Articles: microvascular-decompression-surgery.
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To investigate use of multidata analysis based on an artificial neural network (ANN) to predict long-term pain outcomes after microvascular decompression (MVD) in patients with trigeminal neuralgia (TN) and to explore key predictors. ⋯ The ANN model, constructed using multiple data, predicted long-term pain prognosis after MVD in patients with TN objectively and accurately. The model was able to assess the importance of each factor in the prediction of pain outcome.
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In 1%-2% of patients with symptomatic vascular compression of a cranial nerve, the compression may be due to a tortuous dolichoectatic vertebrobasilar artery. The most common technique used for microvascular decompression relies on the placement of a polytetrafluoroethylene (Teflon) pledget or other buffer between the root of the nerve and the offending vessel loop, thereby decompressing the cranial nerve. In cases of macrovascular compression by a large tortuous artery, these buffering techniques fail to produce lasting results with risk for cranial nerve compression-related deficit, specifically the facial nerve. ⋯ While this technique completely resolved the compression from the vertebrobasilar artery, there was still a remaining vein contacting the nerve anterior to the artery. A Teflon pledget was placed between the vein and the root entry zone, as it was a pontine vein and we planned to preserve it. The patient recovered well without complication and was completely free from hemifacial spasm at >2 years long-term follow-up.
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Bibliometric analyses assess the impact and influence of articles in the academic community. There is no previous work that has used bibliometric analysis of microvascular decompression (MVD). This study aims to identify and characterize the 100 most cited articles on MVD. ⋯ This work provides a detailed evaluation of the 100 most cited articles on MVD, thus allowing recognition and selected reading of the most influential academic contributions related to this surgical technique in a variety of cranial nerve disorders.
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This work illustrates the case of surgical treatment of trigeminal neuralgia (TN), as a tardive complication after vestibular schwannoma (VS) removal (Koos III, Figure 1), in a female patient. After VS surgery, the postoperative computed tomography scan did not show any significant complication, although a thin blood clot was present in the surgical bed (Figure 2). However, 3 months later, our patient developed a TN involving the territories V2-V3. ⋯ The paucity of cases reported in the literature lead us to think that TN as complication of VS removal is underestimated because it may be responsive to medical treatment. Laser-evoked potentials may be useful to study the integrity of the Tn, ensuring that no anatomic damage has been done during surgery. On the basis of our experience, surgery can be an effective treatment option when TN is not responsive to medical therapy and the anatomic-functional integrity of the Tn has been preserved.
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Hemifacial spasm (HFS) is generally caused by compression of the root exit zone (REZ) of the facial nerve by the anterior and posterior inferior cerebellar arteries and occasionally the vertebral artery (VA). Owing to its large caliber and high stiffness, microvascular decompression (MVD) for VA-associated HFS is considered more difficult, and the result is worse than for HFS not associated with the VA.1,2 Therefore, a safer, more reliable MVD is required for VA-associated HFS. In Video 1, we demonstrate our MVD technique in a 57-year-old woman who presented with left HFS owing to facial nerve compression by a dolichoectatic VA. ⋯ MVD of the facial nerve REZ was achieved. The patient's postoperative course was uneventful, and her HFS resolved postoperatively. Patient consent was obtained to perform the surgery and to publish the surgical video.