Microvascular decompression for trigeminal neuralgia attributable to the vertebrobasilar artery: decompression technique
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ORIGINAL ARTICLE - FUNCTIONAL NEUROSURGERY - PAIN
Microvascular decompression for trigeminal neuralgia attributable to the vertebrobasilar artery: decompression technique and significance of separation from the nerve root Takuro Inoue 1 & Satoshi Shitara 1 & Yukihiro Goto 2 & Mustaqim Prasetya 3 & Takanori Fukushima 4 Received: 26 June 2020 / Accepted: 28 August 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Separation of the vertebrobasilar artery (VBA) from the trigeminal nerve root in microvascular decompression (MVD) is technically challenging. This study aimed to review the clinical features of VBA involvement in trigeminal neuralgia and evaluate surgical decompression techniques in the long term. Methods We retrospectively reviewed the surgical outcomes of 26 patients (4.4%) with VBA involvement in 585 consecutive MVDs for TGN using a Teflon roll for repositioning the VBA. The final operative status of the nerve decompression was categorized into two groups: the separation group and the contact group. Separation of the VBA from the nerve root was completed in 13 patients in the separation group, and slight vascular contact remained in the remaining 13 patients of the contact group. The clinical features of VBA-related TGN were investigated and the operative results were analyzed. Results Multiple arteries are involved in neurovascular compression (NVC) in most cases. The anterior inferior cerebellar artery was the most common concomitant artery (69%). The site of the NVC varies from the root entry zone to the distal portion of the root. All patients were pain-free immediately after surgery and maintained medication-free status during the follow-up period, except for one patient (3.8%) who had recurrent facial pain 8 years after surgery. Postoperative facial numbness was observed in six patients (23%). Of these, one patient showed improvement within 3 months and the other five patients had persistent facial numbness (19.2%). Other neurological deficits include one dry eye, one diplopia due to trochlear nerve palsy, two decreased hearing (< 50 db), two facial weaknesses, and two cerebellar ataxia. Although most of them were transient, one dry eye, two hearing impairments, and one cerebellar ataxia became persistent deficits. Statistical analyses revealed no difference in surgical efficacy or complications in the long term between the two groups. Conclusions Slightly remaining vascular contact does not affect pain relief in the long term. Our study indicated that once the tense trigeminal nerve is loosened, further attempts to mobilize the VBA are not necessary. Keywords Basilar artery . Microvascular decompression . Trigeminal neuralgia . Vertebral artery
This article is part of the Topical Collection on Functional Neurosurgery - Pain * Takuro Inoue [email protected] 1
Department of Neurosurgery, Subarukai Koto Kinen Hospital, 2-1 Hiramatsu-cho, Higashiomi-shi, Shiga 527-0134, Japan
2
Department of Neurosurgery, Saiseikai Shiga Hospital, Ritto, Shiga, Japan
3
Depa
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