Teflon or Ivalon®: A Scoping Review of Implants Used in Microvascular Decompression for Trigeminal Neuralgia

Pressman, Elliot; Jha, R. Tushar; Zavadskiy, Gleb; Kumar, Jay I.; Peto, Ivo; Loveren, Harry van; Gompel, Jamie J. Van; Agazzi, Siviero

doi:10.1055/s-0040-1702679

30th Annual Meeting North American Skull Base Society 2020

DOI: 10.1055/s-0040-1702679

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Teflon or Ivalon®: A Scoping Review of Implants Used in Microvascular Decompression for Trigeminal Neuralgia

Elliot Pressman

R. Tushar Jha

Gleb Zavadskiy

et al.

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2022

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“…[1][2][3] MVDs require a suboccipital craniectomy or craniotomy, microsurgical dissection around the affected nerve, and placement of pledgets to separate offending, compressive arteries from the nerve. 4 Outcomes associated with MVDs are highly favorable. For example, with respect to trigeminal neuralgia, which has been described in the literature as one of the most debilitating orofacial pains, MVDs result in greater than 90% rates of initial freedom from pain.…”

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“…For example, with respect to trigeminal neuralgia, which has been described in the literature as one of the most debilitating orofacial pains, MVDs result in greater than 90% rates of initial freedom from pain. [4][5][6][7] Indeed, recent estimates report that 80% of patients who receive MVDs will remain pain-free at 1 year, 75% at 3 years, and 73% at 5 years. [6][7][8][9][10] Although serious complications after MVD are rare, opening of the posterior fossa presents the risk of postoperative cerebrospinal fluid (CSF) leak in approximately 5% of patients.…”

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Factors Predicting Cerebrospinal Fluid Leaks in Microvascular Decompressions: A Case Series of 1011 Patients

Materi

et al. 2022

Operative Neurosurgery

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BACKGROUND:Microvascular decompression (MVD) using a retrosigmoid approach is a highly effective, open-surgical procedure for neurovascular conflict in the posterior fossa, although there is a risk of postoperative cerebrospinal fluid (CSF) leak.OBJECTIVE:To identify factors associated with postoperative CSF leakage after MVD.METHODS:We retrospectively reviewed all patients who underwent MVDs at our institution from 2007 to 2020. Patient demographics, clinical diagnoses, and procedural characteristics were recorded and compared. Factors leading to CSF leak were analyzed using χ2, univariate, and multivariate regression.RESULTS:Of 1011 patients who underwent MVDs, 37 (3.7%) presented with postoperative CSF leaks. In univariate analysis, the use of Cranios/Norian to obliterate the air cells was protective against CSF leak (P = .01). Craniotomies (P = .002), the use of dural substitutes such as Durepair (P = .04), dural onlays such as DuraGen (P = .04), muscle/fascia (P = .03), and titanium mesh cranioplasty >5 cm (P = .03) were associated with CSF leak. On multivariate analysis, only the presence of craniotomies (P = .04) and nonprimary dural closure (P = .03) were significant risk factors for CSF leak. When excluding the 34 (3.4%) patients who underwent a craniotomy, the lack of primary dural closure still remained significantly associated with postoperative CSF leak (P = .04).CONCLUSION:Our results represent one of the largest series of posterior fossa surgeries for a uniform indication in North America. Our study demonstrates increased risk for postoperative CSF leak when craniotomies are performed and when primary dural closure is not established. Given the small sample of patients who received a craniotomy, however, future studies corroborating this finding should be performed.

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confidence: 99%

Factors Predicting Cerebrospinal Fluid Leaks in Microvascular Decompressions: A Case Series of 1011 Patients

Materi

et al. 2022

Operative Neurosurgery

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Teflon or Ivalon®: A Scoping Review of Implants Used in Microvascular Decompression for Trigeminal Neuralgia

Cited by 1 publication

References 0 publications

Factors Predicting Cerebrospinal Fluid Leaks in Microvascular Decompressions: A Case Series of 1011 Patients

Factors Predicting Cerebrospinal Fluid Leaks in Microvascular Decompressions: A Case Series of 1011 Patients

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