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01-10-2017 | Short Review

Microvascular decompression is an effective therapy for trigeminal neuralgia due to dolichoectatic basilar artery compression: case reports and literature review

Authors: Caroline Apra, Jean-Pascal Lefaucheur, Caroline Le Guérinel

Published in: Neurosurgical Review | Issue 4/2017

Excerpt

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%).

Table 1

Cases of trigeminal neuralgia secondary to compression by a dolichoectatic vertebrobasilar artery [4, 5, 6‐19]

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

NR not reported

…

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Title: Microvascular decompression is an effective therapy for trigeminal neuralgia due to dolichoectatic basilar artery compression: case reports and literature review
Authors: Caroline Apra
Jean-Pascal Lefaucheur
Caroline Le Guérinel
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: Neurosurgical Review / Issue 4/2017
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-017-0812-5

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