Articles: microvascular-decompression-surgery.
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Endoscopic-microvascular decompression (E-MVD) is a well-described treatment for trigeminal neuralgia (TGN), but there has been debate on the safety of intraoperative sacrifice of the petrosal vein (PV) due to concern for subsequent venous insufficiency. Our objective was to investigate the risk of PV sacrifice during E-MVD in TGN and subsequent postoperative complications and pain outcomes. ⋯ This study did not find higher complication rates in patients undergoing petrosal vein sacrifice during E-MVD for trigeminal neuralgia. In this series where petrosal vein was sacrificed only 59% of the time, it appears to be a safe technique, but larger studies will be needed to determine true incidence of complications after PV sacrifice.
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Nervus intermedius neuralgia is an extremely rare craniofacial neuralgia characterized by paroxysmal episodes of pain located deep in the ear, typically triggered by sensory or mechanical stimuli at the wall of the auditory canal without underlying pathology. Pain is sometimes associated with disorders of lacrimation, salivation, and taste. ⋯ It is important to keep in mind the possibility of nervus intermedius neuralgia in patients who present with intermittent episodes of pain located deep in the ear. Furthermore, 3D-MRC/MRA fusion imaging is useful for decision-making in surgery. Microvascular decompression was highly effective in our case. Based on radiological findings, microvascular decompression should be considered a viable treatment option.
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Review Meta Analysis
Prognostic value of abnormal muscle response during microvascular decompression for hemifacial spasm: a meta-analysis.
To perform a comprehensive meta-analysis to systematically assess the value of abnormal muscle response (AMR) in predicting the surgical outcome of patients with hemifacial spasm. ⋯ The disappearance of AMR during microvascular decompression demonstrates limited prognostic value for a favorable short-term outcome, and does not appear effective in predicting the long-term outcome of patients with hemifacial spasm.
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Trigeminal neuralgia is featured by episodic and severe unilateral facial pain triggered usually by innocuous cutaneous stimuli.1-4 Microvascular decompression (MVD) is a safe and effective treatment for cases refractory to medical treatment caused by neurovascular conflicts.1,5-7 This Video 1 demonstrates MVD using arachnoid membrane and petrosal dura to transpose dual offending arteries. Informed consent was obtained from the patient for publication of this operative video. The patient was a 64-year-old woman with refractory right trigeminal neuralgia (V2 territory). ⋯ Postoperative imaging demonstrated no signs of cerebellar contusion or hemorrhage. The patient presented complete resolution of her pain, and no neurologic deficits were observed. We demonstrate MVD with 2 different transposition techniques that can be considered for trigeminal neuralgia with dual offending arteries (AICA, SCA).
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Microvascular decompression (MVD) is highly effective in managing the neuropathic facial pain of trigeminal neuralgia (TN). Its utility in patients with TN and concurrent multiple sclerosis (MS) has been a subject of debate. The goal of this study was to identify demographic and perioperative variables associated with favorable outcome after MVD over the past 20 years in patients from our institution. ⋯ MVD is a reasonable treatment option for patients with TN and MS, although the rate of freedom from pain is lower than that for the general TN population. Preoperative pain severity may be a predictor of treatment success.