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Intracranial microvascular decompression for “cryptogenic” hemifacial spasm, tirgeminal and glossopharyngeal neuralgia, paroxysmal vertigo and tinnitus: II. Clinical study and long-term follow up

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Abstract

20 patients who had undergone microvascular decompression for the treatment of “idiopathic” trigeminal neuralgia (9 cases), hemifacial spasm, (7 cases), glossopharyngeal neuralgia (3 cases) and paroxysmal vertigo and tinnitus (1 case) were followed up for 25 months on average. Permanent relief of symptoms was observed in 19 (95%), with sparing of cranial nerve function. Analysis of the clinical data shows that the patients described in the present series did not differ from those considered to suffer from “idiopathic” cranial nerve dysfunction syndromes.

The importance of vascular cross compression as etiological factor in such conditions is stressed and the pathophysiology discussed. The term “cryptogenic” applied to trigeminal neuralgia or hemifacial spasm thus needs revising. Lastly, the indications of microvascular decompression in the treatment of “cryptogenic” cranial nerve dysfunction syndromes are defined.

Sommario

Venti pazienti affetti da forme “essenziali” di nervralgia trigeminale (9 casi), emispasmo facciale (7 casi), nevralgia glosso-faringea (3 casi) e vertigine e tinnito parossistici (1 caso), operati di decompressione microvascolare, sono stati riesaminati ad una distanza media dall'intervento di 25 mesi. In 19 pazienti (95%) si è osservata la completa guarigione, in assenza di deficit funzionali a carico dei nervi cranici interessati.

In base ai dati clinici e neuroradiologici, i pazienti qui descritti non sono differenziabili dal gruppo generale di malati con forme “idiopatiche” di nevralgia od emispasmo.

Viene sottolineata l'importanza del fattore compressivo vascolare nel determinismo delle disfunzioni “essenziali” dei nervi cranici, e se ne discutono le interpretazioni fisiopatologiche. Si suggerisce quindi la necessità di rivedere il concetto di “idiopatico” applicato a tali condizioni morbose. Infine vengono definite le precise indicazioni ed il ruolo della decompressione microvascolare nella terapia della patologia “essenziale” dei nervi cranici.

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References

  1. Adams CBT, Kaye AH, Teddy PJ:The treatment of trigeminal neuralgia by posterior fossa microsurgery.J. Neurol Neurosurg Psychiat, 45:1020–1026, 1982.

    CAS  PubMed  Google Scholar 

  2. Apfelbaum RI:A comparison of percutaneous radiofrequency, trigeminal neurolysis and microvascular decompression of the trigeminal nerve for the treatment of tic douloureux. Neurosurgery, 1: 16–21, 1977.

    CAS  PubMed  Google Scholar 

  3. Auger RG, Piepgras DG, Laws ER, Miller RH:Microvascular decompression of the facial nerve for hemifacial spasm: clinical and electrophysiologic observations. Neurology, 31: 346–350, 1981.

    CAS  PubMed  Google Scholar 

  4. Barba D, Alksne JF:Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia. J Neurosurg, 64: 104–107, 1984.

    Google Scholar 

  5. Breeze R, Ignelzi RJ:Microvascular decompression for trigeminal neuralgia. Results with special reference to the late recurrence rate. J Neurosurg, 57: 487–490, 1982.

    CAS  PubMed  Google Scholar 

  6. Burchiel KJ, Steege TD, Howe JF, Loeser JD:Comparison of percutaneous radiofrequency gangliolysis and microvascular decompression, for the surgical management of tic douloureux. Neurosurgery, 9: 111–119, 1981.

    CAS  PubMed  Google Scholar 

  7. Calbucci F, Tognetti F, Bollini C, Cuscini A, Michelucci R, Tassinari CA:Intracranial microvascular decompression for “cryptogenic” hemifacial spasm, trigeminal and glossopharyngeal neuralgia, paroxysmal vertigo and tinnitus: I. Surgical Technique and results, Ital J Neurol Sci in press, 1986.

  8. Deparis M:Glossopharyngeal neuralgia. In: Handbook of Clinical Neurology, Vol. 5, Vinken, P.J., Bruyn G.W. (eds), North-Holland Publishing CO., Amsterdam, pp. 350–361, 1968.

    Google Scholar 

  9. Diamond C, Frew I:The facial nerve. Oxford University Press, Oxford, 1979.

    Google Scholar 

  10. Eidelman BH, Nielsen VK, Moller M, Jannetta PJ:Vascular compression hemifacial spasm, and multiple cranial neuropathy. Neurology, 35: 712–716, 1985.

    CAS  PubMed  Google Scholar 

  11. Fabinyi GCA, Adams CBT:Hemifacial spasm: treatment by posterior fossa surgery. J Neurol Neurosurg Psychiat 41:829–833, 1978.

    CAS  PubMed  Google Scholar 

  12. Fein JM, Frishman W:Neurogenic hypertension related to vascular compression of the lateral medulla. Neurosurgery, 6:615–622, 1980.

    CAS  PubMed  Google Scholar 

  13. Fromm GH, Terrence CF, Maroon JC:Trigeminal neuralgia. Current concepts regarding etiology and pathogenesis. Arch Neurol, 41: 1204–1207, 1984.

    CAS  PubMed  Google Scholar 

  14. Gardner WJ:Trigeminal neuralgia. Clin Neurosurg, 15:1–56, 1968.

    CAS  PubMed  Google Scholar 

  15. Gardner WJ, Miklos MV:Response of trigeminal neuralgia to “decompression” of sensory root. Discussion of cause of trigeminal neuralgia. JAMA, 170: 1773–1776, 1959.

    CAS  Google Scholar 

  16. Haines SJ, Jannetta PJ, Zorub DS:Microvascular relations of the trigeminal nerve. An anatomical study with clinical correlation. J. Neurosurg, 52: 381–386, 1980.

    CAS  PubMed  Google Scholar 

  17. Hardy DG, Rhoton AL:Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve. J Neurosurg, 49:669–678, 1978.

    CAS  PubMed  Google Scholar 

  18. Iwakuma T, Matsumoto A, Nakamura N:Hemifacial spasm. Comparison of three different operative procedures in 110 patients. J Neurosurg, 57: 753–756, 1982.

    CAS  PubMed  Google Scholar 

  19. Jannetta PJ:Gross (mesoscopic) description of the human trigeminal nerve and ganglion. J Neurosurg, 26: 109–111, 1967.

    PubMed  Google Scholar 

  20. Jannetta PJ:Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg, 26: 159–162, 1967.

    PubMed  Google Scholar 

  21. Jannetta PJ:Trigeminal neuralgia and hemifacial spasm. Etiology and definitive treatment. Arch Neurol, 32:353, 1975.

    Google Scholar 

  22. Jannetta PJ: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.

    CAS  PubMed  Google Scholar 

  23. Jannetta PJ:Treatment of trigeminal neuralgia by suboccipital and transtentorial cranial operations. Clin Neurosurg 24:538–549, 1977.

    CAS  PubMed  Google Scholar 

  24. Jannetta PJ:Microsurgery of cranial nerve crosscompression. Clin Neurosurg, 26:607–615, 1979.

    CAS  PubMed  Google Scholar 

  25. Jannetta PJ:Neurovascular compression in cranial nerve and systemic disease. Ann Surg, 192: 518–525, 1980.

    CAS  PubMed  Google Scholar 

  26. Jannetta PJ:Cranial nerve vascular compression syndromes (other than tic douloureux and hemifacial spasm. Clin Neurosurg, 25:445–456, 1981.

    Google Scholar 

  27. Jannetta PJ:Microsurgical management of trigeminal neuralgia. Arch Neurol, 42:800, 1985.

    CAS  PubMed  Google Scholar 

  28. Jannetta PJ, Gendell HM:Clinical observations on etiology of essential hypertension. Surg Forum, 30: 431–432, 1979.

    CAS  PubMed  Google Scholar 

  29. Jannetta PJ, Abbasy M, Maroon JC, Ramos FM, Albin MS:Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg, 47: 321–328 1977.

    CAS  PubMed  Google Scholar 

  30. Kaye AH, Adams CBT: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.

    CAS  PubMed  Google Scholar 

  31. Laha RK, Jannetta PJ:Glossopharyngeal neuralgia. J Neurosurg, 47:316–320, 1977.

    CAS  PubMed  Google Scholar 

  32. Laurent B, Devoize JC, Schott B:Etude clinique et traitement médical de la névralgie faciale essentielle. Encycl Méd-Chir Paris, Neurologie, 17091 A-10, 5–1980.

  33. Morley TP:Case against microvascular decompression in the treatment of trigeminal neuralgia. Arch Neurol, 42:801–802, 1985.

    CAS  PubMed  Google Scholar 

  34. Nielsen VK:Pathophysiology of hemifacial spasm: I. Ephaptic transmission and ectopic excitation. Neurology, 34:418–426, 1984.

    CAS  PubMed  Google Scholar 

  35. Nielsen VK:Pathophysiology of hemifacial spasm: II. Lateral spread of the supraorbital nerve reflex. Neurology, 34:427–431, 1984.

    CAS  PubMed  Google Scholar 

  36. Nielsen VK, Jannetta PJ:Pathophysiology of hemifacial spasm: III. Effects of facial nerve decompression. Neurology, 34:891–897, 1984.

    CAS  PubMed  Google Scholar 

  37. Penman J:Trigeminal neuralgia. In: Handbook of Clinical Neurology, Vol. 5. Vinken P.J., Bruyn G.W. (eds), North-Holland Publishing CO., Amsterdam, pp. 296–322, 1968.

    Google Scholar 

  38. Petty PG, Southby R:Vascular compression of the lower cranial nerves. Observations using microsurgery, with particular reference to trigeminal neuralgia. Aust NZ J Surg, 47:314–320, 1977.

    CAS  Google Scholar 

  39. Ross GS, Chipman M:The neuralgias. In: Clinical Neurology, Vol. 3. Baker A.B., Baker L.H. (eds), Harper & Row, Publishers, Philadelphia, Chapt. 39, pp. 1–28, 1981.

    Google Scholar 

  40. Ruby JR, Jannetta PJ:Hemifacial spasm: ultrastructural changes in the facial nerve induced by neurovascular compression. Surg Neurol, 4:369–370, 1975.

    CAS  PubMed  Google Scholar 

  41. Sobel D, Norman D, Yorke CH, Newton TH:Radiography of trigeminal neuralgia and hemifacial spasm. AJR, 135:93–95, 1980.

    CAS  PubMed  Google Scholar 

  42. Sunderland S.:The arterial relations of the internal auditory meatus. Brain, 68:23–27, 1945.

    Google Scholar 

  43. Taarnhoj P:Decompression of the posterior trigeminal root in trigeminal neuralgia. A 30-year follow-up review. J Neurosurg, 57:14–17, 1982.

    CAS  PubMed  Google Scholar 

  44. Weidmann MJ:Trigeminal neuralgia. Surgical treatment by microvascular decompression of the trigeminal root. Med J Aust, 2:628–630, 1979.

    CAS  PubMed  Google Scholar 

  45. Wilson CB, Yorke C, Prioleau G:Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm. West J Med, 132:481–484, 1980.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Istituto di Clinica Neurologica, II Cattedra, Università degli Studi di Bologna, Via U. Foscolo, 7-40123, Bologna

    Michelucci R., Tassinari C. A. & Samoggia G.

  2. Divisione di Neurochirurgia I, Osp. Bellaria, Bologna

    Tognetti F. & Calbucci F.

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  1. Michelucci R.
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  2. Tassinari C. A.
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  3. Samoggia G.
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  4. Tognetti F.
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  5. Calbucci F.
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Michelucci, R., Tassinari, C.A., Samoggia, G. et al. Intracranial microvascular decompression for “cryptogenic” hemifacial spasm, tirgeminal and glossopharyngeal neuralgia, paroxysmal vertigo and tinnitus: II. Clinical study and long-term follow up. Ital J Neuro Sci 7, 367–374 (1986). https://doi.org/10.1007/BF02340877

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