Clinical analysis and surgical treatment of trigeminal neuralgia caused by vertebrobasilar dolichoectasia: A retrospective study. (May 2017)

• Record Type: Journal Article
• Authors: Sun, Shoujia; Jiang, Wei; Wang, Junwen; Gao, Pan; Zhang, Xiaojing; Jiao, Liwu; Liu, Weihua; Shu, Kai; Lei, Ting
• Is Part Of: International journal of surgery. Volume 41(2017)
• Page Start: 183
• Page End: 189
• Publication Date: 2017-05
• Subjects: Microvascular decompression -- Trigeminal neuralgia -- Vertebrobasilar dolichoectasia; AICA anterior inferior cerebellar artery -- BA basilar artery -- BNI the Barrow Neurological Institute -- CTA computed tomography angiography -- DSA digital subtraction angiography -- FHE facial hyperalgesia -- HFS hemifacial spasm -- ITN idiopathic trigeminal neuralgia -- MRA magnetic resonance angiography -- MVD microvascular decompression -- RFT radiofrequency thermocoagulation -- SCA superior cerebellar artery -- SPPR selective partial posterior rhizotomy -- TN trigeminal neuralgia -- VA vertebral artery -- VBA vetebrobasilar artery -- VBD vertebrobasilar dolichoectasia -- VBE vertebrobasilar ectasia; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2017.04.015
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: Trigeminal neuralgia (TN) caused by vertebrobasilar dolichoectasia (VBD) is rare and needs further exploration. The purpose of this study is to investigate the clinical features and surgical treatment of TN caused by VBD. Methods: 15 patients with TN caused by VBD were included in our study. The patient data regarding clinical characteristics, neuroimaging presentations, intraoperative findings and treatment outcomes were analyzed retrospectively. Moreover, the previous relevant literature was reviewed simultaneously. Simple MVD was performed in 13 cases and MVD plus trigeminal nerve selective partial posterior rhizotomy (SPPR) was conducted in 2 patients. Results: Of all patients, 7 cases were female and 8 were male. The average age at operation was 60.8 years old (range, 35yrs–75yrs). 13 patients suffered from hypertension and 7 had a history of stoke. The extended and ectatic vetebrobasilar artery (VBA) was preliminarily identified in preoperative imaging presentations and finally confirmed during surgical procedure. The facial neuralgia disappeared immediately after surgery in all patients. All patients were relieved of pain (BNI score I) with an average of 29.8 months follow-up. Conclusions: Our results suggest that simple MVD is effective for TN caused by VBD. MVD plus SPPR can be cautiously performed if patient has advanced age and is susceptible to numbness. Highlights: The TN mainly occurs in older male patients with hypertension and stoke history. All cases with TN caused by VBD were pain-free after MVD and no recurs. Simple MVD (or with SPPR) is effective and enough to deal with TN caused by VBD.