Outcome of microvascular decompression for trigeminal neuralgia using autologous muscle graft: A five-year prospective study

Abstract

Introduction:Trigeminal Neuralgia (TGN) is a syndrome characterized by Paroxysmal, shock like hemifacial pain. Among the various treatment options micro vascular decompression (MVD) has gained popularity in the recent years.Materials and Methods:182 patients underwent MVD, between 1995–2007 out of 530 patients treated for Trigeminal Neuralgia at our service. All were operated by retro auricular sub occipital craniectomy by a single surgeon using autologous muscle graft. They were assessed for pain relief, complications and the data was analysed.Results:Males were 84 (61.3%) females 53 (38%) with a ratio of 1.5=1. Age ranged from 25-75 years. Duration of symptoms ranging from 6 months to 25 years (average 4-6 years). Seventy seven (56.2% were affected on the right side whereas 60 (43.8%) had pain on the left side. Imaging demonstrated vascular compression in 84 (61%). At surgery superior cerebellar artery was the commonest cause of compression in 71.5%. More than one artery was found in relation to the nerve in 15.3%. There was no mortality, CSF leak 2.9% and transient facial palsy in 2.2% were the notable complications.Conclusion:MVD is the procedure of choice for TGN if there is no contraindication for surgery. Adequate tissue respect, meticulous surgical steps and experience will reduce complications. Autologus muscle graft can give comparable and durable results possibly with lesser complications.

Trigeminal neuralgia

“…Autologous muscle graft,[ 167 ] oxidized regenerated cellulose,[ 168 ] and fibrin glue alone[ 169 ] can be used to transpose vessel away from the nerve. Transposition of the offending vessel with Teflon wool or slings, especially in tortuous NVC, is a useful.…”

Minimally invasive asterional approach for microvascular decompression in trigeminal neuralgia

“…Considering the percentage of cases without pain after 36 months (class A, 69%), our results are within the range of success reported in most series. If these cases are added those cases where pain persisted but was relieved with non-steroidal analgesics (27%), our acceptable pain control rate reaches 96%, which even exceeds that of other reports 8,11,15,[18][19][20] . None of our patients required re-intervention due to inadequate pain control.…”

“…Once the cerebellum is exposed, the use of retractors should be avoided, which can promote contusions, hematomas or cerebellar edema. However, when necessary, neurosurgeons should not hesitate to gently use them to contain the cerebellar lobe ipsilateral to the approach, since this maneuver facilitates visualization of the nerve 10,13,15,[18][19][20] .…”

Hydroxyapatite bone cement application for the reconstruction of retrosigmoid craniectomy in the treatment of cranial nerves disorders

“…Retrosigmoid craniecotomy (RSC) is used to access a wide variety of neurosurgical posterior fossa pathologies and cranial nerves disorders. [ 3 4 6 8 14 15 21 25 29 ] Closure methods often include watertight dural and galeal closure in addition to bone, muscle, pericranial, and fat grafts. Titanium plates and mesh are often utilized for structural support over the craniectomy defect.…”

“…[ 5 17 19 24 30 ] Current data suggest that the rate of wound infection associated with HBC cranioplasty ranges from 0 to 1.3%. [ 11 12 24 ] The incidences of CSF leak and infection after non-HBC RSC have been previously reported to be 0 to 23.4%[ 12 14 21 28 31 ] and 0 to 10.9%,[ 8 12 16 27 28 31 ] respectively.…”