Trigeminal Neuralgia due to Vertebrobasilar Artery Compression
| Autor: | C Michael Honey, Anthony M. Kaufmann |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Decompression medicine.medical_treatment Length of hospitalization Microvascular decompression Cohort Studies 03 medical and health sciences 0302 clinical medicine Trigeminal neuralgia Ectasia medicine Vertebrobasilar Insufficiency Humans Aged Retrospective Studies Trigeminal nerve business.industry Rhizotomy Length of Stay Middle Aged Trigeminal Neuralgia medicine.disease Surgery Microvascular Decompression Surgery 030220 oncology & carcinogenesis cardiovascular system Vertebrobasilar artery Female Neurology (clinical) business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | World neurosurgery. 118 |
| ISSN: | 1878-8769 |
| Popis: | Objective Classical trigeminal neuralgia (cTN) is rarely caused by ectatic vertebrobasilar artery compression of the trigeminal nerve. These patients present a surgical challenge and often are not considered for microvascular decompression (MVD) due to assumed risk. Methods A review of patients who were surgically treated by the senior author between 1997 and 2016 with an admitting diagnosis of cTN was performed. Details of the surgery were documented, including the technique for maintaining vascular decompression, complications, and the length of stay. Clinical follow-up was obtained from patient charts as well as telephone questionnaires. Results During the 20-year review, 552 patients underwent MVD for cTN, and 13 (2.4%) had dolichoectatic vertebrobasilar compressions (10 male, 3 female). The average hospital length of stay was 2.8 days (range 2–7) with no major complications. At final follow-up (>2 years), 7 had no pain with no medications (78%), 2 had persistent pain (22%)—1 of whom underwent a successful glycerol rhizotomy at 8 months—2 were lost to follow-up, and 2 had surgery within 2 years. Conclusions Patients with cTN due to a dolichoectatic vertebrobasilar artery compression present a unique surgical challenge. Mobilizing the vessel can be difficult because it may be firm from atherosclerosis, maintaining its separation from the nerve is similarly difficult, and manipulating the vessel can be dangerous because of its brainstem perforators. Our case series provides some evidence to support the safety and efficacy of MVD for patients with vertebrobasilar ectasia for those that major surgery is not contraindicated. |
| Databáze: | OpenAIRE |
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