RESUMEN
Neurovascular compression syndrome (NVCS), characterized by cranial nerve compression due to adjacent blood vessels at the root entry zone, frequently presents as trigeminal neuralgia (TN), hemifacial spasm (HFS), or glossopharyngeal neuralgia (GN). Despite its prevalence in NVCS assessment, Magnetic Resonance Tomographic Angiography (MRTA)'s limited sensitivity to small vessels and veins poses challenges. This study aims to refine vessel localization and surgical planning for NVCS patients using a novel 3D multimodal fusion imaging (MFI) technique incorporating computed tomography angiography and venography (CTA/CTV). A retrospective analysis was conducted on 76 patients who underwent MVD surgery and were diagnosed with single-site primary TN, HFS, or GN. Imaging was obtained from MRTA and CTA/CTV sequences, followed by image processing and 3D-MFI using FastSurfer and 3DSlicer. The CTA/CTV-3D-MFI showed higher sensitivity than MRTA-3D-MFI in predicting responsible vessels (98.6% vs. 94.6%) and NVC severity (98.6% vs. 90.8%). Kappa coefficients revealed strong agreement with MRTA-3D-MFI (0.855 for vessels, 0.835 for NVC severity) and excellent agreement with CTA/CTV-3D-MFI (0.951 for vessels, 0.952 for NVC). Resident neurosurgeons significantly preferred CTA/CTV-3D-MFI due to its better correlation with surgical reality, clearer depiction of surgical anatomy, and optimized visualization of approaches (p < 0.001). Implementing CTA/CTV-3D-MFI significantly enhanced diagnostic accuracy and surgical planning for NVCS, outperforming MRTA-3D-MFI in identifying responsible vessels and assessing NVC severity. This innovative imaging modality can potentially improve outcomes by guiding safer and more targeted surgeries, particularly in cases where MRTA may not adequately visualize crucial neurovascular structures.
Asunto(s)
Angiografía por Tomografía Computarizada , Angiografía por Resonancia Magnética , Cirugía para Descompresión Microvascular , Síndromes de Compresión Nerviosa , Neuralgia del Trigémino , Humanos , Cirugía para Descompresión Microvascular/métodos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Síndromes de Compresión Nerviosa/cirugía , Síndromes de Compresión Nerviosa/diagnóstico por imagen , Adulto , Estudios Retrospectivos , Neuralgia del Trigémino/cirugía , Neuralgia del Trigémino/diagnóstico por imagen , Angiografía por Resonancia Magnética/métodos , Angiografía por Tomografía Computarizada/métodos , Espasmo Hemifacial/cirugía , Espasmo Hemifacial/diagnóstico por imagen , Imagenología Tridimensional/métodos , Enfermedades del Nervio Glosofaríngeo/cirugía , Anciano de 80 o más Años , Flebografía/métodosRESUMEN
This study aims to analyze and evaluate the comparative clinical outcomes associated with microvascular decompression (MVD) and gamma knife radiosurgery (GKRS), focusing on pain relief, pain recurrence, and complications encountered in the treatment of trigeminal neuralgia (TN). Among 155 surgical procedures performed for TN (90 GKRS, and 65 MVD) between March 1997 and December 2020, the exclusion criteria encompassed prior surgical interventions, the presence of other pathological conditions such as tumors, vascular diseases, and multiple sclerosis, as well as patients who were lost to follow-up. Ultimately, 101 patients received their initial treatment for primary TN (47 GKRS, and 54 MVD) and were followed up for more than 1 year. The MVD procedures utilized the suboccipital retrosigmoid sinus approach, whereas GKRS was conducted with MR imaging guidance, employing a single 4mm isocenter, with median GKRS doses of 80 Gy. We retrospectively analyzed patient characteristics, including sites of divisions, distributions of pain, and clinical outcomes. The assessment of outcomes was performed utilizing the Barrow Neurological Institute Pain Intensity Score and the Visual Analog Scale (VAS), with evaluations taking place preoperatively and after 1, 3, 6 and 12 months. Postoperative VAS scores for patients undergoing either MVD or GKRS demonstrated a significant improvement when compared with their preoperative counterparts. The reduction in postoperative VAS scores within the MVD group was significantly more substantial than that observed in patients who underwent GKRS at the initial postoperative evaluations (Pâ =â .037). The maintenance of pain relief after MVD proved significantly superior to that following GKRS (Pâ <â .01). Both MVD and GKRS present as safe and efficacious therapeutic options for individuals diagnosed with primary TN, though MVD displayed superior initial outcomes in terms of pain relief and its maintenance. However, for older patients or those with medical contraindications to invasive procedures, GKRS emerges as a viable and less invasive alternative for initial treatment in cases of primary TN.
Asunto(s)
Cirugía para Descompresión Microvascular , Radiocirugia , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/cirugía , Neuralgia del Trigémino/radioterapia , Radiocirugia/métodos , Cirugía para Descompresión Microvascular/métodos , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Resultado del Tratamiento , Dimensión del Dolor , Adulto , Anciano de 80 o más AñosRESUMEN
BACKGROUND AND OBJECTIVES: Patients undergoing percutaneous rhizotomy for trigeminal neuralgia (TN) may require several procedures to manage their pain. However, it is not fully understood whether repeat procedures influence postoperative complication rates. METHODS: We retrospectively reviewed patients undergoing rhizotomy at our institution from 2011 to 2022. Patients were included only if they had no history of prior interventions including microvascular decompression (MVD) or radiosurgery. We collected baseline patient information, pain characteristics, and postoperative complications for each patient. Patients were dichotomized into those undergoing primary rhizotomy versus those undergoing a repeat rhizotomy. Potential drivers of postoperative complications were included in a multivariate logistic regression model. RESULTS: Of the 1904 cases reviewed, 965 met our inclusion criteria. 392 patients underwent primary rhizotomy, and 573 patients underwent repeat rhizotomies. The repeat rhizotomy group was significantly older, p<0.001. Patients in the repeat rhizotomy group expressed higher frequencies of bilateral pain, p=0.01. Patients in the repeat rhizotomy group demonstrated a significantly higher rate of preoperative numbness and postoperative numbness, p<0.001. There were no significant differences in any of the considered complications between the single rhizotomy and repeat rhizotomy groups. On multivariate logistic regression, repeat rhizotomy did not predict an increased risk of any postoperative complications, p=0.14. CONCLUSIONS: Patients undergoing repeat rhizotomy may be at risk of postoperative numbness but are not at increased risk for postoperative complications. These results are of use to patients who are poor surgical candidates, and thus may require multiple rhizotomies to effectively manage their pain over time.
Asunto(s)
Complicaciones Posoperatorias , Reoperación , Rizotomía , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/cirugía , Rizotomía/métodos , Femenino , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Anciano , Estudios Retrospectivos , Adulto , Resultado del Tratamiento , Cirugía para Descompresión Microvascular/métodos , Cirugía para Descompresión Microvascular/efectos adversos , Factores de RiesgoRESUMEN
AIM: To review our experience with patients presenting with recurrent trigeminal neuralgia (TN) and who have undergone repeat microvascular decompression surgery (rMVD). MATERIAL AND METHODS: This retrospective observational study was conducted at the Department of Neurosurgery at a university hospital. Patients who initially experienced complete pain relief after the first MVD but later had a recurrence of TN symptoms which required an rMVD were included in the study. Pain control outcomes were evaluated based on the Barrow Neurological Institute (BNI) scale score. RESULTS: Of the 375 patients who underwent MVD for TN over a 20-year period, 19 patients (6 females and 13 males) with a mean age of 57.68 ± 9.78 years developed symptom recurrence which necessitated an rMVD (5.06%). The average duration of the symptoms before the rMVD was 16.1 ± 19.36 months. The mean BNI score of the patients before the rMVD was 4.5 ± 0.5. Recurrence was primarily attributed to compression by a new offending vessel (n=9, 47.4%) or a Teflon granuloma (n=8, 42.1%). Two patients (10.5%) did not have any identifiable compression. During a follow-up period of 106.3 ± 58.3 months, excellent pain relief (BNI-I) was achieved in 10 patients (52.6%). Eight patients (42.1%) experienced a good outcome (BNI-III), and one patient (5.3%) experienced a poor outcome (BNI-IV). CONCLUSION: Recurrence of TN symptoms can occur even after an initially successful MVD. Subsequent MVDs should be considered as the primary treatment option for recurrent TN, as it significantly controls pain with low morbidity.
Asunto(s)
Cirugía para Descompresión Microvascular , Recurrencia , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/cirugía , Femenino , Masculino , Cirugía para Descompresión Microvascular/métodos , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Anciano , Reoperación/estadística & datos numéricos , Adulto , Dimensión del DolorRESUMEN
BACKGROUND: Percutaneous balloon compression (PBC) is an effective, low-cost, and simple treatment for primary trigeminal neuralgia (TN). However, PBC has poor efficacy and no better solution for the third branch (V3) of TN. METHODS: Clinical data of 52 patients with trigeminal neuralgia treated with PBC were retrospectively analyzed. Postoperative numbness of the patient was evaluated by facial numbness at the Barrow Neurological Institute (BNI-N). The main observation was the incidence of higher numbness in the V3 than in the other two branches or equally strong numbness in the three branches in the immediate postoperative period. RESULTS: The efficacy values in the pear-shaped balloon group at the first postoperative day (T1), the first month (T2), in the third month (T3), and the sixth month (T4) were 96.7%, 93.3%, 93.3%, and 90%, respectively, and 1 patient (3.3%) had recurrence. The efficacy value for the extracapsular capsule group was 95.5% at all times and there were no patients with recurrence within 6 months after surgery. In the immediate postoperative period, the effective compression rate of V3 in the pear-shaped balloon group was 43.3%, and 86.4% in the extracapsular capsule group (P = 0.020). At six months of follow-up, the effective compression rate of V3 was higher in the extracapsular capsule group than in the pear-shaped balloon group. CONCLUSIONS: The riveted structure of the extracapsular capsule can effectively compress V3, thus performing PBC with a balloon shaped as an extracapsular capsule is a new, effective, and safe treatment option for TN V3. TRIAL REGISTRATION: ClinicalTrials.gov ChiCTR2300067313.
Asunto(s)
Neuralgia del Trigémino , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Nervio Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Neuralgia del Trigémino/terapia , Estudios de Casos y ControlesRESUMEN
BACKGROUND: Microvascular decompression (MVD) is a well-established and effective treatment for primary trigeminal neuralgia (TN). Endoscopy has been implemented to provide a comprehensive view of neurovascular conflict and minimizes the damages of brain retraction during MVD. OBJECTIVES: To preliminarily evaluate the surgical safety and efficacy of fully endoscopic microvascular decompression (EMVD) for primary TN with surgeon performing two-hand manipulation and assistant holding endoscope. METHODS: Retrospective clinical analysis of 189 patients with primary TN underwent EMVD between June 2019 and August 2022 was performed. By analyzing the intraoperative situation, the outcomes of postoperative symptoms and the main complications, we evaluated the reliability and effectivity of the operative technique in the treatment of primary TN. RESULTS: We summarized the standard operating procedure of EMVD for primary TN with surgeon performing two-hand manipulation and assistant holding endoscope. In addition, acicular bipolar electrocoagulation technique was developed to handle venous compression. During the follow-up period, good pain relief was achieved in 178 patients (94.2%) and recurrence of pain was observed in 4 patients (2.1%). Postoperative temporary complications included trigeminal dysesthesias (7 patients, 4.8%), cerebrospinal fluid leak (2 patients, 1.1%), hearing difficulty (3 patient, 1.6%), facial paresis (2 patients, 1.1%) and vertigo (5 patients, 2.7%). There were no cases of intracranial hemorrhage, cerebellar swelling and death. CONCLUSION: This EMVD technique is reliable and effective, and can be used as a routine surgical procedure for primary TN.
Asunto(s)
Cirugía para Descompresión Microvascular , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/cirugía , Cirugía para Descompresión Microvascular/métodos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Adulto , Resultado del Tratamiento , Neuroendoscopía/métodos , Complicaciones Posoperatorias/prevención & control , Endoscopía/métodos , Anciano de 80 o más AñosRESUMEN
Microvascular decompression (MVD) is the preferred treatment for hemifacial spasm (HFS) and trigeminal neuralgia (TN), and fully endoscopic microvascular decompression (E-MVD) has been widely discussed in recent years. Considering the endoscopic diving technique used in endoscopic transsphenoidal pituitary adenoma resection, we developed the endoscopic semidiving technique. This technique involves preserving some cerebrospinal fluid (CSF) and positioning the endoscope at an appropriate distance from it; the potential advantages include reducing cerebellar retraction, accurately identifying the responsible vessels and minimizing mechanical damage. This study aimed to preliminarily evaluate the safety and feasibility of the semidiving technique in E-MVD. A total of 359 patients with HFS and TN scheduled to undergo E-MVD were included in the study. Patients with each disease were divided into a nonsemidiving technique group and a semidiving technique group. Surgical data, postoperative outcomes, complications, and recurrence rates were compared between the groups. In patients with HFS, the effective rate was 95.6% (nonsemidiving)and 92.9% (semidiving) respectively, with no statistically significant difference. The semidiving technique group had a lower incidence of postoperative permanent hearing loss compared with the nonsemidiving technique group (0% vs. 5.9%). In TN patients, no significant differences in effectiveness or postoperative complications were observed. The application of the semidiving technique in E-MVD for HFS not only ensures surgical quality and postoperative efficacy but also reduces the incidence of postoperative hearing loss, shortens the surgical duration and reduces the number of postoperative hospitalization days, aligning with the concept of enhanced recovery after surgery (ERAS).
Asunto(s)
Espasmo Hemifacial , Cirugía para Descompresión Microvascular , Neuralgia del Trigémino , Humanos , Cirugía para Descompresión Microvascular/métodos , Femenino , Masculino , Persona de Mediana Edad , Neuralgia del Trigémino/cirugía , Anciano , Adulto , Resultado del Tratamiento , Espasmo Hemifacial/cirugía , Complicaciones Posoperatorias/epidemiología , Neuroendoscopía/métodos , Endoscopía/métodos , Neoplasias Hipofisarias/cirugíaRESUMEN
According to the literature, cerebellopontine angle tumors cause secondary trigeminal neuralgia and other symptoms of neurovascular compression in 1-9.9% of cases. We present a 58-year-old patient with left-sided secondary trigeminal neuralgia caused by ipsilateral posterior petrous meningioma. Stereotactic irradiation was followed by effective tumor growth control. However, residual trigeminal pain paroxysms significantly reduced the quality of life and required subsequent microsurgery. Trigeminal facial pain regressed after total resection of tumor. Considering this clinical case, we would like to discuss several issues: follow-up of meningioma requiring radiosurgery, course of secondary trigeminal neuralgia in a patient with apical petrous meningioma, characteristics of pain before and after radiosurgery, the best treatment option for these patients. Stereotactic radiosurgery seems unreasonable for CPA tumors with secondary trigeminal neuralgia. Indeed, persistent pain is possible even after tumor shrinkage. Moreover, primary stereotactic irradiation significantly complicates subsequent resection of tumor.
Asunto(s)
Meningioma , Radiocirugia , Neuralgia del Trigémino , Humanos , Persona de Mediana Edad , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/complicaciones , Meningioma/cirugía , Meningioma/radioterapia , Meningioma/complicaciones , Microcirugia/métodos , Radiocirugia/métodos , Neuralgia del Trigémino/cirugía , Neuralgia del Trigémino/etiologíaRESUMEN
BACKGROUND: The classic percutaneous balloon compression (PBC) technique is used to complete an operation under the guidance of C-arm radiography under general anesthesia, making communication with patients during the operation impossible. It is not accurate or objective to predict the classic technique's curative effect solely by determining whether the projection of the x-ray lateral image of the filled balloon is pear-shaped. OBJECTIVES: This study aimed to upgrade classic PBC to awake computed tomography (CT)-guided PBC technology under conscious local anesthesia and analgesia monitoring. STUDY DESIGN: Prospective clinical study. SETTING: Department of Anesthesiology and Pain Medical Center, Jiaxing, People's Republic of China. METHODS: Puncture was designed and guided by CT scanning, and the curative effect was assessed by asking the patients about what they are feeling during the operation. RESULTS: CT can design the puncture path and accurately guide puncture, observe the position and shape of the balloon through 3-dimensional reconstruction during the operation, and judge the curative effect according to the patient's chief concern. LIMITATIONS: Local anesthetic analgesia is not perfect, resulting in some patients experiencing pain during surgery. CONCLUSIONS: PBC can be completed under conscious local anesthesia and analgesia. Its curative effect and operative end standard can be determined according to the patient's chief concern. Under CT guidance, the puncture path can be designed to complete an accurate puncture and to intuitively understand the position and shape of the balloon.
Asunto(s)
Tomografía Computarizada por Rayos X , Ganglio del Trigémino , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/cirugía , Neuralgia del Trigémino/diagnóstico por imagen , Ganglio del Trigémino/cirugía , Ganglio del Trigémino/diagnóstico por imagen , Estudios Prospectivos , Femenino , Persona de Mediana Edad , Masculino , AncianoRESUMEN
Trigeminal neuralgia (TN), a severe facial pain condition, is often treated with microvascular decompression (MVD). While MVD is effective for arterial neurovascular compression, its efficacy in cases of venous compression and the intraoperative management of such cases remain areas of debate. This review aimed to analyze the intraoperative management strategies for offending veins during MVD and evaluate the outcomes of these procedures in cases of TN with purely venous compression. An extensive review of studies reporting on the intraoperative handling of veins and the surgical outcomes of MVD in purely venous compression cases was conducted. Fifteen full-text studies were included, encompassing a total of 600 patients. Notably, 82.33% of these patients achieved a Barrow Neurological Institute (BNI) I pain score, with follow-up periods ranging from 3 months to 12 years. MVD is a viable and effective treatment option for TN in cases of venous compression, with a significant proportion of patients experiencing substantial pain relief.
Asunto(s)
Cirugía para Descompresión Microvascular , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/cirugía , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/diagnóstico por imagen , Cirugía para Descompresión Microvascular/métodos , Venas/cirugía , Resultado del Tratamiento , Femenino , MasculinoRESUMEN
OBJECTIVE: Trigeminal neuralgia (TN) due to venous compression is far less common than that due to arterial compression, and its pathogenesis is less clear. We investigated the clinical and imaging features of TN caused by solely venous compression by measuring the morphologies of the posterior cranial fossa (PCF) and the trigeminal nerve. METHODS: We retrospectively reviewed records of TN patients who underwent microvascular decompression at our institution and extracted cases with solely arterial or solely venous compression. Preoperative magnetic resonance imaging was used to find the length (Y), width (X), height (Z), and volume (V) of the PCF, the angle between the trigeminal nerve and pons, and the distance between Meckel's cave and the root entry zone of the trigeminal nerve. RESULTS: Of 152 patients, 24 had TN caused solely by venous compression. The value of Y was significantly smaller in the venous group than the arterial group (P < 0.01). The trigeminal nerve and pons was significantly smaller in the venous group (P < 0.01). We hypothesized that TN patients with solely venous compression had a characteristic PCF morphology with a short anteroposterior diameter (Y), such that age-related changes in brain morphology could alter the course of the trigeminal nerve and cause compression by a vein. CONCLUSIONS: The morphological features of the PCF differed between patients with TN of venous and those with TN of arterial etiology. Age-related changes in brain morphology and changes of course of the trigeminal nerve may also add to the possibility of developing TN, especially of venous etiology.
Asunto(s)
Cirugía para Descompresión Microvascular , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/cirugía , Neuralgia del Trigémino/diagnóstico por imagen , Neuralgia del Trigémino/etiología , Cirugía para Descompresión Microvascular/métodos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Adulto , Nervio Trigémino/cirugía , Nervio Trigémino/diagnóstico por imagen , Venas Cerebrales/cirugía , Venas Cerebrales/diagnóstico por imagen , Síndromes de Compresión Nerviosa/cirugía , Síndromes de Compresión Nerviosa/diagnóstico por imagen , Fosa Craneal Posterior/cirugía , Fosa Craneal Posterior/diagnóstico por imagen , Anciano de 80 o más Años , Imagen por Resonancia Magnética , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVE: Trigeminal Neuralgia (NT) is a common pathology in Neurosurgery. It can be classified as idiopathic or secondary to other pathologies, such as Multiple Sclerosis (MS). Several surgical treatments have been described, some of them being replaced by more modern techniques. Partial sensory rhizotomy (PSR), described by Dandy is a technique replaced by other techniques due to its permanent side effects. We present our experience with this technique in patients with recurrent NT. METHODS AND MATERIALS: A retrospective review is carried out on five patients who underwent surgery at our center from 2018 to 2023 using the PSR technique. RESULTS: All the patients intervened showed significant clinical improvement, except one patient who required reintervention due to uncontrolled pain. According to the Barrow Neurological Institute (BNI) scale, 80% (4/5) of patients showed improvement from grade V to grades I/II except for one of them. This patient suffered from MS. Additionally, one patient presented a corneal ulcer after surgery due to impairment of the corneal reflex. CONCLUSION: In our experience, PSR is a valid treatment option in selected patients with recurrent TN. It has a low incidence of complications with an adequate surgical technique and anatomical knowledge of the region. To the best of our knowledge, we are one of the few centers in Spain to publish our results with PSR in the last ten years. We report good results in pain control withdrawing medication in 80% (4/5) of the operated patients.
Asunto(s)
Recurrencia , Rizotomía , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/cirugía , Rizotomía/métodos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Resultado del Tratamiento , AdultoRESUMEN
BACKGROUND: This study aimed to investigate individualized treatment strategies and clinical outcomes in patients with recurrent trigeminal neuralgia after undergoing microvascular decompression (MVD). METHODS: One hundred forty-four patients with recurrent trigeminal neuralgia after MVD were retrospectively examined and grouped according to treatment. Surgical efficacy and pain recurrence were analyzed as outcomes. RESULTS: Repeat craniotomy was performed in 31 patients (21.5 %), percutaneous balloon compression (PBC) in 67 (46.5 %), and radiofrequency thermocoagulation (RFT) in 46 (32.0 %). Effectiveness did not differ among the three types of treatment (P = 0.052). The incidence of postoperative complications, including trigeminal nerve cardiac reflex, facial numbness, and mastication weakness, was lower in the craniotomy group than the PBC and RFT groups (P < 0.001). The 5-year pain recurrence rate was significantly higher than the 1-year rate in all groups. Although the 1-year pain recurrence rate did not differ among the groups, the 5-year rate was significantly lower in the repeat craniotomy group than the other groups (P < 0.001). CONCLUSION: Patients with recurrent trigeminal neuralgia after MVD should be treated based on imaging evaluation and general condition. Repeat craniotomy, PBC, and RFT are all effective. Incidence of postoperative complications and long-term pain recurrence-free survival are superior for repeat craniotomy.
Asunto(s)
Cirugía para Descompresión Microvascular , Recurrencia , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/cirugía , Cirugía para Descompresión Microvascular/métodos , Cirugía para Descompresión Microvascular/efectos adversos , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Adulto , Craneotomía/métodos , Craneotomía/efectos adversosRESUMEN
BACKGROUND: Gamma Knife radiosurgery (GKRS) has well-known efficacy in the treatment of idiopathic trigeminal neuralgia (TN). However, few studies have evaluated the effects of GKRS in the treatment of multiple sclerosis (MS)-related TN. This study analyzed the efficacy and complications of GKRS for MS-related TN. METHODS: This retrospective study included 28 MS-related TN patients who underwent GKRS with a median follow-up of 27 (range, 12-181) months. The cisternal segment of the trigeminal nerve was targeted with a median radiation dose of 80 (80-90) Gy. Pain intensity was assessed using Barrow Neurological Institute (BNI)-Pain Intensity Scores (BNI-PIS). Before GKRS, all patients suffered from BNI pain levels of 4 or 5. A reduction in pain to BNI 3b or below was deemed as adequate pain relief. RESULTS: The initial proportion of patients who experienced adequate pain relief was 71.4%, with a median interval of 21 (1-45) days. At the final follow-up, 50% of patients had achieved adequate pain relief. Ten patients (35.7%) suffered from complications, including four with facial sensorial dysfunctions, four with a decline in their corneal reflexes, and two with jaw weakness. Among the 20 initial responders, six (30%) patients suffered pain recurrence after a median interval of 35 (12-180) months. CONCLUSIONS: GKRS is an effective means of pain relief in MS-related TN, but has side effects that are relevant to other ablative treatments. The benefits and risks of GKRS should be discussed with patients who wish to avoid surgery or when previous treatments fail.
Asunto(s)
Esclerosis Múltiple , Radiocirugia , Neuralgia del Trigémino , Humanos , Radiocirugia/métodos , Radiocirugia/efectos adversos , Neuralgia del Trigémino/radioterapia , Neuralgia del Trigémino/cirugía , Neuralgia del Trigémino/etiología , Femenino , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/complicaciones , Estudios Retrospectivos , Adulto , Anciano , Resultado del Tratamiento , Estudios de Seguimiento , Dimensión del DolorRESUMEN
OBJECTIVES: Cerebellopontine angle (CPA) tumors are a common cause of secondary trigeminal neuralgia (TN), characterized by their concealed location, slow progression, and difficulty in early detection. This study aims to explore the clinicopathological characteristics of patients with secondary TN due to CPA tumors to enhance understanding and management of secondary TN. METHODS: A retrospective analysis was conducted on clinical data and pathological results of 116 patients with CPA tumor-related TN treated at Xiangya Hospital of Central South University from January 1, 2017 to December 31, 2022. The study analyzed the relationship of tumor pathological types with clinical manifestations, tumor location, surgical methods, and treatment outcomes. RESULTS: Among the cases, 95.7% (111/116) were benign tumors, 3.4% (4/116) were malignant tumors, and 0.9% (1/116) were borderline tumors. Benign tumors were predominantly acoustic neuromas, meningiomas, and schwannomas. Among the patients, 46.6% (54/116) presented with isolated TN, while 53.4% (62/116) exhibited other associated symptoms depending on factors such as tumor growth location and rate. The complete resection rate in this group was over 90%, with 41.4% (48/116) of patients undergoing concurrent microvascular decompression after tumor resection, predominantly for schwannomas. The overall effective rate of surgical treatment reached 93.9%, with schwannomas showing higher efficacy rates compared with acoustic neuromas and meningiomas (P<0.05). The recurrence rate of acoustic neuromas was significantly higher than that of meningiomas and schwannomas (P<0.05). CONCLUSIONS: CPA tumors are a major cause of secondary TN, predominantly benign, with occasional underdiagnosed malignant tumors. Early diagnosis and treatment significantly impact prognosis. Different tumor types vary in clinical symptoms, surgical approaches, and treatment efficacy. Surgical strategies should balance tumor resection extent and neural function preservation, with microvascular decompression as necessary.
Asunto(s)
Neoplasias Cerebelosas , Ángulo Pontocerebeloso , Meningioma , Neuroma Acústico , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/cirugía , Estudios Retrospectivos , Ángulo Pontocerebeloso/patología , Neoplasias Cerebelosas/complicaciones , Neoplasias Cerebelosas/patología , Neoplasias Cerebelosas/cirugía , Meningioma/complicaciones , Meningioma/cirugía , Meningioma/patología , Neuroma Acústico/complicaciones , Neuroma Acústico/cirugía , Neuroma Acústico/patología , Neurilemoma/complicaciones , Neurilemoma/cirugía , Neurilemoma/patología , Femenino , Masculino , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/cirugía , Persona de Mediana Edad , Descompresión Quirúrgica/métodosRESUMEN
PURPOSE: The trigeminocardiac reflex (TCR) has traditionally been characterized by a sudden decrease in heart rate, asystole, or hypotension during the manipulation of the trigeminal nerve (MTN) or its branches. While this classical TCR is well-documented, there is limited literature on alternative forms of TCR, such as the development of intraoperative hypertension (HTN) or tachycardia, and the underlying pathogenesis. Furthermore, a gap exists in understanding the correlation between intraoperative blood pressure readings and postoperative outcomes, particularly regarding pain relief in patients with trigeminal neuralgia (TN). Our study aims to examine intraoperative blood pressure trends during microvascular decompression (MVD) for TN and assess their impact on postoperative outcomes. METHODS: We selected 90 patients who underwent MVD for TN treatment. Blood pressure and heart rate were recorded both preoperatively and during the procedure, specifically during the MTN period, using an arterial line. The Barrow Neurological Institute (BNI) Pain Scale was calculated for all patients both pre- and post-operatively to evaluate pain relief after surgery. RESULTS: The mean age of the patients was 61.0 ± 12.35 years, with 64.4% being females. Classical TCR (hypotension) was observed in only 2.2% of patients, whereas 80% of patients developed hypertension (≥ 140/90) during MTN. The mean preoperative systolic blood pressure was 128 ± 22.25, and the mean intraoperative systolic blood pressure during MTN was 153.1 ± 20.2. An analysis of covariance, utilizing either preoperative BNI or duration of symptoms as covariate variables, revealed a statistically significant association between intraoperative HTN and postoperative BNI. A linear regression model demonstrated that intraoperative HTN following MTN significantly predicted a lower postoperative BNI score (p = 0.006). CONCLUSIONS: Intraoperative HTN during MTN, an observed yet underexplored phenomenon, demonstrated a correlation with improved postoperative outcomes. Furthermore, it is recommended to conduct additional investigations into potential neurovascular conflicts in patients not manifesting intraoperative HTN following MTN. A comprehensive understanding of TCR, encompassing its various forms, is vital for optimizing surgical management. This study underscores the imperative for further research to unravel the mechanisms linking intraoperative HTN to surgical outcomes in TN patients.