SURGICAL VIDEO Microsurgical Decompression in Trigeminal Neuralgia With or Without Vascular Compression: Illustrative Cases With 3-Dimensional Operative Video Anil Nanda, MD,MPH,DeviPrasadPatra,MD, MCh, MRCS, Tanmoy K Maiti, MD, MCh, Shyamal C. Bir, MD, PhD Department of Neurosurgery, Louisiana State University Health Sciences Centre, Shreveport, Louisiana Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opx223 The trigeminal neuralgias (TNs) are thought to be due to 2. Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. NEnglJMed. compression and irritation of the trigeminal nerve at the dorsal 1996;334(17):1077-1084. root entry zone by vessels. In the majority of patients, arterial 3. Shi L, Gu X, Sun G, et al. After microvascular decompression to treat trigeminal compression from a loop of the superior cerebellar artery or neuralgia, both immediate pain relief and recurrence rates are higher in patients with anterior inferior cerebellar artery is the mail offending pathology; arterial compression than with venous compression. Oncotarget. 2017; 8(27):44819- however, a few patients do have venous compression traversing 4. Ko AL, Lee A, Raslan AM, Ozpinar A, Mccartney S, Burchiel KJ. at the root entry zone. These patients benefit from vascular Trigeminal neuralgia without neurovascular compression presents earlier than decompression by separation of the arterial loop (or coagulation trigeminal neuralgia with neurovascular compression. JNeurosurg. 2015;123(6): of the venous loop) and placement of shredded Teflon balls 1519-1527. between the nerve and the vessel. In a subset of patients, no vascular compression is noted and these patients may benefit from neurolysis of the trigeminal nerve that involves microsurgical COMMENTS division of the nerve along the nerve fascicles. There is growing his video montage shows 3 cases representing the 3 scenarios evidence suggesting that TNs without vascular compression are T encountered during a microvascular decompression for trigeminal more prone to inadequate pain relief and higher recurrence neuralgia. The videos are clear, the surgical technique superb, and 1,2 rates than the cases with vascular compression. Similarly, the narration clear. As with all disease, proper patient selection is critical and outcome is worse in patients with venous compression than it is important to emphasize that each of the situations demonstrated arterial compression. In addition, patients without vascular results in increasingly poorer outcome (higher recurrence with venous compression are more prone to early and atypical facial pain. compression than arterial, etc) and is associated with increasingly atypical This operative video is a compilation of the 3 prototype cases pain preoperatively. where we have demonstrated the common techniques of micro- surgical decompression. The cases include patients with TN with Paul A. Gardner Pittsburgh, Pennsylvania arterial compression (Case 1), venous compression (Case 2), and without vascular compression (Case 3). he authors present an excellent operative representation of microvas- Informed consents were obtained from all 3 patients for T cular decompression with both arterial and venous decompression possible publication in Operative Neurosurgery. with cotton pledget placement, previously described by Janetta et al. The authors also present a case of intraneural neurolysis, this is of great clinical significance given the practice is not frequently employed. Disclosure The authors have no personal, financial, or institutional interest in any of the VernardS.Fennell drugs, materials, or devices described in this article. Elad I. Levy Buffalo, New York REFERENCES 1. Lee A, Mccartney S, Burbidge C, Raslan AM, Burchiel KJ. Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression. JNeurosurg. 1. Jannetta PJ, McClaughlin MR, Casey KF. Technique of microvascular decom- 2014;120(5):1048-1054. pression: Technical note. Neurosurg Focus. 2005;18(5):E5. 710 | VOLUME 14 | NUMBER 6 | JUNE 2018 www.operativeneurosurgery-online.com Downloaded from https://academic.oup.com/ons/article-abstract/14/6/710/4587632 by Ed 'DeepDyve' Gillespie user on 21 June 2018
Operative Neurosurgery – Oxford University Press
Published: Nov 2, 2017
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