Abstract
Intracranial microvascular decompression was performed in 21 out of 24 patients with hyperactive dysfunction of cranial nerves: 8 cases of hemifacial spasm, 12 of trigeminal neuralgia, 3 of glossopharyngeal neuralgia and 1 case of paroxysmal vertigo and tinnitus. In 21 cases an abnormal vascular loop was found to impinge on the root entry zone of the nerve in the brainstem. Dissection of this loop with decompression of the nerve resulted in long-lasting relief of symptoms in all but two patients who presented early recurrence; in one of these a second procedure was eventually successful. In two patients with trigeminal neuralgia a benign tumor of the cerebellopontine angle that had escaped preoperative diagnosis was present. Finally, in one case no compressive lesions were found. From the data of the literature and from our present experience microvascular decompression can be considered a safe as well as an effective procedure, affording a high success rate in conditions often or usually resistant to medical treatment and erroneously considered “idiopathic”.
Sommario
Sono stati operati con intervento di decompressione microvascolare dei nervi cranici 21 pazienti su 24 affetti da emispasmo del facciale (8 casi), nevralgia del trigemino (12 casi), nevralgia del glossofaringeo (3 casi), vertigini parossistiche (1 caso). In 21 casi fu riscontrata all'intervento un'ansa vascolare anomala comprimente il nervo all'emergenza dal tronco. La separazione dell'arteria dal nervo con tecnica microchirurgica ha consentito di risolvere i disturbi in tutti i casi eccetto due che presentarono una recidiva precoce: in uno di questi il reintervento fu risolutivo. In due pazienti con nevralgia del trigemino furono riscontrati due piccoli tumori benigni dell'angolo ponto-cerebellare non evidenziati dagli accertamenti neuroradiologici pre-operatori. In un caso non è stata riscontrata alcuna lesione compressiva. I risultati ottenuti confermano l'efficacia dell'intervento, e indicano come queste patologie siano erroneamente ritenute essenziali.
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References
Apfelbaum R I:A comparison of percutaneous radio-frequency, trigeminal neurolysis and microvascular decompression of the trigeminal nerve for the treatment of tic douloureux. Neurosurgery, 1: 16–21, 1977.
Auger R G, Piepgras D G, Laws E R, Miller R H:Microvascular decompression of the facial nerve for hemifacial spasm: clinical and electrophysiologic observations. Neurology, 31: 346–350, 1981.
Breeze R, Ignelzi R J:Microvascular decompression for trigeminal neuralgia. Results with special reference to the late recurrence rate. J Neurosurg, 57: 487–490, 1982.
Burchiel K J, Steege T D, Howe J F, Loeser J D:Comparison of percutaneous radiofrequency gangliolysis and microvascular decompression for the surgical management of tic douloureux. Neurosurgery, 9: 111–119, 1981.
Dandy W E:The treatment of trigeminal neuralgia by the cerebellar route. Ann Surg 96: 787–795, 1932.
Dandy W E:Concerning the cause of trigeminal neuralgia. AM J Surg 24: 447–455, 1934.
Fabinyi G C A, Adams C B T:Hemifacial spasm: treatment by posterior fossa surgery. J Neurol Neurosurg Psychiat, 41: 829–833, 1978.
Fein J M, Frishman W:Neurologic hypertension related to vascular compression of the lateral medula. Neurosurgery, 6: 615–622, 1980.
Gardner W J:Concerning the mechanism of trigeminal neuralgia and hemifacial spasm. J Neurosurg, 19: 947–958, 1962.
Hardy D G, Rhoton A L:Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve. J Neurosurg, 49: 669–678, 1978.
Iwakuma T, Matsumoto A, Nakamura N:Hemifacial spasm. Comparison of three different operative procedures in 110 patients. J Neurosurg, 57: 753–756, 1982.
Jannetta P J:Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg, 26: 159–162, 1967.
Jannetta P J:Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia. Definitive microsurgical treatment and results in 117 patients. Neurochirurgia, 20: 145–154, 1977.
Jannetta P J, Abbasy M, Maroon J C et al:Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg, 47: 321–328, 1977.
Jannetta P J:Microsurgery of cranial nerve cross-compression. Clin Neurosurg 26: 607–615, 1979.
Jannetta P J, Gendell H M:Clinical observations on etiology of essential hypertension. Surg Forum, 30: 431–432, 1979.
Jannetta P J:Neurovascular compression in cranial nerve and systemic disease. Ann Surg, 192: 518–525, 1980.
Jannetta P J:Cranial nerve vascular compression syndromes (other than tic douloureux and hemifacial spasm). Clin Neurosurg, 25: 445–456, 1981.
Jannetta P J:Microsurgical management of trigeminal neuralgia. Arch Neurol 42: 800, 1985.
Kaye A H, Adams C B T:Hemifacial spasm; a long term follow-up of patients treated by posterior fossa surgery and facial nerve wrapping. J Neurol Neurosurg Psychiat, 44: 1100–1103, 1981.
Laha R K, Jannetta P J:Glossopharyngeal neuralgia. J Neurosurg, 47: 316–320, 1977.
Maroon J C:Hemifacial spasm. A vascular cause. Arch Neurol, 35: 481–483, 1978.
Michelucci R, Tassinari C A, Samoggia G, et al:Intracranial microvascular decompression for cryptogenic hemifacial spasm, trigeminal and glossopharyngeal neuralgia, paroxysmal vertigo and tinnitus: II. Clinical study and long-term follow-up. Ital J Neurol Sci, in press, 1986.
Morley T P:Case against microvascular decompression in the treatment of trigeminal neuralgia. arch Neurol 42: 801–802, 1985.
Piatt J H, Wilkins R H:Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships. Neurosurgery, 14: 462–471, 1984.
Rand R W:The Gardner neurovascular decompression operation for trigeminal neuralgia. Acta Neurochirurgica, 58: 161–166, 1981.
Sobel D, Norman D, Yorke C H et al.:Radiography of trigeminal neuralgia and hemifacial spasm. AJR, 135: 93–95, 1980.
Sunderland S:The arterial relations of the internal auditory meatus. Brain, 68: 23–27, 1945.
Taarnhoj P:Decompression of trigeminal root and the posterior part of the ganglion as treatment in trigeminal neuralgia. J Neurosurg, 11: 299–305, 1954.
Taarnhoj P:Decompression of the posterior trigeminal root in trigeminal neuralgia. A 30-year follow-up review. J Neurosurg, 57: 14–17, 1982.
Wilson C B, Yorke C, Prioleau G:Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm. West J Med, 132: 481–484, 1980.
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Calbucci, F., Tognetti, F., Bollini, C. et al. Intracranial microvascular decompression for “cryptogenic” hemifacial spasm, trigeminal and glossopharyngeal neuralgia, paroxysmal vertigo and tinnitus: I. Surgical technique and results. Ital J Neuro Sci 7, 359–366 (1986). https://doi.org/10.1007/BF02340876
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DOI: https://doi.org/10.1007/BF02340876