Peduncular hallucinosis following microvascular decompression for trigeminal neuralgia without direct brainstem injury: case report

We report a 68-year-old woman who experienced visual hallucinations diagnosed as peduncular hallucinosis (PH) following microvascular decompression for trigeminal neuralgia. Postoperative MRI showed only ischemic oedema of the left cerebellar hemisphere due to retraction. Our case first reveals that PH can be induced without direct brainstem injury, instead possibly by a cerebellar lesion.     

显微血管减压治疗原发性三叉神经痛126例临床分析

目的　探讨微血管减压术治疗三叉神经痛的手术方法及疗效。　方法　原发性三叉神经痛 12 6例 ,经乙状窦后入路行显微外科微血管减压术。术中发现 12 2例血管压迫神经 ,用涤纶棉垫隔分离减压。　结果　随访 113例 ,随访时间 (1- 9)年 ,术后疼痛消失、减轻 110例 ,总有效率达 97 3% (110 /113)。　结论　显微血管减压术是治疗三叉神经较为理想的方法 ,手术创伤小 ,并发症少 ,疗效好。     

三叉神经痛微血管减压术的麻醉进展

背景 通过多年对原发性三叉神经痛的研究发现,桥小脑角区血管压迫多根脑神经进出脑干区可导致相应的综合征,即神经血管压迫综合征;微血管减压术(microvascular decompression,MVD)已经成为安全有效的治疗原发性三叉神经痛的首选方法,三叉神经痛患者在微血管减压术中可能出现心动过缓及出现脑搏动干扰手术操作等不良事件;术后也可由于麻醉医师体液管理不当等原因,出现包括头痛、恶心及呕吐等低颅压反应. 目的 拟对以上不良事件总结合理解决方案,避免此类并发症的发生. 内容 主要描述三叉神经痛MVD的手术体位、方式和麻醉的基本要求,包括呼吸及循环管理、神经电生理的监测、补液原则及脑搏动的处理等;此外还叙述了麻醉相关并发症及其解决方案. 趋向 MVD已被广泛应用于治疗原发性三叉神经痛,现有的麻醉手段已经日趋成熟,但仍需不断完善,以保障患者手术安全,避免并发症的发生.     

微血管减压术治疗三叉神经痛并发高血压的疗效分析

目的探讨显微血管减压术治疗三叉神经痛患者伴发高血压的疗效。方法回顾性分析微血管减压治疗的538例伴有高血压病的三叉神经痛患者,均行延髓腹外侧微血管减压术,并监测术后血压改变。结果538例中治愈341例(63．4％),显效71例(13．2％),有效53例(9．8％),无效73例(13．6％);483例患者得到1．0-15．8年随访(平均6．3年),有313例治愈,63例显效,42例有效,65例无效。结论异常血管袢压迫三叉神经根及延髓,长期疼痛刺激和情绪紧张是神经性高血压的病因,行该区的微血管减压术是治疗三叉神经痛并发高血压的有效方法。     

强化三维损毁梯度回波序列在三叉神经痛微血管减压术前评价中的作用

目的 研究强化三维损毁梯度回波序列(3D-SPGRI)在三叉神经痛微血管减压(MVD)术前评价和病例选择中的作用.方法 33例三叉神经痛患者行高分辨率强化3D-SPGRI及三维脑血管成像(3D-MRA)扫描,观察三叉神经出脑干段神经及邻近血管关系,并与MVD术中观察结果 对比.结果 33例患者中29例显示与疼痛侧别一致的神经血管接触或压迫并行显微手术减压,手术证实,其中27例MR图像符合术中所见,所有手术患者术后疼痛完全缓解.结论 3D-SPGRI结合3D-MRA能够清晰显示脑池段三叉神经及其邻近血管,为MVD术前评价、病例选择、判断预后提供有价值的信息.     

A prospective study of microvascular decompression for trigeminal neuralgia

Summary In a prospective study of 25 patients with trigeminal neuralgia (TN), we examined the results of microvascular decompression (MVD). Initial pain relief was complete in 22 patients and partial in one. There were two primary failures. After a median observation time of 38 months. 20 of the 22 patients still were completely free of pain, and one patient reported then 50% pain relief. A vascular compression of the trigeminal root was found intra-operatively in 23 patients. No serious complications occurred. Minor but bothersome dyaesthesias were reported by two patients (8%). The results were satisfactory when compared to other MVD studies.     

羟考酮对三叉神经微血管减压术患者术后早期恢复质量的影响

目的评价羟考酮在三叉神经微血管减压术患者中应用的安全性和有效性,并比较羟考酮与舒芬太尼对三叉神经微血管减压术患者术后早期恢复质量的影响。方法选择择期行三叉神经微血管减压术患者86例,男38例,女48例,年龄18~65岁,BMI 18~30kg/m2,ASAⅠ或Ⅱ级。采用随机数字表法将其分为两组:羟考酮组(O组)和舒芬太尼组(S组),每组43例。两组均接受静-吸复合麻醉,麻醉诱导时O组静脉注射羟考酮0.3mg/kg,S组静脉注射舒芬太尼0.4μg/kg,在手术进行到关硬膜后即刻,O组静脉注射羟考酮0.07mg/kg,S组静脉注射舒芬太尼0.1μg/kg。于术前1d、术后4、24和48h采用数字评分法(numeric rating scale,NRS)评估患者手术切口疼痛和三叉神经区面部疼痛程度。当NRS评分≥4分时O组静脉注射羟考酮3mg,S组静脉注射舒芬太尼5μg进行补救镇痛。于术前1d和术后3d采用40项恢复质量评分量表(QoR-40量表)评估患者恢复质量。记录术后补救镇痛情况、拔管时间、出院时间以及术后恶心呕吐、心动过缓、排尿困难、头晕和瘙痒的发生情况。结果 O组术后3d的QoR-40量表评分中身体舒适度评分、情绪状态评分、心理支持评分、疼痛评分及总评分明显高于S组(P0.05)。O组术后恶心呕吐发生率明显低于S组(20.9%vs 37.2%)(P0.05)。结论在手术时间短于5h的三叉神经微血管减压术患者中,羟考酮0.3mg/kg可安全用于其麻醉诱导,羟考酮0.07mg/kg及3mg可分别安全有效地用于其预防性镇痛及补救镇痛;与舒芬太尼比较,羟考酮可提高三叉神经微血管减压术患者术后早期恢复质量,减少术后恶心呕吐。     

Microvascular decompression for trigeminal neuralgia

Summary An analysis of 57 patients with trigeminal neuralgia (TN) treated with microvascular decompression (MVD) is presented. Mean follow-up time was 3.1 years. Vascular compression of the trigeminal nerve root was noted in 54 cases. In the remaining 3 patients, adhesions were observed in two, whereas no obvious cause was found in one case.Among the patients with vascular compression, 43 (80%) became painfree immediately after surgery, and have remained so during the observation period. There was an indisputable relationship between the degree of observed vascular compression of the nerve and longterm complete pain relief. There was no mortality in association with the surgery. Major morbidity was seen in 3.6%, and partial facial sensory loss was seen in seven patients (12%). The implications of these findings are discussed.     

Long-term follow-up of microvascular decompression for trigeminal neuralgia

We conducted a study to evaluate the follow-up characteristics of patients with trigeminal neuralgia (TN) and to evaluate the factors affecting long-term outcome of microvascular decompression (MVD) in TN. Between 1983 and 2003, 156 patients with TN treated with MVD by 4 neurosurgeons at University Medical Centre Groningen/the Netherlands were evaluated. Baseline data from operative outcome were evaluated using univariate and multivariate analysis. The group consisted of 156 patients with TN: 90 females and 66 males with a median follow-up period of 9.7 years. The average age of initial symptoms was 51 years. The average duration of symptoms was 58 months. Postoperative 22 patients had a facial hyperpathia or hyperesthesia. Postoperatively, 137 patients had immediate relief. Postoperatively 1 year, 140 patients still had a good outcome of the operation. Twenty-seven patients with good immediate postoperative results had recurrent pain. From the group of patients with typical TN, 82% had good long-term results after operation. Patients with typical TN and immediate postoperative remission, in univariate analysis, had significantly more often an excellent/good postoperative outcome. Immediate postoperative remission is an independent predictive factor for a good long-term outcome. The long-term results of MVD in majority of patients were good with no mortalities and no major morbidities. Patients with typical TN had better long-term outcomes and less recurrence.     

微血管减压术治疗三叉神经痛2643例临床分析

目的评价微血管减压术治疗三叉神经痛的临床疗效。方法回顾分析微血管减压术治疗三叉神经痛2643例的手术经验及术中所见。结果2643例中治愈2487例,显效76例,有效48例,无效31例,死亡1例。2136例得到3～240个月随访,有1918例治愈,85例显效,39例有效,30例无效,64例疼痛复发（其中有37例行第2次手术后治愈）。结论异常血管压迫三叉神经入根区,神经根周围蛛网膜增厚粘连是三叉神经痛的病因,行该区粘连的蛛网膜分离后,微血管减压是治疗三叉神经痛的有效方法。     

Long-term results of microvascular decompression for trigeminal neuralgia with reference to probability of recurrence

Summary Sixty-one patients with trigeminal neuralgia who underwent microvascular decompression were analysed. Vascular compression of the trigeminal nerve root was found in all cases. The recurrence rate of pain in this series was 18% with an average follow-up of 80 months (range: 13 to 126 months). Ten patients developed recurrence of their trigeminal neuralgia during follow-up. Fifteen factors, including the clinical and operative findings in the pain-free patients versus the 10 patients with recurrence were analysed. Only the patients with venous compression singly or in combination with arteries were significantly related to recurrence. There was no relationship between recurrence and the duration of symptoms or the degree of compression. Based on vascular compression as the sole cause of TN, the results and interesting findings can not be explained. With reference to the hypothesis that vascular compression is only one of at least two causative factors for the development of trigeminal neuralgia, it is suggested that the intrinsic lesion in trigeminal neuralgia may be responsible for late recurrence.     

Microvascular decompression for trigeminal neuralgia. A five-year follow-up study

A series of 72 patients with typical trigeminal neuralgia who underwent microsurgical exploration of the trigeminal nerve in the posterior fossa is analyzed. The operations were performed between 1977 and 1980 with an average follow-up period of 4.94 years. Seventy-eight percent of the patients have remained free of pain after the operation. Of the 16 patients (22%) that were either not relieved of their pain or had a recurrence, two are well-controlled with medical treatment and the rest have required a variety of surgical procedures (mostly radiofrequency rhizotomy) for pain relief. Recurrences were significantly more common in females. There was no relationship between recurrence rate and the age of the patient or the duration of the symptoms before surgery. Definite compression of the trigeminal nerve at the root entry zone by an arterial loop singly or in combination with other arteries or a vein was found in 82% of the patients. The recurrence rate in this group was 19%. Definite compression by a vein was found in seven patients and the pain recurred in four (47%), a significant difference. There was no death or disabling stroke in this series, but persistent unilateral hearing loss occurred in a total of 14 patients (19%), with complete deafness in the ipsilateral ear in five patients (7%). In addition, two patients suffered mild but persistent ataxia of gait and two patients intermittent diplopia. These results are compared with the results of other reported series.     

微血管减压术治疗三叉神经痛

目的 探讨微血管减压术治疗原发性三叉神经痛的安全有效性。方法 回顾分析微血管减压术治疗13例原发性单侧三叉神经痛的临床资料。术前采用SE序列及三维稳态旋进快速成像(3-Dfast inflow with steady—state precession)序列进行MR扫描，手术采用乙状窦后入路，分离血管神经后用人造血管补片隔离。结果 术中见所有三叉神经均受到血管压迫，11例为小脑上动脉压迫，1例为基底动脉和小脑上动脉压迫，1例为静脉压迫。术后疼痛完全消失，无手术死亡及永久性并发症。随访11例，时间6月～24月，平均13月，无疼痛复发。结论 微血管减压术治疗原发性三叉神经痛是安全有效的。     

Microvascular decompression in the surgical management of trigeminal neuralgia

The pathophysiological mechanisms underlying trigeminal neuralgia are not clearly understood and several therapeutic modalities have been advocated. Microvascular decompression (MVD) is a widely used surgical approach for the decompression of the affected root entry zone (REZ) of the fifth cranial nerve. In this paper, we present our experience based on 32 patients with trigeminal neuralgia who were treated with MVD, and discuss the role of this procedure in the surgical management of trigeminal neuralgia.All patients had typical TN pain and had had previous medical management which was unsuccessful. Fourteen patients (44%) had been previously treated with other surgical procedures and had persisting pain at the time of admission. Preoperatively, computerized tomography was obtained in all patients; twelve patients (37.5%) were evaluated with magnetic resonance imaging. These neuroradiological studies revealed an asymmetrical vascular structure at the involved REZ in nine patients (28%). All patients underwent MVD, and a vascular loop causing compression on the REZ of the fifth cranial nerve was demonstrated in each case. No mortality was observed, and the only permanent morbidity was cerebellar infarction in one patient (3%). Symptorns disappeared in all patients in the early postoperative period, and only three recurrences (12%) were observed within the follow-up period (mean: 26 months).     

Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature

This retrospective study summarizes our experience based on treating 62 patients with trigeminal neuralgia treated with microvascular decompression. All patients had typical trigeminal neuralgia symptoms, with 24 of them (38%) having failed to benefit from other previous treatment paradigms. We excluded subjects with atypical and/or secondary forms of trigeminal neuralgia. Follow-up duration ranged from 5 months to 10 years 6 months, with recurrence being identified in three patients (4.8%).We found that the superior cerebellar artery is the leading offending vessel in our cases (33.9%; 21 patients). Interestingly, seven patients (11.3%) underwent an early reoperation 12-48 h later after the first operation was deemed ineffective. This subgroup recovered satisfactorily following isolation of the pathogenic vessels. Overall, no mortality was observed in our patients, and the only permanent morbidity outcome was a case of facial nerve palsy (1.6%). We conclude that microvascular decompression and its reapplicaiton for patients who showed no pain relief immediately after the first decompression are safe and effective treatments for trigeminal neuralgia.     

内窥镜配合显微镜微血管减压治疗三叉神经痛

目的总结采用内窥镜配合显微镜微血管减压术治疗三叉神经痛的临床治疗经验。方法 2008年3月～2011年3月,采用内窥镜配合显微镜微血管减压术治疗三叉神经痛41例。在显微镜下探查三叉神经整个脑池段全程,再以内窥镜观察三叉神经脑干端和Meckel腔内口处,显露压迫或接触神经根的动脉襻或静脉,静脉电凝后切断,动脉襻采用Teflon棉垫隔开。结果术中发现单纯动脉压迫29例,单纯静脉压迫6例,动静脉联合压迫6例。小脑上动脉25例,小脑前下动脉5例,小脑后下动脉3例,基底动脉2例,扭曲、冗长的椎动脉2例,其中2例为2根动脉压迫;岩静脉分支12例。术后疼痛立即消失34例,疼痛延迟缓解5例（术后2周4例,术后1个月1例）,疼痛无明显减轻2例。手术有效率95.1%（39/41）。术后轻度面瘫伴耳鸣1例,面部麻木1例,3周内症状均消失。39例有效者随访6个月～3年,平均21.4月,其中〉12个月31例,无复发。结论微血管减压术是治疗三叉神经痛的有效方法,内窥镜配合显微镜技术可有效降低术后并发症,减少创伤,避免遗漏责任血管。     

Glossopharyngeal neuralgia with cardiac syncope. A case successfully treated by microvascular decompression

A case of glossopharyngeal neuralgia associated with episodic cardiac arrest and syncope is presented. Posterior fossa exploration showed that the left glossopharyngeal and vagus nerves were compressed by the posterior inferior cerebellar artery. Microvascular decompression resulted in complete relief of glossopharyngeal neuralgia, cardiac syncope, and seizure. The mechanism of glossopharyngeal neuralgia associated with cardiac syncope is discussed.     

Reoperation for recurrent trigeminal neuralgia after microvascular decompression

1. 1. The causes of RTN may be an offending vessel or Teflon felt effect. Further vascular compression of the trigeminal nerve can be relieved. In cases of severe adhesion caused by Teflon felt, the result is satisfactory if the fibrotic adhesion can be removed completely.

2. 2. In those patients with major recurrence of TN after MVD, radiologic examinations (e.g., CT scan and MRI) may reveal the etiology.

     

Adjunctive use of endoscopy during microvascular decompression in the cerebellopontine angle: 27 case reports

Microvascular decompression is an important procedure for the management of microvascular compression syndromes in the cerebellopontine angle (CPA) like trigeminal neuralgia or hemifacial spasm. The ability to identify the offending vessel is the key to success. Can the endoscope help surgeons to identify and understand the responsible conflict in order to treat them? Our series concerns 27 consecutive patients who underwent microvascular decompression systematically using an endoscope with an angulation of 30° at the beginning and the end of the intervention. The decompression procedure was done under microscope. Endoscopic exploration was successful for all patients. Endoscopy improved visualization of the cranial nerves and allowed to see and understand the neurovascular conflicts, which were not able to be observed using the microscope alone for two of the 27 patients. The endoscope is a useful adjunct to microscopic exploration of the cranial nerves in the CPA avoiding significant cerebellar or brainstem retraction.     

微血管减压术治疗原发性三叉神经痛临床疗效分析

目的 探讨微血管减压术治疗原发性三叉神经痛的方法及临床效果.方法 分析2008年1月至2010年7月我院治疗的58例原发性三叉神经痛患者的临床资料.结果 所有患者术后面部疼痛完全消失.随访6～24个月,4例复发,2例有轻微疼痛,口服卡马西平后疼痛可控制.结论 微血管减压术治疗原发性三叉神经痛疗效明显,可以作为首选外科治...