Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression

Sindou, Marc; Leston, J.; Decullier, Évelyne; Chapuis, François

doi:10.3171/jns-07/12/1144

Cited by 269 publications

(106 citation statements)

References 53 publications

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“…Some works have established the notion that the outcome of microvascular decompression (MVD) depends on the severity of the NVC. 1,2,21 According to our data, when clear-cut and marked vascular compression was present at surgery, the long-term cure rate was 90% after a 15-year followup. Conversely, when the vessel was merely in contact with the root-that is, without any visible root displacement or indentation-the long-term success rate was only 60%, 21 suggesting that in cases with low-grade compression other factors could play a role in the genesis of neuralgia.…”

mentioning

confidence: 99%

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

Leal¹,

Barbier

Hermier

et al. 2014

JNS

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108

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S trong evidence suggests that in classic trigeminal neuralgia (TN) caused by neurovascular compression (NVC), the neuralgia is related to morphological and structural changes in the trigeminal nerve (TGN) that are probably the result of chronic vascular compression. Morphological changes in the nerve include nerve deviation, distortion, groove formation, and atrophy. 5 Atrophy of the nerve is seen in most cases of TN 20 and is probably attributable to structural abnormalities such as axonal loss and demyelination, 4,10,12,18 but these morphological changes are difficult to describe objectively. Object. The aim of this study was to prospectively evaluate atrophic changes in trigeminal nerves (TGNs) using measurements of volume (V) and cross-sectional area (CSA) from high-resolution 3-T MR images obtained in patients with unilateral trigeminal neuralgia (TN), and to correlate these data with patient and neurovascular compression (NVC) characteristics and with clinical outcomes.Methods. Anatomical TGN parameters (V and CSA) were obtained in 50 patients (30 women and 20 men; mean age 56.42 years, range 22-79 years) with classic TN before treatment with microvascular decompression (MVD). Parameters were compared between the symptomatic (ipsilateralTN) and asymptomatic (contralateralTN) sides of the face. Twenty normal control subjects were also included. Two independent observers blinded to the side of pain separately analyzed the images. Measurements of V (from the pons to the entrance of the nerve into Meckel's cave) and CSA (at 5 mm from the entry of the TGN into the pons) for each TGN were performed using imaging software and axial and coronal projections, respectively. These data were correlated with patient characteristics (age, duration of symptoms before MVD, side of pain, sex, and area of pain distribution), NVC characteristics (type of vessel involved in NVC, location of compression along the nerve, site of compression around the circumference of the root, and degree of compression), and clinical outcomes at the 2-year follow-up after surgery. Comparisons were made using Bonferroni's test. Interobserver variability was assessed using the Pearson correlation coefficient.Results. The mean V of the TGN on the ipsilateralTN (60.35 ± 21.74 mm 3 ) was significantly smaller (p < 0.05) than those for the contralateralTN and controls (78.62 ± 24.62 mm 3 and 89.09 ± 14.72 mm 3 , respectively). The mean CSA of the TGN on the ipsilateralTN (4.17 ± 1.74 mm 2 ) was significantly smaller than those for the contralateralTN and controls (5.41 ± 1.89 mm 2 and 5.64 ± 0.85 mm 2 , respectively). The ipsilateralTN with NVC Grade III (marked indentation) had a significantly smaller mean V than the ipsilateralTN with NVC Grade I (mere contact), although it was not significantly smaller than that of the ipsilateralTN with NVC Grade II (displacement or distortion of root). The ipsilateralTN with NVC Grade III had a significantly smaller mean CSA than the ipsilateralTN with NVC Grades I and II (p < 0.05). The TGN on the ipsilateralT...

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mentioning

confidence: 99%

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

Leal¹,

Barbier

Hermier

et al. 2014

JNS

Self Cite

108

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“…Sindou ve ark. [11] ise primer TN nedeniyle ameliyat edilen 362 hastanın bir yıl sonunda başarı oranını %91 olarak bildirirken, 15 yıllık takiplerinde bu oranı %73 olarak bildirmişlerdir. Yazarlar, MRG incelemesi ve cerrahi sırasında damar sinir basısını tam olarak görebildikleri TN olgularında başarının %90 olduğunu bildirmişlerdir.…”

Section: Discussionunclassified

“…Yazarlar, MRG incelemesi ve cerrahi sırasında damar sinir basısını tam olarak görebildikleri TN olgularında başarının %90 olduğunu bildirmişlerdir. [11] Manyetik rezonans görüntüleme tekniklerindeki ilerlemeler serebellopontin köşedeki nörovaskü-ler ilişkiyi saptama kolaylığı sağlamıştır. Manyetik rezonans görüntüleme bulgularının cerrahi bulgular ile ilişkisi cerrahiyi sonlandırma kararını verirken önemlidir.…”

Section: Discussionunclassified

Vascular compression syndromes: our 24 year endoscope-assisted microvascular decompression experiences

Tutar

Şahin²,

Tutar³

et al. 2014

Kulak Burun Bogaz Ihtis Derg

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Amaç: Bu çalışmada hemifasiyal spazm, trigeminal nevralji, kokleovestibüler sinir kompresyonu gibi vasküler kompresyon sendromları nedeniyle yapılan endoskop yardımlı mikrovasküler dekompresyon deneyimlerimiz sunuldu. Hastalar ve Yöntemler:Mart 1999 -Haziran 2013 tarihleri arasında kliniğimizde vasküler kompresyon sendromları nedeniyle 55 hastaya (34 kadın, 21 erkek; ort. yaş 44 yıl; dağılım 24-77 yıl) endoskop yardımlı retrosigmoid yaklaşımla mikrosvasküler dekompresyon ameliyatı uygulandı. Tanı öykü, nörolojik muayene, manyetik rezonans görüntüleme bulguları ve odyovestibüler testler ile konuldu. Bulgular:Toplam 49 hastada (%89.1) tam iyileşme, iki hastada (%3.6) kısmi iyileşme, dört hastada (%7.3) ise semptomlarda düzelmeme görüldü. Sadece iki (%3.6) hastada ameliyat sırası komplikasyon olarak beyin omurilik sıvısı kaçağı gelişti. En sık bası yapan damarsal yapı ön ve alt serebellar arter olup, 14 hastada gözlendi. Esansiyel hipertansiyonlu dört hasta eş zamanlı sol medulla oblongata basısı dekomprese edildikten sonra normotansif oldu. Sonuç:Mikrovasküler kompresyon ameliyatı ile vasküler kompresyon sendromlu hastaların semptomlarında anlamlı iyileşme sağlanır. Ameliyat mikroskobuna yardımcı olarak açılı teleskopların kullanılması kraniyal sinire root entry zone bölgesinde bası nedenini saptamada önemli yardım sağlamaktadır.Anahtar Sözcükler: Endoskop yardımlı retrosigmoid yaklaşım; arka kraniyal fossa; retrosigmoid yaklaşım; root entry zone; vasküler kompresyon sendromları.Objectives: This study aims to report our experience on endoscope-assisted microvascular decompression experiences performed due to vascular compression syndromes such as hemifacial spasm, trigeminal neuralgia, and cochleovestibular nerve compression. Patients and Methods:Between March 1999 and June 2013, 55 patients (34 females, 21 males; mean age 44 years; range 24 to 77 years) underwent endoscope-assisted microvascular decompression surgery through a retrosigmoid approach due to vascular compression syndromes in our clinic. The diagnosis was based on history, neurological examination, magnetic resonance imaging findings and audio-vestibular tests.Results: A total of 49 patients (89.1%) had complete relief of the symptoms and two had (3.6%) a partial relief, while four had (7.3%) no relief of the symptoms. Only two patients had (3.6%) cerebrospinal fluid leakages as a perioperative complication. The major offending vessels were anterior and inferior cerebellar arteries in 14 patients. Four patients with essential hypertension became normotensive after decompression of the left medulla oblongata as well. Conclusion:Microvascular decompression surgery provides a significant relief of the symptoms in patients with vascular compression syndromes. An angled endoscope as an adjunct to microscope contributes to the diagnosis of the offending vessel in the root entry zone of the cranial nerve.

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“…Conversely when the vessel was only in contact, without any visible indentation, with the root, the long-term cure rate was only 60% [26].…”

Section: The Neurosurgical Armamentariummentioning

confidence: 99%

Trigeminal neuralgia: a plea for microvascular decompression as the first surgical option. Anatomy should prevail

Sindou

2009

Acta Neurochir

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Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression

Cited by 269 publications

References 53 publications

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes

Vascular compression syndromes: our 24 year endoscope-assisted microvascular decompression experiences

Trigeminal neuralgia: a plea for microvascular decompression as the first surgical option. Anatomy should prevail

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