra meatal tubercle. Her preoperative BNI score was 5. Patient had left retrosigmoid craniotomy and drilling of left suprameatal tubercle. No other structures were seen in contact with left trigeminal nerve root entry zone. Patient had significant improvement on her pain, postoperative BNI score was 1 until the last follow-up 4 years. Conclusion EST is a rare cause of TGN and should be suspected as the offending compressing structure when no other causes seen on imaging studies.

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“…The pain resolution after MVD is expected in more than 76% of patients, even at 10 years following the surgery (7,8). Furthermore, improved surgical instruments and techniques had achieved even better pain control in the recent studies (9)(10)(11). This advancement has emphasized the integral role of a neurosurgeon in the management of TN.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Patients With Trigeminal Neuralgia Referred to the Indonesian National Brain Center Neurosurgery Clinic

et al. 2022

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Trigeminal neuralgia (TN) is a debilitating neuropathic pain involving the fifth cranial nerve. There has been no study investigating the clinical and socioeconomical characteristics of patients with TN in Indonesia. A total of 100 patients were included in this study. Symptoms indicating a later stage of the illness, namely, involvement of all the trigeminal nerve branches, numbness, and concomitant persistent pain, were the common presentations found in our cohort. Only one TN diagnosis was made by a general practitioner (GP). None were immediately referred to a neurosurgeon following their diagnosis. Access to our clinic took as long as 4.7 ± 5.1 years (mean ± SD) from the onset. Older age was a significant predictor of an increased likelihood of not knowing their illness upon the referral (21.9%, p = 0.008). Upon their first presentation, 25.5% of patients had experienced drug-related side effects due to prolonged medication. Only 50% of patients were compensated by the universal health coverage (UHC) system. Seven patients spent ≥ 50 million rupiahs and eight patients had already lost their jobs. In conclusion, early contact with a neurosurgeon contributes to better management of TN, both for the patients and healthcare system in Indonesia. A refined understanding of TN nature is still needed in this country.

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Resection of the suprameatal tubercle in microvascular decompression for trigeminal neuralgia

Cited by 8 publications

References 11 publications

Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study

Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study

Case report of unusual cause of trigeminal neuralgia: Trigeminal neuralgia secondary to enlarged suprameatal tubercle

Characteristics of Patients With Trigeminal Neuralgia Referred to the Indonesian National Brain Center Neurosurgery Clinic

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