Microsurgical Vascular Decompression Research Articles

The preoperative evaluation value of 3D-slicer program before microsurgical vascular decompression in patients with hemifacial spasm

BackgroundTo compare the diagnostic accuracy of 3D fast imaging employing steady-state acquisition (FIESTA) combined with 3D-time-of-flight (TOF) MR angiography (MRA) sequences (FTMS) and 3D-reconstuction synthesized by 3D-slicer program in evaluation the neurovascular relationships and offending vessels preoperatively in patients with hemifacial spasm (HFS). MethodsClinical data of HFS patients who underwent microsurgical vascular decompression (MVD) were analyzed. All patients underwent MRA scans with FTMS and 3D-reconstruction before surgery. The neurovascular relationship and offending vessels were evaluated and compared with intraoperative findings. ResultsForty patients were included in this study, 18 (45%) of them were male. The mean age was 49.6 years. The Kappa identity tests identified the agreement between the FTMS and intraoperative findings in evaluating the neurovascular relationship and offending vessel was 0.263 and 0.643, respectively. The agreement between the 3D-reconstruction and intraoperative findings was 0.633 and 0.921 respectively. There was borderline significant difference between the two methods in predicting neurovascular relationship (χ2 = 9.363, P = 0.053), and there were significant differences between the two methods in predicting offending vessels (χ2 = 188.408, P < 0.001). The sensitivity and specificity of FTMS in evaluating the neurovascular relationship were 89.7% and 100%, respectively, while those with 3D-reconstruction were both 100%. Moreover, the correct 3D- reconstruction examinations in predicting vessel and nerve relationships (r = 0.634, P = 0.034) and offending vessels (r = 0.652, P = 0.028) were significantly correlated with completely symptoms remission. ConclusionsThe 3D-reconstuction synthesized by 3D-slicer program was more accurate than FTMS in preoperative evaluation of neurovascular relationship and offending vessel. The technique is expected to be helpful in preoperative evaluation. Availability of data and materialThe dataset used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Small Posterior Cranial Fossa and Cerebellopontine Cistern Volumes Are Associated With Bilateral Trigeminal Neuralgia.

Objective: To investigate whether small volumes of the posterior cranial fossa and cerebellopontine cisterns are associated with bilateral trigeminal neuralgia (BTN) and to provide further knowledge regarding the etiology and treatment of this rare disease.Methods: We retrospectively analyzed clinical data and imaging examination results for 30 BTN patients between January 2009 and December 2019. Thirty age- and sex-matched healthy individuals and 30 patients with unilateral trigeminal neuralgia (UTN) were selected as two control groups. The volume of the posterior cranial fossa (VPCF) and volumes of the cerebellopontine cisterns were measured using ITK-SNAP 3.0, which considers the cerebrospinal fluid (CSF) volume based on the region of interest (ROI). Preoperative and postoperative statuses were based on visual analog scale (VAS) pain scores and Barrow Neurological Institute (BNI) scores.Results: A total of 30 patients (11 males; 19 females) were included, and the age of the BTN participants ranged from 41 to 77 (59.93 ± 9.89) years. The duration of TN ranged from 1 to 20 (5.36 ± 3.92) years, and the interval between the two sides ranged from 0 to 3 (1.10 ± 0.79) years. Three patients (10%) in the BTN group had familial trigeminal neuralgia, with no other hereditary history of neurological disorders. In BTN patients, with 25 (83.3%) cases on the left side and 26 (86.7%) on the right side, veins were identified in the operative field and regarded as the individual or offending vessel. The mean VPCF was significantly lower in the patients with BTN than in the healthy controls (4,813 ± 1,155 mm3 vs. 5,127 ± 1,129 mm3, p = 0.008). The volumes of the cerebellopontine cisterns on both sides were significantly smaller in the BTN patients than in the healthy controls (477 ± 115 mm3 vs. 515 ± 112 mm3 on the left side, p = 0.001; and 481 ± 114 mm3 vs. 515 ± 110 mm3 on the right side, p = 0.007). There was no significant difference between the BTN group and the UTN group in terms of the VPCF (4,843 ± 1,184 mm3 vs. 4,813 ± 1,155 mm3, p = 0.402), and there was also no significant difference between the two groups in terms of preoperative VAS pain scores or BNI scores.Conclusion: Overcrowding in the posterior fossa will lead to closer neurovascular relations and, a higher incidence of NVC, and ultimately may be more likely to lead to TN. Veins are the common offending vessels that cause BTN; they might be associated with abnormal vascular development leading to NVC. Microsurgical vascular decompression (MVD) is a safe and effective method for the treatment of BTN, similar to UTN.

Efficacy of microsurgical vascular decompression in trigeminal neuralgia

ObjectivesAnalysis of the long-term efficacy of microvascular decompression surgery in trigeminal neuralgia. Material and methodsA single-center retrospective study included patients undergoing microvascular decompression surgery for trigeminal neuralgia after failure of well-conducted medical or complementary therapy, with visualization of nerve compression syndrome on MRI. ResultsEighty-seven patients were included. Nerve compression was alleviated without interposition of polytetrafluoroethylene in 79.3% of cases. Postoperative efficacy on pain was immediate in 97.7% of cases. There were no postoperative deaths, and the rate of severe complications was low (2.3%). The efficacy of microvascular decompression surgery was total at 2 years in 90.8% of cases and at 10 years in 92.3%, without resumption of medical treatment. The failure rate was 10.3%; 26.3% of these patients had been previously treated by a lesional technique (P: 0.043) and 33.3% by interposition of polytetrafluoroethylene (P: 0.003). ConclusionsWith confirmed clinical and radiological diagnosis, microvascular decompression surgery for trigeminal nerve compression was safe, with total effectiveness in the immediate, short and long terms. It should be considered in first line in case of failure or intolerance of well-conducted medical treatment.

Comparison of the Improvement Effect of MVD and Gamma Knife on Pain, Anxiety and Depression of Patients after Treatment of Primary Trigeminal Neuralgia

Objective: To explore the effects of microsurgical vascular decompression (MVD) and gamma knife respectively on the treatment of pain, anxiety and depression in patients with primary trigeminal neuralgia. Methods: From February 2011 to June 2017, we treated 108 patients with primary trigeminal neuralgia. According to the treatment plan of the patients, they were divided into an observation group and a control group, 54 cases each. The observation group underwent microsurgical vascular decompression (MVD) for the treatment of primary trigeminal neuralgia, while the control group received gamma knife treatment. The effects of pain, improvement of anxiety and depression were compared between two groups at 1 week, 3 months, and 6 months after treatment. Results: The pain, anxiety and depression scores of the observation group was significantly lower than that of the control group (P&lt;0.05). Conclusion: MVD can relieve patients' pain, anxiety and depression symptoms, as well as improve quality of life and restore self-confidence in life.

Quantitative Sensory Changes Following Gasserian Ganglion Radiofrequency Thermocoagulation in Patients with Medical Refractory Trigeminal Neuralgia: A Prospective Consecutive Case Series.

Microsurgical vascular nerve decompression and percutaneous ablative interventions aiming at the Gasserian ganglion are promising treatment modalities for patients with medical refractory trigeminal neuralgia (TN). Apart from clinical reports on a variable manifestation of facial hypoesthesia, the long-term impact of trigeminal ganglion radiofrequency thermocoagulation (RFT) on sensory characteristics has not yet been determined using quantitative methods. We performed standardized quantitative sensory testing according to the established protocol of the German Research Network on Neuropathic Pain in a cohort of patients with classical (n = 5) and secondary (n = 11) TN before and after percutaneous Gasserian ganglion RFT (mean follow-up: 6 months). The test battery included thermal detection and thermal pain thresholds as well as mechanical detection and mechanical pain sensitivity measures. Clinical improvement was also assessed by means of renowned pain intensity and impairment questionnaires (Short-Form McGill Pain Questionnaire, Pain Disability Index, and Pain Catastrophizing Scale), pain numeric rating scale, and anti-neuropathic medication reduction at follow-up. All clinical parameters developed favorably following percutaneous thermocoagulation. Only mechanical and vibration detection thresholds of the affected side of the face were located below the reference frame of the norm population before and after the procedure. Statistically significant persistent changes in quantitative sensory variables caused by the intervention could not be detected in our patient sample. Our data suggest that TN patients improving considerably after RFT do not undergo substantial long-term alterations regarding quantitative sensory perception.

LINAC stereotactic radiosurgery for trigeminal neuralgia \u2013retrospective two-institutional examination of treatment outcomes

BackgroundIn this pooled 2-center series LINAC radiosurgery (SRS) has been applied as a treatment option for a subset of refractory trigeminal neuralgia (TN) patients. This study approached to retrospectively assess the efficacy and safety of LINAC SRS and to provide a brief overview addressed to the technical development from frame-based towards frameless robotic SRS.MethodsFrom 2001 to 2017 n = 55 patients (pts) were treated, n = 28 were female (51%), mean age: 66 years (range 36–93 years); TN etiology: 37 classic TN, 15 multiple sclerosis (MS)-related TN, 2 symptomatic TN, and 1 atypical TN. Previous treatment was present in n = 35 (63.6%) pts. (some multiple or combined) with n = 23 microsurgical vascular decompression and n = 17 percutaneous retrogasserian rhizotomy. A 6 MV LINAC (4–5 mm collimators) was applied in all pts. (n = 26 framebased - n = 29 frameless robotic). The dorsal root entry zone (DREZ) was targeted in n = 35 cases and the retrogasserian target in n = 20 pts. with a homogeneous dose for the entire study cohort (90 Gy). SRS outcome was measured using the Barrow Neurological Institute (BNI) score for pain and hypaesthesia and statistically evaluated by univariate and multivariate analyzes.ResultsMean follow-up (FU) was 30 months (2 lost FU); the total rate of post SRS BNI pain I-IIIa (=painfree w or w/o medication) was 69% (88% for the classic TN pts), 29% (38.8% classic TN) were classified as BNI pain I-II (=painfree w/o medication). A BNI hypaesthesia II-III was present in 9.4% (n = 5) and BNI hypaesthesia IV in n = 2. Between groups analysis demonstrated no correlation of SRS responsiveness with age, gender, MS- or not MS-associated TN, previous surgery, framebased/frameless robotic SRS. DREZ targeting significantly better suppressed TN compared to RG targeting (p = 0.01). Additionally, a statistical trend for a better BNI pain outcome (p = 0.07) along with a significant increase in BNI hypaesthesia (p = 0.01) was found when using a larger partial trigeminal 70 Gy volume.ConclusionOur retrospective analysis support LINAC SRS as an effective and safe treatment option in TN. Frameless robotic SRS of TN is safe when using a dedicated LINAC system. A target definition closer to the brainstem and tendencially a larger target volume were associated with a better outcome for pain.

Is there a place for microsurgical vascular decompression of the brainstem for apparent essential blood hypertension? a review.

There are anatomical and physiological evidences that the ventrolateral (VL) region of the medulla plays an important role in blood pressure regulation and that dysfunction at this level may generate hypertension (HT). Vascular compression by a megadolicho-artery from the vertebrobasilar arterial system at the root entry/exit zone (REZ) of the glossopharyngeal (IXth) and vagal (Xth) cranial nerves (CNs) and the adjacent VL aspect of the medulla has been postulated as a causal factor for HT from neurogenic origin. The first attempts at microvascular decompression (MVD) of the IX-Xth CNs together with the neighbouring VL brainstem was revealed promising. These surgical attempts, as well as the numerous MRI studies, with the goal to detect and identify likely responsible neurovascular conflicts (NVC), are reviewed. Established criteria for indication of MVD as an aetiological treatment of apparent essential HT are still needed.

Séquences IRM pour la détection des conflits vasculonerveux à l’origine de la névralgie trigéminale et leur valeur prédictive pour la caractérisation du conflit (en particulier le degré de la compression vasculaire)

Background and purpose A long-term study of the results on trigeminal neuralgia (TN) after microsurgical vascular decompression (Kaplan-Meier curves at 20 years) showed that cure was achieved in 88.1 % of the patients with a neurovascular compression (NVC) producing a large groove on the nerve (Grade III), 78.3 % of the patients with a NVC with nerve distortion or displacement (Grade II), and 58.3 % of the patients with a NVC with simple contact on the nerve (Grade I). Therefore, preoperative visualization of the NVC by MRI and determination of its grading are important for the therapeutic decision. In this study, we investigated the predictive value of MRI for detecting and assessing the degree of vascular compression in trigeminal neuralgia. Methods The study included 91 consecutive patients with a preoperative MRI (1.5 Testa) using 3D T2-weighted and angio–MR–TOF. NVC prediction and the degree of compression made by an independent observer were correlated with surgical data. Results Eighty of the 91 patients had a NVC on MRI, but 83 (91.2 %) patients showed a NVC at surgical exploration (eight patients had no NCV). Thus, the sensitivity of imaging in detecting a NVC on the symptomatic nerves was 96 % (80/83) and the specificity 100 % (8/8). In addition, imaging analysis predicted the responsible vessel in 88.7 % (71/80) of the cases and characterized the degree of NVC in 85 % (68/80). The Kappa-coefficient (KC) for prediction of the NVC degree was 0.795 for arterial and venous compressions together ( p < 0.01; 95 % confidence interval, 0.71–0.88). The CK was 0.758 ( p < 0.01, good agreement) for grade I, 0.787 ( p < 0.01, good agreement) for grade II and 0.824 ( p < 0.01, excellent agreement) for grade III. Conclusions High-resolution 3D T2-weighted imaging in combination with angio–MR–TOF is a reliable technique for detecting NVC and predicting the degree of the compression in NVC.

Microvascular decompression for the treatment of hemifacial spasm. Retrospective study of a consecutive series of 75 operated patients--electrophysiologic and anatomical surgical analysis.

The authors report the results of a series of 75 patients operated on for hemifacial spasm by the same surgeon between October 1981 and January 1997. Microsurgical vascular decompression was performed through a retromastoid approach in contralateral position. The conflicting vessel was identified as the posterior inferior cerebellar artery in 41.3% of the cases, the anterior inferior artery in 38.6%, and the vertebrobasilar complex in 18.7%. Follow-up varied from 1 month to 13 years (with a mean duration of 5 years and 2 months). The outcome was excellent (total improvement) in 57 cases, good (> 75% improvement) in 11 cases, fair (< 75%) in 4 cases and poor in 3 cases. Neurological complications included deafness or hearing loss in 3 cases (2 occurred in the absence of intraoperative monitoring and the other during the first part of the series) and facial paralysis in 1 case. Brainstem auditory evoked potential (BAEP) intraoperative monitoring should be performed to avoid postoperative auditory complications; a marked auditory loss was observed in only 1.6% of the 60 patients of our series who underwent BAEP intraoperative monitoring.

Anatomical findings in microsurgical vascular decompression for trigeminal neuralgia. Correlations between topography of pain and site of the neuro-vascular conflict.

We here report on the anatomical findings in a series of 350 patients with trigeminal neuralgia (TN) and operated on using a microsurgical key-hole approach to the CPA. In 5.7% there was a tumour or a vascular malformation, in 2.3% a mega-vertebro-basilar-artery. Among the remaining 322 (= real idiopathic TN), only 3.1% had no visible compressive factor, whilst 96.9% had one (or several) conflicting vessel(s): SCA in 90%, AICA in 23.6%, a vein in 24.7%. In 35.7% of the patients, several neurovascular conflicts (NVC) were found. Beside the NVC(s), a global atrophy of the entire root was seen in 67% of the cases. Degree of severity of the NVC and its site along the root were studied. The site of the conflict was: anteriorly to the root when pain was in V1, anteriorly and superiorly when in V2, superiorly and posteriorly when in V3.

Outcome following microsurgical vascular decompression or partial sensory rhizotomy in 125 cases of trigeminal neuralgia.

Microsurgical vascular decompression (MVD) was used for 92 patients with trigeminal root entry zone (REZ) compression. In 2 patients, abnormal nerve roots were sectioned; 5 had extra-axial tumors, and 26 with no apparent REZ pathology had partial sensory rhizotomy (PSR). Mean follow-up was 26 months; 105 patients, including those with tumors, are pain-free. Nine have infrequent discomfort, requiring no medication. Eleven patients had recurrence, 9 within 1 year; 4 on medication and 3 after reoperation are pain-free. Complications were few. No patient died. Although PSR and MVD had equal efficacy, MVD is favored to relieve trigeminal neuralgia without sensory loss.

Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm

Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm

Microsurgical vascular decompression of cranial nerves

Vascular compression of the fifth and seventh cranial nerves is considered the cause of tic douloureux and hemifacial spasm. Therefore, these conditions are best treated by microvascular decompression. Success with these disorders has encouraged neurosurgeons to consider vascular compression the cause of other idiopathic cranial nerve syndromes.

TONIC AND REFLEX FUNCTIONS OF MEDULLARY SYMPATHETIC CARDIOVASCULAR CENTERS

TONIC AND REFLEX FUNCTIONS OF MEDULLARY SYMPATHETIC CARDIOVASCULAR CENTERS