Tag: Venous compression

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A Case Series of Trigeminal Neuralgia With Pure Venous Compression: Postoperative Outcomes Associated With Intraoperative Venous Transposition Versus Coagulation

Operative Neurosurgery 24:377–382, 2023

Microvascular decompressions (MVDs) are effective open-surgical procedures for trigeminal neuralgia (TN). Intraoperative management of compressive veins may include either venous transposition or coagulation. Although both are generally considered safe,which technique results in optimal postoperative outcomes remains unclear.

OBJECTIVE: To compare postoperative pain and numbness outcomes after an MVD in patients with TN of exclusive venous compression.

METHODS: We retrospectively reviewed all patients with TN who underwent MVDs at our institution from 2007 to 2020. Patients with TN of pure venous compression were identified using MRI imaging, which was subsequently confirmed intraoperatively. Patient demographics, procedural characteristics, and postoperative pain and numbness scores were recorded and compared. Factors associated with pain recurrence were assessed using survival analyses and multivariate regressions.

RESULTS: We identified 181 patients who presented with TN of pure venous compression. Using a multivariate linear regression, adjusted for age, sex, and presence of multiple sclerosis, use of venous transposition vs coagulation was not significantly associated with the Barrow Neurological Institute pain score at final follow-up, although venous transposition was significantly predictive of a worse postoperative Barrow Neurological Institute numbness score (P = .003). Using a Kaplan–Meier survival analysis and a multivariate Cox proportional hazards regression, respectively, venous transposition was significantly associated with faster (P = .01) as well as higher risk for pain recurrence (P = .01).

CONCLUSION: The use of venous coagulation during an MVD is associated with better postoperative pain and numbness outcomes. The results of our study may help inform preoperative patient counseling and surgical management for TN cases that involve pure venous compression.

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Purely venous compression in trigeminal neuralgia—can we predict the outcome of surgery

Acta Neurochirurgica (2022) 164:1567–1573

Controversies regarding venous compression and trigeminal neuralgia (TN) still exist. The study demonstrates our experience for microvascular decompression (MVD) in TN caused by purely venous compression. The goal was to identify prognostic anatomical or surgical factors that may influence the outcome.

Methods Between 2004 and 2020, 49 patients were operated with purely venous compression. Average age was 58.4 years. Mean history of TN was 7.8 years. Microsurgical procedures included transposition or separation of the vein, coagulation, and division. Several features have been analyzed with respect to BNI scores.

Results Evaluation on discharge revealed a complete pain relief in 39 (80%), partial improvement in 7 (14%), and no benefit in 3 (6%) patients. Facial hypesthesia was reported by 14 (28.6%) patients. Mean follow-up (FU) was 42.1 months. BNI pain intensity score on FU revealed 71.4% excellent to very good scores (score 1: 32 (65.3%); 2: 3 (6.1%)). BNI facial numb- ness score 2 could be detected in 13 patients (26.5%) during FU. There was no statistical relationship between immediate pain improvement or BNI pain intensity score on FU with respect to surgical procedure, size of trigeminal cistern, type of venous compression, venous caliber, trigeminal nerve indentation, or neurovascular adherence. BNI facial numbness score was dependent on type of venous compression (p < 0.05).

Conclusion We did not find typical anatomical features that could either predict or influence the outcome regarding pain improvement or resolution in any form. Neither classic microvascular decompression (interposition/transposition) nor sacrificing the offending vein made any difference in outcome.

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Trigeminal neuralgia due to venous neurovascular conflicts

Acta Neurochir (2017) 159: 237

Implication of veins as neurovascular conflict (NVC) in the genesis of trigeminal neuralgia (TN) remains a matter of debate. Few reports dealing with venous NVC have been published. The objective of this study is to describe the outcome in a historical cohort of consecutive patients with classical TN due to venous compression.

Methods: All patients with TN treated by microvascular decompression (MVD) from 2005 to 2013 were included if a marked venous compression was found at the surgery either alone or accompanied by an artery. Patients were evaluated for clinical presentation, operative findings and the long-term outcome. Outcome was considered favourable if patients were classed as BNI I or II (i.e. not requiring any medication). Kaplan-Meier analysis was used to determine probability of a favourable outcome at 10 years of follow-up.

Results:  Out of the overall series of 313 patients having been treated by MVD and considered for the study, in 55 (17.5 %) a vein was the main compressive vessel; in 26 (8.3 %) it was the only compressive vessel. Probability of relief with no need for medication at 10 years was 70.6 %. The patients with focal arachnoiditis had a poor long-term outcome, i.e. BNI III-V, in 85.7 % compared with 20.8 % without arachnoiditis (p = 0.0037 Fisher’s exact test). No differences in outcome were found between patients presenting with purely venous compression and patients with mixed compression. Outcome was similarly good for patients with atypical neuralgia when compared to patients with typical clinical presentation.

Conclusions: Venous NVC as a cause of TN is far from rare. MVD with complete liberation of the entire root in cases with clear-cut venous compression on imaging studies gives a good probability of long-term pain relief, thus encouraging to propose surgery for such patients.

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Clinical features and surgical treatment of trigeminal neuralgia caused solely by venous compression

Acta Neurochir (2011) 153:1037–1042. DOI 10.1007/s00701-011-0957-x

Purpose To summarize our experience and lessons of microvascular decompression surgery for trigeminal neuralgia caused solely by venous compression.

Methods Fifteen patients with idiopathic trigeminal neuralgia caused by venous compression only underwent microvascular decompression. The entire course of the trigeminal root was explored thoroughly; and coagulating and cutting techniques were preferred in decompressing the culprit veins. Their clinical features, outcomes and operative complications were analyzed.

Results The compressing veins included the transverse pontine vein in five cases (33.3%), the transverse pontine vein and the vein of middle cerebellar peduncle in one (6.7%), the transverse pontine vein and the vein of cerebellopontine fissure in one (6.7%), the superior petrosal vein in three (20%), the pontotrigeminal vein in one (6.7%), the vein of the cerebellopontine fissure in two (13.3%), and the plexus venosus or venule in two (13.3%). After microvascular decompression, 11 cases (73.3%) had “excellent” or “good” pain relief. Four cases (26.7%) failed the first surgery; and two of them underwent re-operation and got “excellent” pain relief. Postoperative facial numbness appeared in four cases, due to injury to trigeminal nerve when coagulation.

Conclusion The transverse pontine vein is the most common offending vein. For this type of trigeminal neuralgia, coagulating and cutting techniques are preferred in decompressing the culprit veins. The entire course of the trigeminal root should be explored and decompressed. Following these principles, excellent or good pain relief could be achieved in most cases; and recurrence is rare. However, sometimes injury to the nerve is unavoidable when coagulating the culprit vein.

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