Role of arterioles in management of microvascular decompression in patients with hemifacial spasm

Zhu, Jin; Li, Shiting; Zhong, Jun; Guan, Heng; Ying, Tiejin; Ye, Min; Yang, Xiaosheng; Zhou, Qiu-Meng; Jiao, Wei

doi:10.1016/j.jocn.2011.04.046

Cited by 27 publications

(11 citation statements)

References 26 publications

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“…36 As the neurovascular confliction theory has been accepted worldwide as the etiology of the disease, this process should give rise to an immediate pain free once the offending vessel was removed from the trigeminal nerve. 15,16,37,[61][62][63][64][65][66][67][68][69][70][71] Nevertheless, the common cure rate was found to be less than 90% in this research, which implied that this process needs to be further refined.…”

Section: Discussionmentioning

confidence: 62%

Effectiveness and Safety of Microvascular Decompression Surgery for Treatment of Trigeminal Neuralgia

Xia¹,

Zhong²,

Zhu³

et al. 2014

Journal of Craniofacial Surgery

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109

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Microvascular decompression has been now accepted worldwide as a reasonable treatment for trigeminal neuralgia, yet, as a functional operation in the cerebellopontine angle, this process may be risky and the postoperative outcomes might not be good enough sometimes. To assess the effectiveness and safety of microvascular decompression for treatment of trigeminal neuralgia, we conducted a systematic review. Using the keywords "trigeminal neuralgia", "microvascular decompression", or "neurovascular conflict", manuscripts published in English-language journals and indexed in PubMed between January 1, 2000 and June 1, 2013 on the treatment of trigeminal neuralgia (TN) with microvascular decompression were considered for this study. The success and complications were analyzed. The success in this investigation was defined as complete pain free. Continuous outcomes were summarized using means or medians, and dichotomous outcomes were presented as percentage associated with 95% confidence interval. Twenty-six papers with 6,847 patients were finally enrolled in this review. Among them, the male-to-female ratio was 1:1.4, the left-to-right ratio was 1:1.6, and the pain was located in the innervation of V3 and/or V2 in most of the cases with only 2.3% (0.1-4.7) of V1 exclusively. The average age at surgery was 60.9 years (52.5-64.1) with TN symptoms duration of 24.7 months (6.1-42.1) before microvascular decompression (MVD). Operative findings confirmed the superior cerebellar artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery, and multiple vascular contacts (including veins) as the most common sources of nerve compression. The average follow-up duration was 35.8 months (26.2-56.6). The success rate was 83.5% (79.6-89.1). Complications included incisional infection in 1.3% (0.1-2.5), facial palsy 2.9% (0.5-6.2), facial numbness 9.1% (1.3-19.6), cerebrospinal fluid leak 1.6% (0.7-2.5), and hearing deficit 1.9% (0.2-3.9). The postoperative mortality was 0.1% (0.02-0.2). Accordingly, MVD is the most effective treatment for patients with trigeminal neuralgia. An immediate pain free can be achieved by an experienced neurosurgeon with good knowledge of the regional anatomy. To avoid complications, each single step of the process cannot be overemphasized.

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Section: Discussionmentioning

confidence: 62%

Effectiveness and Safety of Microvascular Decompression Surgery for Treatment of Trigeminal Neuralgia

Xia¹,

Zhong²,

Zhu³

et al. 2014

Journal of Craniofacial Surgery

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109

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“…The operation was performed through a routine retrosigmoid approach. 6, [14][15][16] When the surrounding arachnoid membranes were completely opened, the neurovascular relationship was studied to identify the culprit in contact with cranial nerve V. In traditional MVD, the offending artery or vein was removed from the nerve root, and small pieces of shredded Teflon (Youwen Medical Technology Co., Shanghai, China) was placed to keep this neurovascular separation. In MVD plus, the entire intracranial course of the cranial nerve V root was exposed, and any vessel attaching to the nerve was freed away.…”

Section: Surgerymentioning

confidence: 99%

Treatment of Trigeminal Neuralgia with “Microvascular Decompression Plus” Technique

Liu

Zhong

Xia

et al. 2020

J Neurol Surg B Skull Base

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Objectives Although microvascular decompression (MVD) has been widely accepted as an effective treatment of trigeminal neuralgia (TN), some patients have not been cured. To improve the postoperative outcome, the surgical procedure should be further refined. Design This is a retrospective study. Setting Present study conducted at a cranial nerve disorder center. Participants: Clinical data were collected from patients with TN who had undergone surgery in our center, including 685 who had undergone traditional MVD and 576 who had undergone the “MVD plus” procedure, in which any vessel attached to the trigeminal nerve was freed away (“nerve-combing”), which was followed by intraoperative neurolysis. Main Outcome Measures Postoperative outcomes and complications in the two groups were compared. Results Among patients who underwent traditional MVD, the rates of immediate relief and 1-year relief were 89.9 and 86.9%, respectively; among patients who underwent MVD plus group, these rates were 95.1 and 94.6%, respectively (p = 0.05). Patients who underwent MVD plus initially exhibited a higher rate of facial numbness (p < 0.05), but this finding decreased over time and reached the same level as that in the traditional MVD group within 3 months (p > 0.05). Conclusion Sufficient MVD with nerve-combing for the treatment of TN may produce a high rate of cure with less recurrence.

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“…9 Recurrence may develop in 10.3% of patients within two years. 7 Causes of failed MVD may be related to missing the offending vessel, not detaching all offending vessels, or Figure 1: Two selected images from axial post-contrast 3D T1 MRI sequence acquisition show a tuft of tributary veins, or "caput medusae" (A, arrow), consistent with a developmental venous anomaly 14 , in the left posterior pons near the fourth ventricle leading to the larger draining abnormal vein (B, arrowhead) which is seen apposed to the left 7th cranial nerve in its root exit zone in the cerebellopontine angle cistern. There was no infarction, hemorrhage, mass or other relevant finding on the study.…”

Section: Letter To the Editor To The Editormentioning

confidence: 99%

“…10 Intraoperative electromyography monitoring over the mentalis, looking for the reduction or elimination of the abnormal muscle response may help increase the success of MVD. 7 Although repeat MVD may be required with good reported success, 8 this puts patients again at risk of surgical complications, including hearing loss, facial palsy, ataxia, cerebrospinal fluid leakage, diplopia, headache, wound infection, and vertigo. 11,12 Due to these surgical risks, delayed response, and occasional difficulty in identifying a culprit vessel, botulinum toxin may be used as first line for HFS.…”

Section: Letter To the Editor To The Editormentioning

confidence: 99%

Brainstem Developmental Venous Anomaly Causing Hemifacial Spasm – Case Report and Review of the Literature

Rizek

Kumar

Sharma

et al. 2016

Can. J. Neurol. Sci.

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Role of arterioles in management of microvascular decompression in patients with hemifacial spasm

Cited by 27 publications

References 26 publications

Effectiveness and Safety of Microvascular Decompression Surgery for Treatment of Trigeminal Neuralgia

Effectiveness and Safety of Microvascular Decompression Surgery for Treatment of Trigeminal Neuralgia

Treatment of Trigeminal Neuralgia with “Microvascular Decompression Plus” Technique

Brainstem Developmental Venous Anomaly Causing Hemifacial Spasm – Case Report and Review of the Literature

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