Clinical analysis and surgical treatment of trigeminal neuralgia caused by vertebrobasilar dolichoectasia: A retrospective study

Sun, Suyang; Jiang, Wei; Wang, Junwen; Gao, Pan; Zhang, Xiaojing; Jiao, Liwu; Liu, Weihua; Shu, Kai; Lei, Ting

doi:10.1016/j.ijsu.2017.04.015

Cited by 29 publications

(13 citation statements)

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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: 60%

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: 60%

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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“…VBD, a rare arterial disease caused by vertebrobasilar tortuosity and expansion, can lead to obvious compression for the trigeminal nerve, which brings about the occurrence of TN. Some studies have reported that VBD-TN is more common in elderly male patients, usually on the left side, and tends to suffer from arterial hypertension [15,25,29,40,43]. In our study, the clinical baseline characteristics in the MVD and GKRS groups were consistent with those ndings.…”

Section: Discussionsupporting

confidence: 90%

Comparison of microvascular decompression and two isocenters gamma knife for the treatment of trigeminal neuralgia caused by vertebrobasilar compression

Zhao

Chai

Wang

et al. 2021

Preprint

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Objective: Vertebrobasilar dolichoectasia (VBD) is one of the uncommon causes of trigeminal neuralgia (TN). The main surgical treatments for TN caused by VBD (VBD-TN) are invasive microvascular decompression (MVD) and mini-invasive Gamma Knife radiosurgery (GKRS). However, the therapeutic effects of the two methods have not been clinically reported, so this study evaluated the outcomes of MVD and GKRS for patients with VBD-TN.Methods: The retrospective study of patients diagnosed with VBD-TN in Wuhan Union Hospital was performed from March 2011 to March 2019. A total of 80 patients were included in this study, and they were divided into the MVD group (n = 46) and GKRS group (n = 34) according to the surgical methods. Among patients in the GKRS group, all performed by two isocenters gamma knife. The imaging data, intraoperative findings, outcomes, and complications of the two groups were analyzed and compared.Results: Patients who underwent MVD were younger than patients who underwent GKRS (median ages were 61.1 and 65.4 years old, p=0.03). The average follow-up was 61.1 months for the MVD group and was 56.8 months for the GKRS group. The favorable outcomes (BNI score I-II) occurred in 97.8% of patients treated with MVD and in 78.9% of patients treated with GKRS (P=0.009). The favorable outcomes in the percentage of patients after MVD 1,3,5 and 7 years were 95.7%, 85.1%, 74.2%, and 74.2%. The corresponding percentages after GKRS were 76.5%, 66.2%, 56.6% and 47.2%, respectively (P=0.031). The postoperative complications (except facial numbness) in the MVD group were higher than those in the GKRS group (P=0.036), but the incidence of new and worsening facial numbness was higher in the GKRS group (P<0.001).Conclusions: For VBD-TN, MVD is superior to GKRS in obtaining and maintaining favorable outcomes, but it also comes with more complications other than facial sensation. Treatment choice can be tailored to a patient’s unique condition and wishes.

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“…However, several studies have reported symptom recurrence and serious complications (such as hearing loss and facial nerve palsy) after MVD [23]. Also, MVD may trigger facial hypesthesia, hyperalgesia, and diplopia; in particular, excessive surgical manipulation of vessels can induce cerebellar/brainstem ischemia [24]. Although MVD may thus induce some neurological complications, this surgery remains the most reliable form of treatment as revealed by long-term follow-up studies [25].…”

Section: Discussionmentioning

confidence: 99%

Vestibulocochlear Symptoms Caused by Vertebrobasilar Dolichoectasia

Huh

Bae

Woo

et al. 2020

Clin Exp Otorhinolaryngol

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Objectives. Vertebrobasilar dolichoectasia (VBD), an elongation and distension of vertebrobasilar artery, may present with cranial nerve symptoms due to nerve root compression. The objectives of this study are to summarize vestibulocochlear manifestations in subjects with VBD through a case series and to discuss the needs of thorough oto-neurotologic evaluation in VBD subjects before selecting treatment modalities.Methods. Four VBD subjects with vestibulocochlear manifestations were reviewed retrospectively. VBD was confirmed by either brain or internal auditory canal magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Patient information, medical history, MRI/MRA findings, and audiometry or vestibular function tests were reviewed according to patient’s specific symptom.Results. Of the four subjects, three presented with ipsilesional sensorineural hearing loss (SNHL), three with paroxysmal recurrent vertigo, and two with typewriter tinnitus. The MRI/MRA of the four subjects revealed unilateral VBD with neurovascular compression of cisternal segment or the brainstem causing displacement, angulation, or deformity of the cranial nerve VII or VIII that corresponded to the symptoms.Conclusion. Vestibulocochlear symptoms such as SNHL, recurrent paroxysmal vertigo, or typewriter tinnitus can be precipitated from a neurovascular compression of the vestibulocochlear nerve by VBD. Because proper medical or surgical treatments may stop the disease progression or improve audio-vestibular symptoms in subjects with VBD, a high index of suspicion and meticulous radiologic evaluation are needed when vestibulocochlear symptoms are not otherwise explainable, and if VBD is confirmed to cause audiovestibular manifestation, a thorough oto-neurotologic evaluation should be performed before initial treatment.

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Clinical analysis and surgical treatment of trigeminal neuralgia caused by vertebrobasilar dolichoectasia: A retrospective study

Abstract: Our results suggest that simple MVD is effective for TN caused by VBD. MVD plus SPPR can be cautiously performed if patient has advanced age and is susceptible to numbness.

Cited by 29 publications

References 24 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

Comparison of microvascular decompression and two isocenters gamma knife for the treatment of trigeminal neuralgia caused by vertebrobasilar compression

Vestibulocochlear Symptoms Caused by Vertebrobasilar Dolichoectasia

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