Surgical Nuances and Predictors of Requirement for Suprameatal Tubercle Removal in Microvascular Decompression for Trigeminal Neuralgia.

Autor: Iwasaki K; Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.; Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan., Uezato M; Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.; Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan., Nishida N; Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan., Yoshimoto N; Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan., Kitamura K; Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan., Gomi M; Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan., Hashikata H; Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan., Sasaki I; Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan., Toda H; Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
Jazyk: angličtina
Zdroj: Journal of neurological surgery. Part B, Skull base [J Neurol Surg B Skull Base] 2023 Nov 28; Vol. 85 (Suppl 2), pp. e38-e45. Date of Electronic Publication: 2023 Nov 28 (Print Publication: 2024).
DOI: 10.1055/a-2198-8279
Abstrakt: Objective  Suprameatal tubercle (SMT), a bony prominence located above the internal acoustic meatus, is reported to impede the microscopic view during microvascular decompression (MVD) for trigeminal neuralgia (TN). For an enlarged SMT, removal of the SMT may be required in addition to the routine MVD to precisely localize the offending vessels. The objective of this study is to investigate the predictive factors influencing the requirement of SMT removal during trigeminal MVD. Methods  We retrospectively reviewed 197 patients who underwent MVD for TN, and analyzed the correlation of the SMT height and other clinicosurgical data with the necessity to remove the SMT during MVD. The parameters evaluated in the statistical analyses included maximum SMT height, patient's clinical characteristics, surgical data including the type and number of offending vessels, and surgical outcomes. Results  SMT removal was required for 20 patients among a total of enrolled 197 patients. In the univariate analysis, maximum SMT height, patient's age, and number (≥ 2) of offending vessels were associated with the requirement for SMT removal. Multivariate analysis with binary logistic regression revealed that the maximum SMT height and number (≥ 2) of offending vessels were significant factors influencing the necessity for SMT removal. A receiver operating characteristic curve analysis revealed that an SMT height ≥ 4.8 mm was the optimal cutoff value for predicting the need for SMT removal. Conclusion  Large SMTs and the presence of multiple offending vessels are helpful in predicting the technical difficulty of trigeminal MVD associated with the necessity of SMT removal.
Competing Interests: Conflict of Interest None declared.
(Thieme. All rights reserved.)
Databáze: MEDLINE
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