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Acta Neurochirurgica

Published in:

01-04-2017 | Original Article - Functional

Diagnosis and management for trigeminal neuralgia caused solely by venous compression

Authors: Takuro Inoue, Hisao Hirai, Ayako Shima, Fumio Suzuki, Takanori Fukushima, Masayuki Matsuda

Published in: Acta Neurochirurgica | Issue 4/2017

Abstract

Background

Trigeminal neuralgia (TN) caused solely by venous compression is uncommon. An appropriate vein management protocol for microvascular decompression (MVD) has not been established. We evaluated the management of veins for TN solely due to venous involvement.

Method

We analyzed 31 patients with TN in whom only veins were manipulated during MVD. The culprit veins smaller in diameter than the vein of the cerebellopontine fissure (VCPF) were coagulated and divided in 20 patients (divided group), while transposition was performed for larger veins in the remaining 11 patients (non-divided group). Postoperative outcomes were assessed by Barrow Neurological Institute (BNI) pain intensity score and BNI facial numbness score.

Results

Preoperative contrast-enhanced T1 spoiled gradient recalled (SPGR) imaging exhibited higher detection rates for veins (93.5%) than non-contrast fast imaging employing a steady-state acquisition image (74.2%). The transverse pontine vein (TPV) was the most frequently involved vessel. All the divided veins were small TPVs except one. The non-divided group included seven cases of large TPVs and four involving the main trunk of the superior petrosal vein or its large tributaries. The median follow-up duration was 33 months. Pain relief was achieved immediately after the surgery in 28 (90.3%) and within a month in the remaining 3 (9.7%) patients. Numbness was present in seven (22.6%) patients at the final follow-up. Recurrence was observed in only two (10.0%) patients in the divided group compared with four (36.4%) patients in the non-divided group. Comparison at the final follow-up revealed that the divided group had superior outcome compared to the non-divided group.

Conclusions

Contrast-enhanced T1 SPGR imaging is crucial to detect small veins in the preoperative diagnosis. Division of the culprit veins is recommended if the diameter is smaller than the VCPF as it provides a better outcome and lower recurrence rate than transposition.

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Title: Diagnosis and management for trigeminal neuralgia caused solely by venous compression
Authors: Takuro Inoue
Hisao Hirai
Ayako Shima
Fumio Suzuki
Takanori Fukushima
Masayuki Matsuda
Publication date: 01-04-2017
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 4/2017
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-017-3085-4

ACC 2024 Congress

Springer Medicine

Diagnosis and management for trigeminal neuralgia caused solely by venous compression

Abstract

Background

Method

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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