RESUMO
BACKGROUND: The classic percutaneous balloon compression (PBC) technique is used to complete an operation under the guidance of C-arm radiography under general anesthesia, making communication with patients during the operation impossible. It is not accurate or objective to predict the classic technique's curative effect solely by determining whether the projection of the x-ray lateral image of the filled balloon is pear-shaped. OBJECTIVES: This study aimed to upgrade classic PBC to awake computed tomography (CT)-guided PBC technology under conscious local anesthesia and analgesia monitoring. STUDY DESIGN: Prospective clinical study. SETTING: Department of Anesthesiology and Pain Medical Center, Jiaxing, People's Republic of China. METHODS: Puncture was designed and guided by CT scanning, and the curative effect was assessed by asking the patients about what they are feeling during the operation. RESULTS: CT can design the puncture path and accurately guide puncture, observe the position and shape of the balloon through 3-dimensional reconstruction during the operation, and judge the curative effect according to the patient's chief concern. LIMITATIONS: Local anesthetic analgesia is not perfect, resulting in some patients experiencing pain during surgery. CONCLUSIONS: PBC can be completed under conscious local anesthesia and analgesia. Its curative effect and operative end standard can be determined according to the patient's chief concern. Under CT guidance, the puncture path can be designed to complete an accurate puncture and to intuitively understand the position and shape of the balloon.
Assuntos
Tomografia Computadorizada por Raios X , Gânglio Trigeminal , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/diagnóstico por imagem , Gânglio Trigeminal/cirurgia , Gânglio Trigeminal/diagnóstico por imagem , Estudos Prospectivos , Feminino , Pessoa de Meia-Idade , Masculino , IdosoAssuntos
Cirurgia de Descompressão Microvascular , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/etiologia , Cirurgia de Descompressão Microvascular/métodos , Masculino , Feminino , Neuroendoscopia/métodos , Pessoa de Meia-Idade , Idoso , Insuficiência Vertebrobasilar/cirurgia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/complicações , Artéria Basilar/cirurgia , Artéria Basilar/diagnóstico por imagemRESUMO
BACKGROUND: 3D-Slicer is an open-source medical image processing and visualization software. In the surgical treatment of trigeminal neuralgia, it is commonly used to predict the responsible vessels. However, there are few reports on the use of 3D-Slicer software to quantitatively measure the bilateral trigeminal nerve volume in patients with primary trigeminal neuralgia (PTN) based on the three-dimensional images. Therefore, this study aims to explore the role of three-dimensional fused images processed by 3D-Slicer in the evaluation of trigeminal nerve atrophy, providing an objective basis for the diagnosis of PTN. METHODS: 57 PTN patients who underwent microvascular decompression (MVD) or percutaneous balloon compression (PBC) surgery in Hebei general hospital between January 2020 and April 2023 were included. Additionally, 30 patients with facial spasms(HFS) were included as a control group. All patients underwent 3D-TOF-MRA and 3D-FIESTA sequence examinations. Comparisons of bilateral trigeminal nerve volumes within and between groups were conducted by performing image fusion using 3D-slicer. RESULTS: The volume of the affected trigeminal nerve in the MVD group (33.96â¯mm³±12.61â¯mm³) and PBC group (23.05â¯mm³±7.71â¯mm³) was smaller than that of the unaffected trigeminal nerve in the MVD group (39.61â¯mm³±12.83â¯mm³) and PBC group (26.14â¯mm³±6.42â¯mm³), as well as the average volume of the trigeminal nerve in the control group (40.27â¯mm³±10.25â¯mm³) (P<0.05). The differences in bilateral trigeminal ganglion volume (∆V) was significant between the MVD group (∆V=23.59â¯%±14.32â¯%) and the control group (∆V=14.64â¯%±10.00â¯%) (P<0.05). There was no statistical difference in the trigeminal nerve volume difference between the MVD group (∆V=23.59â¯%±14.32â¯%) and the PBC group (∆V=26.52â¯%±15.00â¯%) (P>0.05). CONCLUSION: Trigeminal nerve atrophy is correlated with primary trigeminal neuralgia. 3D-slicer software can quantitatively measure trigeminal nerve volume and assist in the diagnosis of primary trigeminal neuralgia based on the difference in bilateral trigeminal nerve volumes. However, trigeminal nerve atrophy is not associated with postoperative pain recurrence in patients.
Assuntos
Atrofia , Cirurgia de Descompressão Microvascular , Imagem Multimodal , Nervo Trigêmeo , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/diagnóstico por imagem , Feminino , Masculino , Pessoa de Meia-Idade , Nervo Trigêmeo/diagnóstico por imagem , Nervo Trigêmeo/patologia , Nervo Trigêmeo/cirurgia , Estudos Retrospectivos , Idoso , Atrofia/patologia , Cirurgia de Descompressão Microvascular/métodos , Imagem Multimodal/métodos , Adulto , Imageamento Tridimensional/métodosRESUMO
Based on a personal experience of 4200 surgeries, radiofrequency thermocoagulation is useful lesional treatment for those trigeminal neuralgias (TNs) not amenable to microvascular decompression (idiopathic or secondary TNs). Introduced through the foramen ovale, behind the trigemnial ganglion in the triangular plexus, the needle is navigated by radiology and neurophysiological testing to target the retrogasserian fibers corresponding to the trigger zone. Heating to 55-75 °C can achieve hypoesthesia without anaesthesia dolorosa if properly controlled. Depth of anaesthesia varies dynamically sedation for cannulation and lesioning, and awareness during neurophysiologic navigation. Proper technique ensures long-lasting results in more than 75% of patients.
Assuntos
Eletrocoagulação , Neuralgia do Trigêmeo , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/diagnóstico por imagem , Humanos , Eletrocoagulação/métodos , Nervo Trigêmeo/cirurgia , Forame Oval/cirurgia , Forame Oval/diagnóstico por imagem , Gânglio Trigeminal/cirurgia , Cirurgia de Descompressão Microvascular/métodos , Resultado do TratamentoRESUMO
OBJECTIVE: To study the value of three-dimensional CT (3D-CT) reconstruction by comparing the surgical effects of C-arm and 3D-CT in the treatment of trigeminal neuralgia (TN) by percutaneous balloon compression (PBC). METHODS: A total of 136 patients were included from May 2018 to February 2019. Among them, 65 patients underwent PBC treatment with 3D-CT and others with C-arm. During 3D-CT-guided operation, 3D-CT reconstruction software was used to analyze and measure the distances from the internal orifice of Foramen ovale (FO-I) and the external orifice of Foramen ovale (FO-E) to the top of the balloon (BT) and the petrous bone ridge (PR). The data, including the angle between the puncture needle direction and the zygomatic arch, petrous bone ridge, and slope, were used to assist the puncture and balloon plasty. Postoperative follow-up for more than five years was performed to evaluate the efficacy and pain recurrence. RESULTS: The distance from FO-E to PR was (2.10 ± 0.16)cm, the average distance from FO-I to BT was (2.39 ± 0.07)cm, and the average angles between the puncture needle and zygomatic arch, slope, and petrous bone ridge were (56.19 ± 5.59)°, (69.12 ± 6.92)°, and (104.49 ± 6.46)°, respectively. One (1.5 %) patient in the 3D-CT group and three (4.2 %) patients in the C-arm group failed to receive PBC treatment because of failure of FO puncture (P = 0.032).In terms of postoperative pain improvement, 3D-CT group achieved better results than the C-arm group (P = 0.043). There were no significant differences in the rates of major complications and short-term recurrence (P = 0.926) between the two groups after surgery, but the five-year recurrence rate in the 3D-CT group was lower than that in the C-arm group (P = 0.032). CONCLUSION: By guiding the angle and depth of puncture, the intraoperative application of 3D-CT reconstruction technology can improve the accuracy of foramen ovale puncture and alleviate postoperative pain, and also maintain long-term postoperative pain relief, which can be used as a potentially better guidance method to improve the surgical efficacy of PBC.
Assuntos
Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Neuralgia do Trigêmeo , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Forame Oval/cirurgia , Forame Oval/diagnóstico por imagem , Imageamento Tridimensional/métodos , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/diagnóstico por imagemRESUMO
Magnetic resonance-diffusion tensor imaging (MR-DTI) has been used in the microvascular decompression and gamma knife radiosurgery in trigeminal neuralgia (TN) patients; however, use of percutaneous stereotactic radiofrequency rhizotomy (PSR) to target an abnormal trigeminal ganglion (ab-TG) is unreported. Fractional anisotropy (FA), mean and radial diffusivity (MD and RD, respectively), and axial diffusivity (AD) of the trigeminal nerve (CNV) were measured in 20 TN patients and 40 healthy control participants immediately post PSR, at 6-months, and at 1 year. Longitudinal alteration of the diffusivity metrics and any correlation with treatment effects, or prognoses, were analyzed. In the TN group, either low FA (value < 0.30) or a decreased range compared to the adjacent FA (dFA) > 17% defined an ab-TG. Two-to-three days post PSR, all 15 patients reported decreased pain scores with increased FA at the ab-TG (P < 0.001), but decreased MD and RD (P < 0.01 each). Treatment remained effective in 10 of 14 patients (71.4%) and 8 of 12 patients (66.7%) at the 6-month and 1-year follow-ups, respectively. In patients with ab-TGs, there was a significant difference in treatment outcomes between patients with low FA values (9 of 10; 90%) and patients with dFA (2 of 5; 40%) (P < 0.05). MR-DTI with diffusivity metrics correlated microstructural CNV abnormalities with PSR outcomes. Of all the diffusivity metrics, FA could be considered a novel objective quantitative indicator of treatment effects and a potential indicator of PSR effectiveness in TN patients.
Assuntos
Imagem de Tensor de Difusão , Rizotomia , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/diagnóstico por imagem , Masculino , Feminino , Rizotomia/métodos , Pessoa de Meia-Idade , Imagem de Tensor de Difusão/métodos , Idoso , Resultado do Tratamento , Adulto , Nervo Trigêmeo/cirurgia , Nervo Trigêmeo/diagnóstico por imagem , Nervo Trigêmeo/patologia , Radiocirurgia/métodos , Anisotropia , PrognósticoRESUMO
Autonomic symptoms have been long noticed coming along with pain in the head, e.g. Trigeminal Neuralgia, trigeminal autonomic cephalalgias. The symptoms show up during pain attacks, so they are assumed to be activated by the nociceptive afferents of the trigeminal nerve. Here, we present a case with hypersalivation as the complication after percutaneous balloon compression for trigeminal neuralgia, although the patient was pain-free after the treatment. A 71-year-old female with excessive salivation on the affected side after percutaneous balloon compression is described. The patient underwent microvascular decompression several years ago, and both the microvascular decompression and the preoperative imaging examination confirmed that there was no offending vessel at the root entry zone of the trigeminal nerve. After the percutaneous balloon compression, the patient was free of pain, but the autonomic symptoms (hypersalivation) still showed up. The autonomic symptoms which usually came along with pain presented solely as post-percutaneous balloon compression complication in the case. Contrary to popular belief, for the patient who was pain-free after percutaneous balloon compression, the transiently overactivated nerve fibers that led to hypersalivation were not nociceptive afferents of the trigeminal nerve.
Assuntos
Cirurgia de Descompressão Microvascular , Nervo Trigêmeo , Neuralgia do Trigêmeo , Humanos , Feminino , Idoso , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/diagnóstico por imagem , Cirurgia de Descompressão Microvascular/métodos , Nociceptividade/fisiologiaRESUMO
BACKGROUND: Target selection during Gamma Knife radiosurgery (GKRS) in cases of tumor-related trigeminal neuralgia is always debatable. We analyzed the correlation of regression of tumor size and degree of release of the nerve with long-term pain control. METHODS: Between March 2012 and March 2023, 50 cases of tumor-related trigeminal neuralgia were treated with GKRS (tumor was targeted). Radiological findings after GKRS were categorized into 3 types: 1) tumor volume remained same or decreased, additional segment of nerve not seen; 2) tumor volume decreased, additional segment of trigeminal nerve seen, but tumor still adherent to the nerve; 3) tumor volume decreased, adjacent nerve seen completely separated from tumor. Pain score before and after GKRS (Barrow Neurological Institute I-III: good; Barrow Neurological Institute IV and V: poor) was correlated with these subgroups. RESULTS: At median follow-up of 46.5 months, 18 cases showed type 1 radiological response, 23 showed type 2 response, and 9 showed type 3 response. Good pain control was achieved in 10 (55.5%) patients with type 1, 15 (65.21%) with type 2, and 7 (77.8%) with type 3 responses. The outcome differences among these 3 groups were not statistically significant (P = 0.519). Five patients with type 3 radiological response were off medication, which was statistically better than type 1 and type 2 radiological responses, with 3 patients (P = 0.012) and 2 patients (P = 0.002), respectively, still receiving medication. CONCLUSIONS: Tumor volume reduction after GKRS may be associated with good pain control in tumor-related trigeminal neuralgia. Further, this allows visualization of additional segment of nerve that can be targeted in a second session for treating recurrent or failed cases.
Assuntos
Descompressão Cirúrgica , Radiocirurgia , Nervo Trigêmeo , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/radioterapia , Radiocirurgia/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Resultado do Tratamento , Adulto , Descompressão Cirúrgica/métodos , Nervo Trigêmeo/cirurgia , Nervo Trigêmeo/diagnóstico por imagem , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Seguimentos , Carga TumoralRESUMO
Microvascular decompression (MVD) is a well-established and definitive treatment option for trigeminal neuralgia (TN).1 However, complex vascular geometry and numerous offending vessels make it difficult to perform nerve decompression in certain cases.2 The trigeminocerebellar artery (TCA) is a unique branch of the basilar artery. The vessel is named the TCA because it supplies both the trigeminal nerve root and the cerebellar hemisphere.3 This anatomical variant may increase the risk of neurovascular compression in the trigeminal nerve. We present the case of a 74-year-old man with left TN in whom a TCA was one of the responsible compression vessels. Preoperative images revealed the ipsilateral anterior inferior cerebellar artery, well-developed TCA, and superior cerebellar artery, wherein these branches were all suspected to be involved in trigeminal nerve compression. In MVD, 3 arteries were suspected to compress the trigeminal nerve in 5 sites, and all of them needed to be meticulously dissected from the nerve root and decompressed. Moreover, 2 of them branched many short perforators to the brainstem. Three decompression procedures (transposition to the dura, transposition to the brain, and interposition) were performed to decompress the trigeminal nerve. Postoperatively, TN was completely resolved immediately. MVD for TN could be difficult to perform in cases with TCA, as in the present case, and rigorous procedures were required intraoperatively.
Assuntos
Cirurgia de Descompressão Microvascular , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/diagnóstico por imagem , Cirurgia de Descompressão Microvascular/métodos , Masculino , Idoso , Cerebelo/irrigação sanguínea , Cerebelo/cirurgia , Nervo Trigêmeo/cirurgia , Artéria Basilar/cirurgia , Artéria Basilar/diagnóstico por imagemRESUMO
BACKGROUND: Nervus intermedius neuralgia (NIN) is characterized by paroxysmal episodes of sharp, lancinating pain in the deep ear. Unfortunately, only a few studies exist in the literature on this pain syndrome, its pathology and postoperative outcomes. METHOD: We conducted a retrospective review of four cases diagnosed with NIN who underwent a neurosurgical intervention at our center from January 2015 to January 2023. Detailed information on their MRI examinations, intraoperative findings and other clinical presentations were obtained, and the glossopharyngeal and vagus nerves were isolated for immunohistochemistry examination. RESULTS: A total of 4 NIN patients who underwent a microsurgical intervention at our institution were included in this report. The NI was sectioned in all patients and 3 of them underwent a microvascular decompression. Of these 4 patients, 1 had a concomitant trigeminal neuralgia (TN), and 1 a concomitant glossopharyngeal neuralgia (GPN). Three patients underwent treatment for TN and 2 for GPN. Follow-up assessments ranged from 8 to 99 months. Three patients reported complete pain relief immediately after the surgery until last follow-up, while in the remaining patient the preoperative pain gradually resolved over the 3 month period. Immunohistochemistry revealed that a greater amount of CD4+ and CD8+ T cells had infiltrated the glossopharyngeal versus vagus nerve. CONCLUSIONS: NIN is an extremely rare condition showing a high degree of overlap with TN/GPN. An in depth neurosurgical intervention is effective to completely relieve NIN pain, without any serious complications. It appears that T cells may play regulatory role in the pathophysiology of CN neuralgia.
Assuntos
Doenças do Nervo Glossofaríngeo , Cirurgia de Descompressão Microvascular , Neuralgia , Neuralgia do Trigêmeo , Humanos , Nervo Facial , Linfócitos T CD8-Positivos , Neuralgia/etiologia , Neuralgia/cirurgia , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgia , Doenças do Nervo Glossofaríngeo/cirurgia , Resultado do TratamentoRESUMO
Nervus intermedius (NI) arises from the superior salivary nucleus, solitary nucleus, and trigeminal tract. It leaves the pons as 1 to 5 roots and travels between the facial and vestibulocochlear nerves before merging with the facial nerve within the internal auditory canal. The mastoid segment of the facial nerve then gives rise to a sensory branch that supplies the posteroinferior wall of the external auditory meatus and inferior pina. This complex pathway renders the nerve susceptible to various pathologies, leading to NI neuralgia. Here, the authors present an unusual intraoperative finding of an atrophic NI in a patient with refractory NI neuralgia and a history of ipsilateral sudden-onset central facial palsy and microvascular decompression for trigeminal neuralgia. The patient underwent NI sectioning via the previous retrosigmoid window and achieved partial ear pain improvement. The gross size of the NI is compared with a cadaveric specimen through stepwise dissection. This case highlights the potential significance of subtle central ischemic events and subsequent atrophy of NI in the pathogenesis of NI neuralgia, as well as the ongoing need to investigate the therapeutic efficacy of nerve sectioning.
Assuntos
Paralisia Facial , Perda Auditiva Neurossensorial , Humanos , Atrofia , Cadáver , Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Paralisia Facial/etiologia , Perda Auditiva Neurossensorial/cirurgia , Perda Auditiva Neurossensorial/etiologia , Cirurgia de Descompressão Microvascular/métodos , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/etiologiaRESUMO
Classic trigeminal neuralgia is mainly caused by arterial compression; most cases involve the superior cerebellar artery, followed by the anterior cerebellar, basilar, and vertebral arteries. The detection of neurovascular conflicts in trigeminal neuralgia requires special magnetic resonance imaging(MRI)modalities, including high-resolution three-dimensional(3D)-T2 sequence, 3D-time of flight angiography, 3D-T1 sequencing with gadolinium injection, and merged images of these sequences. The conflicting sites are not necessarily restricted to the root entry zone of the trigeminal nerve root and can be located more distally, proximal to the Meckel's cavum. Arterial compression and its severity, including displacement, angulation, distortion, and atrophy of the trigeminal root, are good predictors of the long-term efficacy of decompression surgery. Veins, primarily the transverse pontine vein, comprise 10%-20% of all causative vessels in trigeminal neuralgia. Gadolinium-enhanced 3D-T1 MRI and high-resolution 3D-T2 MRI merged with computed tomographic angiography are useful for detecting venous compression.
Assuntos
Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/cirurgia , Gadolínio , Angiografia , Artéria Basilar , CerebeloRESUMO
In microvascular decompression surgery for trigeminal neuralgia, the veins are essential as an anatomical frame for the microsurgical approach and as an offending vessel to compress the trigeminal nerve. Thorough arachnoid dissection of the superior petrosal vein and its tributaries provides surgical corridors to the trigeminal nerve root and enables the mobilization of the bridging, brainstem, and deep cerebellar veins. It is necessary to protect the trigeminal nerve by coagulating and cutting the offending vein. We reviewed the clinical features of trigeminal neuralgia caused by venous decompression and its outcomes after microvascular decompression. Among patients with trigeminal neuralgia, 4%-14% have sole venous compression. Atypical or type 2 trigeminal neuralgia may occur in 60%-80% of cases of sole venous compression. Three-dimensional MR cisternography and CT venography can help in detecting the offending vein. The transverse pontine vein is the common offending vein. The surgical cure and recurrence rates of trigeminal neuralgia with venous compression are 64%-75% and 23%, respectively. Sole venous compression is a unique form of trigeminal neuralgia. Its clinical characteristics differ from those of trigeminal neuralgia caused by arterial compression. Surgical procedures to resolve venous compression include nuances in safely handling venous structures.
Assuntos
Veias Cerebrais , Cirurgia de Descompressão Microvascular , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgia , Veias Cerebrais/diagnóstico por imagem , Veias Cerebrais/cirurgia , Angiografia , Tronco EncefálicoRESUMO
BACKGROUND AND OBJECTIVES: Classical trigeminal neuralgia (cTN) is a painful disease. Microvascular decompression (MVD) provides immediate and durable relief in many patients. A variety of positive and negative prognostic biomarkers for MVD have been identified. The sagittal angle of the trigeminal nerve at the porus trigeminus (SATNaPT) is an MRI biomarker that can identify a subset of patients with cTN whose trigeminal nerve anatomy is different from normal controls. The purpose of this case-control study was to determine whether an abnormally hyperacute SATNaPT is a negative prognostic biomarker in patients with cTN undergoing MVD. METHODS: Preoperative MRIs from 300 patients with cTN who underwent MVD were analyzed to identify patients with a hyperacute SATNaPT (defined as less than 3 SDs below the mean). The rate of surgical success (pain-free after at least 12 months) was compared between patients with a hyperacute SATNaPT and all other patients. RESULTS: Patients without a hyperacute SATNaPT had an 82% likelihood of surgical success, whereas patients with a hyperacute SATNaPT had a 58% likelihood of surgical success ( P < .05). Patients with a hyperacute SATNaPT who also had no evidence of vascular compression on preoperative MRI had an even lower likelihood of success (29%, P < .05). CONCLUSION: In patients with cTN being considered for MVD, a hyperacute SATNaPT is a negative prognostic biomarker that predicts a higher likelihood of surgical failure. Patients with a hyperacute SATNaPT, particularly those without MRI evidence of vascular compression, may benefit from other surgical treatments or a modification of MVD to adequately address the underlying cause of cTN.
Assuntos
Cirurgia de Descompressão Microvascular , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/etiologia , Cirurgia de Descompressão Microvascular/efeitos adversos , Estudos de Casos e Controles , Nervo Trigêmeo/diagnóstico por imagem , Nervo Trigêmeo/cirurgia , Resultado do Tratamento , Biomarcadores , Estudos RetrospectivosRESUMO
BACKGROUND AND OBJECTIVES: Bone wax is a flexible hemostatic agent commonly used for surgery in the posterior cranial fossa to control bleeding from the mastoid emissary vein. A large amount of bone wax can migrate into the sigmoid sinus through the mastoid emissary canal (MEC). We aimed to identify clinical factors related to intraoperative bone wax migration through the MEC during microvascular decompression (MVD) surgery, which may result in sigmoid sinus thrombosis. METHODS: We retrospectively collected the clinical data of patients with trigeminal neuralgia, hemifacial spasm, or trigeminal neuralgia accompanied by painful tic convulsif who underwent MVD. Basic information and the residual width and length (from the bone surface to the sigmoid sinus) of the MEC on computed tomography images were collected. We compared the collected clinical data between 2 groups of cases with and without intraoperative bone wax migration in the sigmoid sinus. RESULTS: Fifty-four cases with intraoperative bone wax migration and 187 patients without migration were enrolled. The t -test revealed significant differences in the width and length of the MEC ( P = .013 and P = .003, respectively). These variables were identified as significant factors in predicting intraoperative bone wax migration using multivariate logistic regression analysis. CONCLUSION: The large size of the MEC may be related to intraoperative bone wax migration into the sigmoid sinus in MVD. Neurosurgeons should be aware of these risks. Bone wax should be applied appropriately and hemostasis should be considered to control bleeding from the mastoid emissary vein in patients with a large MEC.
Assuntos
Cirurgia de Descompressão Microvascular , Palmitatos , Neuralgia do Trigêmeo , Ceras , Humanos , Estudos de Casos e Controles , Estudos Retrospectivos , Cirurgia de Descompressão Microvascular/efeitos adversos , Cirurgia de Descompressão Microvascular/métodos , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/cirurgia , Craniotomia/efeitos adversos , Craniotomia/métodosRESUMO
OBJECTIVE: High-resolution magnetic resonance imaging (MRI) of the trigeminal nerve is indispensable for workup of trigeminal neuralgia (TN) before microvascular decompression; however, the evaluation is often subjective and prone to variability. We aim to develop and assess sequential thresholding-based automated reconstruction of the trigeminal nerve (STAR-TN) as an algorithm for segmenting the trigeminal nerve and contacting structures that will allow for a structured method for assessing neurovascular conflict. METHODS: A total of 42 patients with TN who underwent high-resolution MRI before microvascular decompression in 2022 were included in our study. Segmentation of the trigeminal nerve and contacting structures was performed on preoperative MRI scans using STAR-TN. The segmentations were then evaluated for neurovascular conflict and compared to the preoperative radiology and operative notes. Geometric features, including the area of contact and distance to conflict, were extracted. RESULTS: Of the 42 patients, 32 (76.2%) were found to show neurovascular conflict based solely on their STAR-TN segmentations and 10 (23.8%) were found to not show neurovascular conflict. Compared with the intraoperative findings, this resulted in a sensitivity of 78.0% and specificity of 100%. In contrast, assessments of neurovascular conflict by radiologists using only 2-dimensional MRI views had a sensitivity of 68.3% and specificity of 100%. Of the 32 patients with neurovascular conflict, 29 (90.9%) had conflict within the root entry zone. Overall, the patients had a median area of contact of 10.66 mm2. CONCLUSIONS: STAR-TN allows for 3-dimensional visualization and identification of neurovascular conflict with improved sensitivity compared with neuroradiologist assessments from MRI slices.
Assuntos
Cirurgia de Descompressão Microvascular , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/cirurgia , Neuralgia do Trigêmeo/patologia , Nervo Trigêmeo/diagnóstico por imagem , Nervo Trigêmeo/cirurgia , Nervo Trigêmeo/patologia , Imageamento por Ressonância Magnética/métodos , Cirurgia de Descompressão Microvascular/métodos , AlgoritmosRESUMO
BACKGROUND AND OBJECTIVE: Microvascular decompression (MVD) is the most definitive and preferred surgical treatment for trigeminal neuralgia (TN). Treatment of TN caused by the vertebrobasilar artery (VBA) has been reported to be challenging and less satisfactory in complications and recurrence. Endoscopy has been implemented to provide a comprehensive view of neurovascular conflicts and minimize brain tissue stretch injury while exploring the trigeminal nerve. However, there are few retrospective studies on the treatment of TN caused by VBA by fully endoscopic microvascular decompression (E-MVD). This article aimed to illustrate the safety and efficacy of E-MVD for TN caused by the VBA. METHODS: Clinical data for 26 patients with TN caused by the VBA who underwent E-MVD from 2019 to 2022 were retrospectively analyzed. The characteristics of vertebrobasilar-associated TN were summarized. The safety and efficacy of E-MVD for vertebrobasilar-associated TN were estimated based on the analysis of intraoperative manipulation, postoperative symptom relief, and complications. RESULTS: Intraoperatively, the vertebrobasilar artery was regarded as a direct offending vessel in all 26 patients with TN, the vertebral artery in 18 (69.23%) and the basilar artery in 10 (38.46%). In addition to the vertebrobasilar artery, other vessels involved included the superior cerebellar artery in 12 patients, anterior inferior cerebellar artery in 9, posterior inferior cerebellar artery in 1, and veins in 4. All patients underwent E-MVD, and TN was entirely resolved in 26 (100%) patients immediately postoperatively. During the follow-up period of 12-45 months, no recurrence or serious complications were found. There were no serious postoperative complications, such as cerebellar swelling, intracranial hemorrhage, or death. CONCLUSION: E-MVD for vertebrobasilar-associated TN is effective and safe.
Assuntos
Cirurgia de Descompressão Microvascular , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgia , Estudos Retrospectivos , Cirurgia de Descompressão Microvascular/métodos , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , EndoscopiaRESUMO
BACKGROUND: Trigeminal neuralgia (TN) is characterized by paroxysmal episodes of severe shocklike orofacial pain typically resulting from arterial compression on the trigeminal root entry zone. However, neurovascular conflict in more proximal parts of the trigeminal pathway within the pons is extremely rare. METHODS: The authors present a case of microvascular decompression for TN caused by dual arterial compression on the dorsolateral pons, along with a brief literature review. RESULTS: Our patient was a 74-year-old man with episodic left-sided facial stabbing pain. Brain magnetic resonance imaging revealed a dual arterial compression on dorsolateral pons, the known site of the trigeminal sensory nucleus and descending trigeminal tract. Microvascular decompression was performed via a retrosigmoid approach. Complete pain relief and partial improvement of the facial hypesthesia were achieved immediately after surgery and the Barrow Neurological Institute (BNI) pain intensity score improved from V to I, and the BNI hypesthesia score decreased from III to II within a month following surgery. The literature review identified 1 case of TN secondary to an arteriovenous malformation in root entry zone with lateral pontine extension. One month following partial coagulation of the draining vein, the patient was reportedly able to reduce medication dosage by half to achieve an improvement of BNI pain intensity score from V to IIIa. CONCLUSIONS: Neurovascular compression in the trigeminal tract and nucleus is a rare but potential cause of TN. A thorough investigation of the trigeminal pathway should be considered during preoperative evaluation and intraoperative inspection, particularly if no clear offending vessel is identified.