Articles: microvascular-decompression-surgery.
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Tobacco use is known to affect incidence and postoperative outcome for several neurosurgical disorders, but its relationship to trigeminal neuralgia (TN) is not known. We sought to identify unique population characteristics that correlate with tobacco use in a cohort of patients with TN who underwent microvascular decompression (MVD), including effect on long-term postoperative outcome. ⋯ In patients undergoing MVD for TN, smoking is associated with younger age of TN onset, more widespread facial pain, and worse long-term postoperative outcome after MVD. These features suggest that TN in smokers may represent a more severe disease form compared with TN in nonsmokers with different responses to treatment.
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Journal of neurosurgery · Feb 2025
Enhancing surgical precision: a novel electromyography finding for confident identification of the root exit zone during microvascular decompression surgery.
The lateral spread response (LSR) is an important electrophysiological sign that predicts successful decompression in patients undergoing microvascular decompression (MVD) for hemifacial spasm (HFS). However, LSRs do not consistently correlate with clinical outcomes, and there are cases in which LSRs are absent. In this study, the authors identified a unique pattern on facial nerve electromyography (EMG) when the root exit zone (REZ) is touched. This distinctive EMG pattern, which the authors coined the "Sang-ku sign" (SKS), could aid in identifying the offending vessel on the REZ, even in the absence of LSRs. ⋯ The SKS could serve as an excellent guide for the facial nerve REZ during surgery. Given that HFS results from abnormal vascular contact on the REZ, this finding plays a crucial role in ensuring surgical success. Alongside LSRs, the SKS could provide valuable insights for neurosurgeons.
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J Clin Monit Comput · Dec 2024
Case ReportsPerioperative ROTEM® evaluation in a patient affected by severe VII factor deficiency undergoing microvascular decompression craniotomy for hemifacial spasm.
The potential use of TEG/ROTEM® in evaluating the bleeding risk for rare coagulation disorders needs to be assessed, considering the common mismatch among laboratory tests and the clinical manifestations. As a result, there is currently no published data on the use of viscoelastic tests to assess coagulation in FVII deficient patients undergoing elective neurosurgery. We describe the case of a patient affected by severe FVII deficiency who underwent microvascular decompression (MVD) craniotomy for hemifacial spasm (HFS). ⋯ The values of coagulation in standard tests, on the contrary, were indicative of a coagulopathy, which was corrected by the administration of replacement therapy. Whether this difference between ROTEM® and standard tests is due to the inadequacy of thromboelastographic normal ranges in this setting, or to the absence of clinically significant coagulopathy, has yet to be clarified. Neurosurgery is a typical high bleeding risk surgery; additional data is required to clarify the potential role for thromboelastographic tests in the perioperative evaluation of the FVII deficient neurosurgical patients.
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Surgical procedures for treating neuropathic pain, including trigeminal neuralgia (TGN), are categorized into three groups: decompression, ablation, and neuromodulation. Microvascular decompression is the only causal therapy for TGN, applicable favorably in cases of classical TGN due to a vascular nerve conflict. ⋯ For irreversible neuropathies of the trigeminal nerve, the algorithm for other neuropathic pain conditions should be considered, along with the potential use of neuromodulatory techniques. When selecting a therapy, diagnosis, medication side effects, individual patient risks, and treatment outcomes must all be taken into account (current S1 guideline from the German Society of Neurology).
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Vascular compression of the optic nerve in a patient with rapid monocular vision loss with otherwise negative diagnostic workup is a rare, but controversial dilemma. The literature is conflicted, advocating for either timely surgical decompression to preserve vision1-6 or observation only given the prevalence of asymptomatic vascular compression and observed arrest of visual decline.7-10 The most frequently reported sources of symptomatic compression are unruptured aneurysms and dolichoectatic vasculature,1-6 with recent consensus reached over a need for extensive perioperative ophthalmologic evaluations and follow-up. We present an illustrative case for microvascular decompression of the prechiasmatic optic nerve. ⋯ Optic canal deroofing, detethering of the optic nerve, and polytetrafluoroethylene (Teflon) patch placement was performed to achieve this decompression. His postoperative course was uncomplicated; only mild improvement of his visual symptoms was noted at 1- and 3-month follow-up. Formal acuity and computerized assessments of vision and extensive follow-up are critical for evaluating the true clinical outcome of patients with microvascular optic nerve compression.