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Erschienen in:
14.01.2017 | Short Review
Microvascular decompression is an effective therapy for trigeminal neuralgia due to dolichoectatic basilar artery compression: case reports and literature review
Erschienen in: Neurosurgical Review | Ausgabe 4/2017
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Essential trigeminal neuralgia due to vasculonervous conflict is a frequent painful disorder with an incidence rate of five for 100,000 people per year [1, 2]. They most commonly involve the superior cerebellar artery, in 75% of cases, the anterior inferior cerebellar artery, in 10%, or a vein, in 7% [3]. However, compressions by vertebrobasilar artery dolichoectasia are rare, ranging from 2 to 2.4% of cases in most studies (cf. Table 1). In our hospital, among 215 consecutive patients treated for trigeminal neuralgia, only three presented vertebrobasilar dolichoectasia (1.4%).|
Reference
|
Number of cases (vertebral/basilar artery)
|
Prevalence
|
Associated nerve compressions
|
Neurological signs associated with neuralgia
|
Sex (M/F)
|
Mean age
|
Trigeminal division and side
|
Treatment (MD: microvascular decompression)
|
Treatment efficacy
|
Complications
|
|---|---|---|---|---|---|---|---|---|---|---|
|
Miyazaki, 1987 [17]
|
45 (0/45)
|
7.7%
|
None
|
None
|
2/3
|
64
|
23 left-sided (51%)
|
NR
|
NR
|
NR
|
|
Harsh, 1991 [11]
|
1
|
NR
|
AICA—facial nerve
|
Facial spasm
|
NR
|
NR
|
NR
|
1 partial rhizotomy + MD
|
100% pain-free immediately
|
NR
|
|
Linskey, 1994 [4]
|
31 (19/12)
|
2.0%
|
23
|
5 (16%) facial spasms
|
21/10
|
60
|
20 left-sided (65%)
|
29 MD; 1 complete rhizotomy; 1 partial rhizotomy + MD
|
100% pain-free immediately; 86% pain-free off medication after 10 years
|
13 hypoesthesia; 7 transient diplopia; 4 hearing loss
|
|
Garcia de Sola, 2001 [8]
|
3
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
3 MD
|
100% pain-free immediately
|
NR
|
|
Kraemer, 2006 [13]
|
1
|
NR
|
None
|
None
|
1/0
|
63
|
Left-sided V2 + V3
|
1 MD
|
100% pain-free immediately
|
Mild and reversible desequilibrium
|
|
Goel, 2009 [9]
|
1 (0/1)
|
NR
|
None
|
Fusion of cervical vertebrae
|
0/1
|
65
|
Left-sided V2 + V3
|
1 foramen magnum decompression
|
100% pain-free off medication after 18 months
|
None
|
|
Noma, 2009 [18]
|
3 (2/1)
|
NR
|
None
|
NR
|
2/1
|
66
|
3 right-sided V3
|
1 MD; 2 thermocoagulations
|
100% pain-free immediately
|
1 paresthesias; 1 hearing impairment; 1 controlateral facial spasm
|
|
Alcala-Cerra, 2011 [6]
|
1
|
NR
|
Brainstem compression
|
None
|
1/0
|
NR
|
Left-sided
|
1 MD
|
100% pain-free; recurrence after 9 years
|
None
|
|
Campos, 2012 [20]
|
1
|
NR
|
None
|
None
|
1/0
|
63
|
Right-sided V2 + V3
|
1 MD
|
NR
|
NR
|
|
Gressot, 2012 [10]
|
1 (0/1)
|
NR
|
NR
|
Spasm
|
1/0
|
66
|
NR
|
1MD
|
100% pain-free immediately
|
NR
|
|
Lin, 2012 [15]
|
3
|
NR
|
1
|
NR
|
1/2
|
73
|
3 left-sided V2 + V3
|
Microvascular suspension
|
100% pain-free off medication after 16 to 92 weeks
|
1 hypoesthesia
|
|
Park, 2012 [5]
|
20(13/7)
|
2.0%
|
NR
|
NR
|
14/6
|
74
|
5 V2 + V3–8 V2–3 V3–4 V1 + V2–4 V1 + V2 + V3
|
20 Gamma knife
|
75% pain-free immediately
|
2 numbness
|
|
Yang, 2012 [19]
|
10(6/4)
|
2.1%
|
8
|
NR
|
5/5
|
64
|
5/10 left-sided
|
10 MD
|
100% pain-free off medication after 3 to 30 months
|
1 numbness
|
|
Ishii, 2013 [12]
|
1
|
NR
|
IV nerve compression
|
None
|
1/0
|
77
|
Left-sided
|
Electrical neurocoagulation
|
Pain-free off medication after 18 months
|
Transient diplopia
|
|
Ma, 2013 [16]
|
11 (6/5)
|
2.4%
|
NR
|
2 facial spasms; 1 hearing loss; 1 hypoesthesia
|
8/3
|
63
|
8 left-sided (73%)
|
9 MD; 2 selective partial posterior nerve rhizotomy + MD
|
100% pain-free off medication after 22 months
|
3 facial numbness; 1 facial palsy; 1 facial spasm
|
|
Our cases, 2016
|
3 (0/3)
|
1.4%
|
0
|
1 facial hypersensitivity
|
3/0
|
63
|
1 left-sided, 1 V2, 1 V2 + V3, 1 V1 + V2 + V3
|
3 MD
|
100% pain-free off medication at 24 months
|
2 transient diplopia, 1 transient facial numbness, 1 mild ataxia
|