Tag: Microvascular decompression

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Prospective Comparison of Posterior Fossa Exploration and Stereotactic Radiosurgery Dorsal Root Entry Zone Target as Primary Surgery for Patients With Idiopathic Trigeminal Neuralgia

Neurosurgery 67:633-639, 2010 DOI: 10.1227/01.NEU.0000377861.14650.98

Trigeminal neuralgia (TN) is the most common facial pain syndrome, with an incidence of approximately 27 per 100 000 patient-years.

OBJECTIVE: To prospectively compare facial pain outcomes for patients having either a posterior fossa exploration (PFE) or stereotactic radiosurgery (SRS) as their first surgery for idiopathic TN.

METHODS: Prospective cohort study of 140 patients with idiopathic TN who had either PFE (n = 91) or SRS (n = 49) from June 2001 until September 2007. The groups were similar with regard to sex, pain location, and pain duration. Patients who had SRS were older (67.1 vs 58.2 years; P < .001). The median follow-up after surgery was 38 months.

RESULTS: Patients who had PFE more commonly were pain free off medications (84% at 1 year, 77% at 4 years) compared with the SRS patients (66% at 1 year, 56% at 4 years; hazard ratio = 2.5; 95% confidence interval, 1.4-4.6; P = .003). Additional surgery for persistent or recurrent face pain was performed in 14 patients after PFE (15%) compared with 17 patients after SRS (35%; P = .009). Nonbothersome facial numbness occurred more frequently in the SRS group (33% vs 18%; P = .04). No difference was noted in other complications between patients who had PFE (12%) (dysesthetic facial pain, n = 3; cerebrospinal fluid leakage, n = 3; hearing loss, n = 2; wound infection, n = 1; pneumonia, n = 1; deep vein thrombosis, n = 1) and patients who had SRS (8%) (dysesthetic facial pain, n = 4; P = .47).

CONCLUSION: PFE is more effective than SRS as a primary surgical option for patients with idiopathic TN

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Microvascular decompression for treating hemifacial spasm: lessons learned from a prospective study of 1,174 operations

Neurosurg Rev (2010) 33:325–334.DOI 10.1007/s10143-010-0254-9

The authors critically analyzed a large series of patients with hemifacial spasm (HFS) and who underwent microvascular decompression (MVD) under a prospective protocol. We describe several “lessons learned” that are required for achieving successful surgery and proper postoperative management.

The purpose of this study is to report on our experience during the previous 10 years with this procedure and we also discuss various related topics.

From April 1997 to June 2009, over 1,200 consecutive patients underwent MVD for HFS. Among them, 1,174 patients who underwent MVD for HFS with a minimum 1 year follow-up were enrolled in the study. The median follow-up period was 3.5 years (range, 1-9.3 years). Based on the operative and medical records, the intraoperative findings and the postoperative outcomes were obtained and then analyzed. At the 1- year follow-up examination, 1,105 (94.1%) patients of the total 1,174 patients exhibited a “cured” state, and 69 (5.9%) patients had residual spasms. In all the patients, the major postoperative complications included transient hearing loss in 31 (2.6%), permanent hearing loss in 13 (1.1%), transient facial weakness in 86 (7.3%), permanent facial weakness in 9 (0.7%), cerebrospinal fluid leak in three (0.25%) and cerebellar infarction or hemorrhage in two (0.17%). There were no operative deaths.

Microvascular decompression is a very effective, safe modality of treatment for hemifacial spasm. MVD is not sophisticated surgery, but having a basic understanding of the surgical procedures is required to achieve successful surgery

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Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging: a prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia

Acta Neurochir (2010) 152:817–825. DOI 10.1007/s00701-009-0588-7

Surgical outcome after microvascular decompression (MVD) for primary trigeminal neuralgia (TN) has been demonstrated as being related to the characteristics of the neurovascular compression (NVC), especially to the degree of compression exerted on the root. Therefore, preoperative determination of the NVC features could be of great value to the neurosurgeon, for evaluation of conflicting nature, exact localization, direction and degree of compression. This study deals with the predictive value of MRI in detecting and assessing features of vascular compression in 100 consecutive patients who underwent MVD for TN.

Methods. The study included 100 consecutive patients with primary TN who were submitted to a preoperative 3D MRI 1.5 T with T2 high-resolution, TOF-MRA, and T1-Gadolinium. Image analysis was performed by an independent observer blinded to the operative findings and compared with surgical data.

Findings. In 88 cases, image analysis showed NVC features that coincided with surgical findings. There were no false-positive results. Among 12 patients that did not show NVC at image analysis, nine did not have NVC at intraoperative observation, resulting in three false-negative cases. MRI sensitivity was 96.7% (88/91) and specificity 100% (9/9). Image analysis correctly identified compressible vessel in 80 of the 91 cases and degree of compression in 77 of the 91 cases. Kappa-coefficient predicting degree of root compression was 0.746, 0.767, and 0.86, respectively, for Grades I (simple contact), II (distortion), and III (marked indentation; p<0.01).

Conclusion. 3D T2 high-resolution in combination with 3D TOF-MRA and 3D T1-Gadolinium proved to be reliable in detecting NVC and in predicting the degree of the root compression

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