Articles: microvascular-decompression-surgery.
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Review
Microvascular decompression for hemifacial spasm: Outcome on spasm and complications. A review.
Over the last decades microvascular decompression (MVD) has been established as the curative treatment of the primary Hemifacial Spasm (HFS), proven to be linked in almost all cases to a neurovascular compression of the facial nerve. Because the disease is not life-threatening and MVD not totally innocuous, efficacy and safety have to be weighted before decision taken of indicating surgery. The authors have been charged by the French Speaking Society of Neurosurgery to conduct a detailed evaluation of the probability of relief of the spasm that MVD is able to obtain, together with its potential complications. ⋯ Because MVD for HFS is functional surgery, scrupulous consideration of its potential risks, together with the ways to avoid complications are of paramount importance. When MVD is estimated to have failed, it is wise to wait one year before considering to repeat surgery, as number of patients may benefit from delayed effect. This is the more so as important as repeated surgery entails a higher rate of complications.
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Although most surgeons are using endoscopy as an adjunct to microscopy in microvascular decompression, a full endoscopic technique is less commonly performed. The present study is aimed to evaluate results of 230 patients of endoscopic vascular decompression. ⋯ Endoscopic vascular decompression is a safe and efficient alternative technique to endoscopic assisted microvascular decompression provided surgeon is experienced in endoscopic surgery. It is helpful in identification of all offending vessels including the double vessel, and anterior compression without brain and nerve retraction.
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Vascular compression of neural structures has long been established as an etiology for dysfunction of multiple cranial nerves. Classically, as is the case of trigeminal neuralgia, vascular compression by an offending artery and sometimes vein-exerting pressure at the root entry zone of the trigeminal nerve can lead to the characteristic pain syndrome. ⋯ Confirming our suspected pathophysiology of this case, we noted resolution of the patient's symptoms following fenestration of cyst and microvascular decompression.
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Case Reports
Microvascular decompression for treatment of trigeminal neuralgia in a patient with a facial nerve schwannoma.
Secondary trigeminal neuralgia (TN) is uncommon. When a space-occupying lesion with mass effect is identified, the associated TN is often exclusively attributed to the tumor. This report illustrates the importance of considering coexistent actionable pathology when surgically treating secondary TN. ⋯ Despite obstruction from a medium-sized tumor, it is still possible to achieve microvascular decompression of the fifth cranial nerve. This emphasizes the importance of considering other actionable pathology during surgical management of presumed tumor-induced TN. Further, TN is relatively uncommon with medium-sized vestibular schwannomas and coexistent causes should be considered.
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Review Comparative Study
Pain-Free Outcomes and Durability of Surgical Intervention for Trigeminal Neuralgia: A Comparison of Gamma Knife and Microvascular Decompression.
Treatment options for trigeminal neuralgia include microvascular decompression (MVD) and Gamma Knife surgery (GKS). There is no consensus which option is more effective at providing immediate and long-lasting pain relief. This study evaluated the differences between these 2 options in terms of rates of complete pain relief and pain-free recurrence. ⋯ MVD may be a more effective intervention than GKS owing to higher rates of initial pain-free outcomes and long-term pain-free outcomes. There is a need for more consistent data reporting of outcomes for treatment of trigeminal neuralgia.