Trigeminal Nerve Isolation Application in Microvascular Decompression for Treating Trigeminal Neuralgia: A Retrospective Study.

This study aimed to compare the outcomes of trigeminal nerve isolation (TNI) with conventional microvascular decompression (CMVD) in cases of trigeminal neuralgia (TN). We retrospectively reviewed 143 TN cases who underwent microvascular decompression from January 2017 to January 2020. The surgical management of TNI or CMVD in all patients was randomized. The cases were divided into two groups, one group underwent a TNI and the other one received CMVD. The general data, postoperative outcomes, and complications were reviewed retrospectively. Cases with a narrow cistern of cerebellopontine, short trigeminal nerve root, and arachnoid adhesion were defined as difficult cases. All of the cases were followed up for at least 1 year. Surgical outcomes were assessed and compared between the two groups. In results, we found no significant differences in the general data, duration of hospitalization and blood loss between the two procedures. However, of the 143 cases, 12 cases (17.1%) recurred after surgery in the CMVD group, and four cases (5.5%) recurred after TNI operation. The rates of pain relief were 69 (94.5%) in the CMVD group, and 58 (82.9%) for TNI ( P =0.027). In the TNI group, there was only one difficult case among four no pain-relief cases, while in the CMVD group, 10 difficult cases were found among the 12 no pain-relief cases ( P =0.008). In conclusion, the TNI technique is more effective than the CMVD procedure and could also be performed on patients with classical TN. Future double-blind and randomized controlled trials are necessary to confirm this result.

Dura-splitting versus a combined technique for Chiari malformation type I complicated with syringomyelia.

BACKGROUND: Surgical approaches for Chiari malformation type I (CM-I) complicated with syringomyelia (SM) are controversial, so we assessed the efficacy and safety of two widely used procedures. METHODS: We retrospectively analyzed results from posterior fossa decompression (PFD) using bony decompression with dura-splitting or a combined technique (duraplasty with arachnoid dissection and coagulation of the herniated tonsils) for CM-I associated with SM between Jan 2008 and Feb 2016. Patients were followed up for at least one year. General data, primary outcomes (symptom improvement, syrinx reductions, and complications) and secondary outcomes (operating time, blood loss, postoperative hospital stay) for each procedure were compared. RESULTS: Of the 49 patients treated, 17 had dura-splitting decompression and 32 had the combined technique. There were no significant differences in general data. The combined technique was significantly superior to dura-splitting for long-term syrinx reductions (length, 100.03 ± 44.79 vs 72.73 ± 34.79 mm, p = 0.040; diameter, 8.09 ± 3.46 vs 5.73 ± 3.02 mm, p = 0.026) and symptom improvement (75.00% vs 47.06%, p = 0.036). No postoperative complications occurred during dura-splitting cases; however, complications occurred in 9 combined technique cases (31.25%, p = 0.010) and surgical time was longer for the combined technique (248.03 ± 60.12 vs 167.94 ± 60.11 min, p < 0.001). CONCLUSIONS: The combined technique improved long-term symptoms and reduced syringes compared to dura-splitting; however, postoperative complications are more likely.

Morphological Parameters of Digital Subtraction Angiography 2D Image in Rupture Risk Profile of Small Intracranial Aneurysms: A Pilot Study.

OBJECTIVE: To analyze the morphological parameters of small intracranial aneurysms using two-dimensional digital subtraction angiography (DSA) and to identify their relationship with rupture risk. METHODS: Clinical and radiologic data from patients with DSA-confirmed small intracranial aneurysms and who received intravascular treatment were retrospectively analyzed. Morphological parameters such as maximum height, transverse diameter, aneurysm neck width, and aspect ratio (AR) were compared between patients with ruptured and unruptured aneurysms. Logistic regression analysis was performed to identify the predictors of rupture risk. RESULTS: There were no significant differences between the unruptured (n = 40) and ruptured groups (n = 34) with respect to maximum height (p = 0.087) and transverse diameter (p = 0.736). However, aneurysm neck width (p = 0.006) and AR (p < 0.001) were found to be significantly different between the groups. AR value was analyzed through the receiver operating characteristic curve, and the best AR threshold was determined to be 1.49. A stepwise multivariate analysis showed that AR was the only independent factor for rupture risk. CONCLUSION: Two-dimensional DSA could be used to determine AR, which was an independent predictor of rupture risk of small aneurysms. Further studies with large sample sizes are needed to validate these results.

Epidemiological and clinical features of Moyamoya disease in Nanjing, China.

OBJECTIVE: The epidemiology of Moyamoya disease in mainland China has not been documented. Therefore, the present study was designed to examine the epidemiological and clinical features of Moyamoya disease in Nanjing, a provincial capital in China. METHODS: Patient records from multiple hospitals in Nanjing from January 2000 to December 2007 were collected. The clinical features of Moyamoya disease were retrospectively analyzed. RESULTS: A total of 202 patients were identified. There were 94 males and 108 females, with ages ranging from 2 to 78 years. There was a dual age peak, one in the group of patients 5-9 years of age and another in the group of patients 35-39 years of age. The initial symptoms included cerebral ischemia (81 patients, 40%), cerebral hemorrhage (113 patients, 55.9%) and asymptomatic disease (8 patients, 3.9%). An increasing incidence rate of Moyamoya disease was observed during the period of 2000-2007, with an average detection rate of 0.43cases/100,000 persons/year (prevalence 3.92/100,000 persons). The incidence of ischemia associated with the disease was 0.16cases/100,000 people-years and the incidence of hemorrhage was 0.22cases/100,000 people-years. CONCLUSION: This first study on the epidemiological and clinical features of Moyamoya disease in mainland China indicated an increasing incidence of Moyamoya disease with bimodal incidence distribution appearing more frequently in adults.