Trigeminal neuralgia due to venous neurovascular conflicts: outcome after microvascular decompression in a series of 55 consecutive patients

Dumot, Chloé; Brînzeu, Andrei; Berthiller, Julien; Sindou, Marc

doi:10.1007/s00701-016-2994-y

Cited by 54 publications

(33 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4,8,10,15,17 The surgical outcome was good or excellent in 70.6%-100% of these patients, 4,8,10,11,15 and recurrence was observed in 0%-36.4% of them. 4,8,10,14 Compared to those with arterial compression, the patients with venous compression may have relatively less pain improvement and higher recurrence rates, although some have reported excellent outcomes in those with venous compression. 10 Venous compression is more frequently seen in patients with atypical (type 2) neuralgia than in those with typical (type 1) disease, 17 and surgical outcomes of patients with atypical disease are inferior to those of patients with typical neuralgia.…”

Section: Discussionmentioning

confidence: 91%

“…Although preserving the venous system may make the surgery slightly more complex, Dumot et al have reported a similar surgical strategy with excellent surgical results. 4 We can perform wide and complete surgical manipulations of the offending vessels, using multiple surgical corridors, and preserve the venous flow of the cerebellum and brainstem (Fig. 1H, Video 1).…”

Section: Discussionmentioning

confidence: 99%

“…4,8,10,11,15,17 This venous compression has been observed in 4.3%-25.7% of the patients with trigeminal neuralgia who underwent microvascular decompression surgery. 4,8,10,15,17 The surgical outcome was good or excellent in 70.6%-100% of these patients, 4,8,10,11,15 and recurrence was observed in 0%-36.4% of them. 4,8,10,14 Compared to those with arterial compression, the patients with venous compression may have relatively less pain improvement and higher recurrence rates, although some have reported excellent outcomes in those with venous compression.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of vascular compression was confirmed by vascular contact with mild indentation on the nerve root (indentation type), distortion of the nerve root (distortion type), or vascular groove on the nerve root (groove type). 4 Venous compression was resolved by moving the offending vein from the nerve root or by cutting it. The mobilized vessels were fixed to the dura mater or adjacent structures by using a small amount of fibrin glue and oxidized cellulose.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…This arachnoid dissection enables further dissection around the trigeminal nerve root to be performed safely. We also focus on the clinical importance of venous compression to the trigeminal 4,8,10,11,15,17 and facial nerve roots. 2,6,7 We summarize the cases with venous compression and their long-term outcomes after microvascular decompression surgery.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Toda

Iwasaki

Yoshimoto

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEIn microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm, the bridging veins are dissected to provide the surgical corridors, and the veins of the brainstem may be mobilized in cases of venous compression. Strategy and technique in dissecting these veins may affect the surgical outcome. The authors investigated solutions for minimizing venous complications and reviewed the outcome for venous decompression.METHODSThe authors retrospectively reviewed their surgical series of microvascular decompression for trigeminal neuralgia and hemifacial spasm in patients treated between 2005 and 2017. Surgical strategies included preservation of the superior petrosal vein and its tributaries, thorough dissection of the arachnoid sleeve that enveloped these veins, cutting of the inferior petrosal vein over the lower cranial nerves, and mobilization or cutting of the veins of the brainstem that compressed the nerve roots. The authors summarized the patient characteristics, operative findings, and postoperative outcomes according to the vascular compression types as follows: artery alone, artery and vein, and vein alone. They analyzed the data using chi-square and 1-way ANOVA tests.RESULTSThe cohort was composed of 121 patients with trigeminal neuralgia and 205 patients with hemifacial spasm. The superior petrosal vein and its tributaries were preserved with no serious complications in all patients with trigeminal neuralgia. Venous compression alone and arterial and venous compressions were observed in 4% and 22%, respectively, of the patients with trigeminal neuralgia, and in 1% and 2%, respectively, of those with hemifacial spasm (p < 0.0001). In patients with trigeminal neuralgia, 35% of those with artery and venous compressions and 80% of those with venous compression alone had atypical neuralgia (p = 0.015). The surgical cure and recurrence rates of trigeminal neuralgias with venous compression were 60% and 20%, respectively, and with arterial and venous compressions the rates were 92% and 12%, respectively (p < 0.0001, p = 0.04). In patients with hemifacial spasm who had arterial and venous compressions, their recurrence rate was 60%, and that was significantly higher compared to other compression types (p = 0.0008).CONCLUSIONSDissection of the arachnoid sleeve that envelops the superior petrosal vein may help to reduce venous complications in surgery for trigeminal neuralgia. Venous compression may correlate with worse prognosis even with thorough decompression, in both trigeminal neuralgia and hemifacial spasm.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Surgical Proceduresmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Toda

Iwasaki

Yoshimoto

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

Exploring biomarkers in trigeminal neuralgia patients operated with microvascular decompression: A comparison with multiple sclerosis patients and non‐neurological controls

Lafta,

Sokolov,

Landtblom

et al. 2023

European Journal of Pain

View full text Add to dashboard Cite

BackgroundTrigeminal neuralgia (TN) is a severe facial pain condition often associated with a neurovascular conflict. However, neuroinflammation has also been implicated in TN, as it frequently co‐occurs with multiple sclerosis (MS).MethodsWe analysed protein expression levels of TN patients compared to MS patients and controls. Proximity Extension Assay technology was used to analyse the levels of 92 proteins with the Multiplex Neuro‐Exploratory panel provided by SciLifeLab, Uppsala, Sweden. Serum and CSF samples were collected from TN patients before (n = 33 and n = 27, respectively) and after (n = 28 and n = 8, respectively) microvascular decompression surgery. Additionally, we included samples from MS patients (n = 20) and controls (n = 20) for comparison.ResultsIn both serum and CSF, several proteins were found increased in TN patients compared to either MS patients, controls, or both, including EIF4B, PTPN1, EREG, TBCB, PMVK, FKBP5, CD63, CRADD, BST2, CD302, CRIP2, CCL27, PPP3R1, WWP2, KLB, PLA2G10, TDGF1, SMOC1, RBKS, LTBP3, CLSTN1, NXPH1, SFRP1, HMOX2, and GGT5. The overall expression of the 92 proteins in postoperative TN samples seems to shift towards the levels of MS patients and controls in both serum and CSF, as compared to preoperative samples. Interestingly, there was no difference in protein levels between MS patients and controls.ConclusionsWe conclude that TN patients showed increased serum and CSF levels of specific proteins and that successful surgery normalizes these protein levels, highlighting its potential as an effective treatment. However, the similarity between MS and controls challenges the idea of shared pathophysiology with TN, suggesting distinct underlying mechanisms in these conditions.SignificanceThis study advances our understanding of trigeminal neuralgia (TN) and its association with multiple sclerosis (MS). By analysing 92 protein biomarkers, we identified distinctive molecular profiles in TN patients, shedding light on potential pathophysiological mechanisms. The observation that successful surgery normalizes many protein levels suggests a promising avenue for TN treatment. Furthermore, the contrasting protein patterns between TN and MS challenge prevailing assumptions of similarity between the two conditions and point to distinct pathophysiological mechanisms.

show abstract

Micro-Vascular Decompression (MVD) and Other Open Microsurgical Procedures for Trigeminal Neuralgias

Sindou

Brînzeu²

2023

Trigeminal Neuralgias: A Neurosurgical Illustrated Guide

View full text Add to dashboard Cite

Trigeminal neuralgia due to venous neurovascular conflicts: outcome after microvascular decompression in a series of 55 consecutive patients

Abstract: Venous NVC as a cause of TN is far from rare. MVD with complete liberation of the entire root in cases with clear-cut venous compression on imaging studies gives a good probability of long-term pain relief, thus encouraging to propose surgery for such patients.

Cited by 54 publications

References 30 publications

Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Exploring biomarkers in trigeminal neuralgia patients operated with microvascular decompression: A comparison with multiple sclerosis patients and non‐neurological controls

Micro-Vascular Decompression (MVD) and Other Open Microsurgical Procedures for Trigeminal Neuralgias

Contact Info

Product

Resources

About