Microvascular decompression for trigeminal neuralgia caused by vertebrobasilar dolichoectasia: interposition technique v
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ORIGINAL ARTICLE - FUNCTIONAL NEUROSURGERY - PAIN
Microvascular decompression for trigeminal neuralgia caused by vertebrobasilar dolichoectasia: interposition technique versus transposition technique Songshan Chai 1 & Hao Xu 1,2 & Qiangping Wang 1 & Junjun Li 1 & Jiajing Wang 1 & Yihao Wang 1 & Hendrik Pool 3 & Minhua Lin 1 & Nanxiang Xiong 1,4 Received: 25 June 2020 / Accepted: 3 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Various techniques of microvascular decompression have been proposed for trigeminal neuralgia (TN) caused by vertebrobasilar dolichoectasia (VBD) with two main modalities: interposition and transposition. This retrospective study compares the outcomes of two techniques belonging to different modalities for VBD-associated TN. Methods From January 2011 to April 2017, 39 patients underwent MVD for VBD-associated TN. The transposition method chosen was the biomedical glue sling technique. Patients were divided into the interposition group (n = 16) and the transposition group (n = 23). The radiologic data, intraoperative findings, complications, and outcomes were analyzed. Results The 1-, 3-, and 5-year pain-free (BNI class I) maintenance rates were 100.0, 91.1, and 91.1%, respectively, in the transposition group and 87.5, 74.5, and 58.7% in the interposition group (p = 0.032). Postoperative complications were similar in both groups, but there was a trend for higher incidence of postoperative facial hypoesthesia using the interposition technique (p = 0.06). Conclusion In cases of VBD-associated TN, the transposition technique using biomedical glue was superior to the traditional interposition technique in maintaining a pain-free status, with no increase in the incidence of complication. Keywords Trigeminal neuralgia . Microvascular decompression . Vertebrobasilar dolichoectasia . Interposition technique . Transposition technique
This article is part of the Topical Collection on Functional Neurosurgery - Pain
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04572-7) contains supplementary material, which is available to authorized users.
Symptomatic trigeminal nerve compression by vertebrobasilar dolichoectasia (VBD) is rare, ranging from 2 to 7.7% of cases in past trigeminal neuralgia (TN) series [2]. When medical therapy for VBD-associated TN has failed, surgical options such as trigeminal rhizotomy, percutaneous thermocoagulation, microvascular decompression (MVD), and gamma knife radiosurgery can be considered [39]. The ideal surgical option is said to be MVD because it is nondestructive and corrects the hypothesized vascular etiology. Various surgical techniques have been applied to deal with the offending vertebrobasilar arteries during MVD. Generally, these techniques can be classified into two different modalities: the interposition method and the transposition method. The former is relatively traditional and routinely requires insertion of implants between the offendi
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