Articles: microvascular-decompression-surgery.
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Journal of neurosurgery · Jan 2018
Comparative StudyProspective comparison of long-term pain relief rates after first-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia.
OBJECTIVE Common surgical treatments for trigeminal neuralgia (TN) include microvascular decompression (MVD), stereotactic radiosurgery (SRS), and radiofrequency ablation (RFA). Although the efficacy of each procedure has been described, few studies have directly compared these treatment modalities on pain control for TN. Using a large prospective longitudinal database, the authors aimed to 1) directly compare long-term pain control rates for first-time surgical treatments for idiopathic TN, and 2) identify predictors of pain control. ⋯ For patients who received SRS, postoperative sensory change was predictive of favorable outcome. However, surgical decision making depends upon many factors. This information can help physicians counsel patients with idiopathic TN on treatment selection.
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Acta neurochirurgica · Jan 2018
How I do it: endoscopic microvascular decompression for hemifacial spasm associated with the vertebral artery.
Microvascular decompression (MVD) of hemifacial spasm (HFS) associated with the vertebral artery (VA) shows higher rates of incomplete cure and complications compared to non-VA-related HFS. ⋯ Endoscopic MVD offers reliable decompression for VA-associated HFS with minimal invasiveness.
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Acta neurochirurgica · Jan 2018
Long-term follow-up of multimodality treatment for multiple sclerosis-related trigeminal neuralgia.
The treatment for multiple sclerosis-related trigeminal neuralgia (MS-TN) is less efficacious and associated with higher recurrence rates than classical TN. No consensus has been reached in the literature on the choice procedure for MS-TN patients. The aim of this study was to assess the incidence and surgical outcomes of medically refractory MS-TN. ⋯ The majority of MS-TN patients become medically refractory and require multiple repeat surgical procedures. MS-TN procedures were associated with high rates of pain recurrence and our data suggests reoperation within 1 year is often necessary. Optimal management strategy in this patient population remains to be determined. Patients need to be counseled on managing expectations as treatments commonly afford only temporary relief.
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Microvascular decompression (MVD) is the most effective treatment for hemifacial spasm (HFS). During MVD surgery, abnormal muscle response (AMR) is widely used. Z-L response (ZLR) is a new monitoring method for HFS. We compared the effectiveness of AMR plus ZLR and simple AMR. ⋯ Regardless of whether the compression vessels of the facial nerve are simple or complicated, combined intraoperative monitoring of AMR plus ZLR monitoring provides more valuable neurosurgical guidance than simple AMR during MVD for HFS.
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Although hearing impairment after microvasuclar decompression (MVD) for hemifacial spasm (HFS) is not common, its occurrence could detrimentally affect the patient's surgical outcome. The object of this study is to address the optimal approaches for reducing postoperative hearing problems after MVD for HFS. ⋯ Few auditory complications, mostly transient, result from MVD. Although MVD is a commonplace surgical technique, to reduce complications it is important to emphasize the need for clean exposure of the lower cranial nerves (except for cranial nerve VIII) to obtain enough working space, sharp arachnoid dissection, minimal cerebellar retraction, and proper responses to changes identified during intraoperative monitoring.