Petrosal Vein Involvement in Neurovascular Conflict in Trigeminal Neuralgia: Surgical Technique and Clinical Outcomes
| Autor: | Takuro Inoue, Satoshi Shitara, Takanori Fukushima, Mustaqim Prasetya, Yukihiro Goto |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Trigeminal nerve
medicine.medical_specialty Nerve root business.industry medicine.medical_treatment Microvascular decompression Trigeminal Neuralgia Neurovascular bundle medicine.disease Cerebral Veins Preoperative care Microvascular Decompression Surgery Surgery medicine.anatomical_structure Trigeminal neuralgia Concomitant medicine Humans Trigeminal Nerve Neurology (clinical) Vein business Retrospective Studies |
| Zdroj: | Operative Neurosurgery. 20:E264-E271 |
| ISSN: | 2332-4260 2332-4252 |
| DOI: | 10.1093/ons/opaa422 |
| Popis: | Background Contact of the main stem of the petrosal vein (PV) to the nerve root is a rare cause of trigeminal neuralgia (TGN). The implication of the PV in relation with neurovascular contact (NVC) is not fully understood. Objective To assess the operative procedures in microvascular decompression (MVD) in patients with PV involvement in the long-term. Methods We retrospectively reviewed 34 cases (7.0%) in 485 consecutive MVDs for TGN, whose PV main stem had contact with the trigeminal nerve root (PV-NVC). PV-NVCs were divided into 2 groups: concomitant arterial contact or no concomitant arterial contact. Surgical techniques, outcomes, complications, and recurrence were assessed. Results The anatomical relationship of the PV with the trigeminal nerve root was consistent with preoperative 3-dimensional imaging in all patients. Pain relief was obtained in most patients immediately after surgery (97.1%) by separating the PV from the nerve root. Postoperative facial numbness was noted in 9 patients (26.5%). Symptomatic venous infarctions occurred in 2 patients (5.9%). Recurrence of facial pain occurred in 3 patients (8.8%) with a median 48 mo follow-up period. Re-exploration surgery revealed adhesion being the cause of recurrence. The statistical analyses showed no difference in the surgical outcomes of the 2 groups. Conclusion Separating the PV from the nerve root contributes to pain relief in patients with PV conflict regardless of concomitant arteries. Preserving venous flow is crucial to avoid postoperative venous insufficiency. |
| Databáze: | OpenAIRE |
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