[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: Trigeminal neuralgia is a disorder associated with severe episodes of lancinating pain in the distribution of trigeminal nerve. The majority of these patients eventually requires surgical management to achieve remission of symptoms. Microvascular decompression addresses the root cause of the disease and is more effective than ablative procedures at preventing recurrence of symptoms. However, several long-term follow-up studies have disclosed that the efficacy of the procedure gradually decreases over time and have related recurrence to some clinical variables. Our objective is to study the impact of the type of interposing materials used for decompression on long-term success rate.
MATERIALS and METHODS: We conducted a retrospective chart review of 65 patients with trigeminal neuralgia operated between 2007 and 2010 in an otology/base of skull tertiary referral center. Endoscopy-assisted microvascular decompression was used for all patients. Three types of interposing material were used: Teflon in 30 patients (Group I); muscle in 19 patients (Group II); and a combination of both in 16 patients (Group III). The minimum follow-up period was 3 years.
RESULTS: In total, 17 (26.1%) of the 65 patients had recurrence of their symptoms. Average time for recurrence was 7.82+/-4.31 months; 95% of recurrences appeared within the first year. Recurrence rate was lower in Group II (5.2%) as compared to Group I (40%) and Group III (23%), and the difference was statistically significant (p≤0.05).
CONCLUSION: Microvascular decompression with interposition of a muscle pad carries a lower recurrence rate as compared to interposition of Teflon alone or in combination with muscle.
Journal of International Advanced Otology 10/2014; Int Adv Otol 2014; 10(2): 107-112 •(2014; 10(2)):107-112. · 0.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Object Vascular compression of the trigeminal nerve is the most common factor associated with the etiology of trigeminal neuralgia (TN). Microvascular decompression (MVD) has proven to be the most successful and durable surgical approach for this disorder. However, not all patients with TN manifest unequivocal neurovascular compression (NVC). Furthermore, over time patients with an initially successful MVD manifest a relentless rate of TN recurrence. Methods The authors performed a retrospective review of cases of TN Type 1 (TN1) or Type 2 (TN2) involving patients 18 years or older who underwent evaluation (and surgery when indicated) at Oregon Health & Science University between July 2006 and February 2013. Surgical and imaging findings were correlated. Results The review identified a total of 257 patients with TN (219 with TN1 and 38 with TN2) who underwent high-resolution MRI and MR angiography with 3D reconstruction of combined images using OsiriX. Imaging data revealed that the occurrence of TN1 and TN2 without NVC was 28.8% and 18.4%, respectively. A subgroup of 184 patients underwent surgical exploration. Imaging findings were highly correlated with surgical findings, with a sensitivity of 96% for TN1 and TN2 and a specificity of 90% for TN1 and 66% for TN2. Conclusions Magnetic resonance imaging detects NVC with a high degree of sensitivity. However, despite a diagnosis of TN1 or TN2, a significant number of patients have no NVC. Trigeminal neuralgia clearly occurs and recurs in the absence of NVC.
Journal of Neurosurgery 02/2014; · 3.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The increasing number of reports of complications after sacrificing the superior petrosal veins, the largest veins in the posterior fossa, has led to a need for an increased understanding of the anatomy of these veins and the superior petrosal sinus into which they empty.
To examine the anatomy of the superior petrosal veins and their size, draining area, and tributaries, and the anatomic variations of the superior petrosal sinus.
Injected cadaveric cerebellopontine angles (CPAs) and 3-D-multifusion angiography images were examined.
The 4 groups of the superior petrosal veins based on their tributaries, course, and draining areas are: the petrosal, posterior mesencephalic, anterior pontomesencephalic, and tentorial groups. The largest group was the petrosal group. Its largest tributary, the vein of the cerebellopontine fissure, was usually identifiable in the suprafloccular cistern located above the flocculus on the lateral surface of the middle cerebellar peduncle. The medial or lateral segment of the superior petrosal sinus was absent in 40% of CPAs studied with venography.
The superior petrosal veins and their largest tributaries, especially the vein of the cerebellopontine fissure, should be preserved if possible. Obliteration of superior petrosal sinuses in which either the lateral or medial portion is absent may result in loss of the drainage pathway of the superior petrosal veins. Preoperative assessment of the superior petrosal sinus should be considered before transpetrosal surgery in which the superior petrosal sinus may be obliterated.
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