Articles: microvascular-decompression-surgery.
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High-resolution magnetic resonance imaging (MRI) of the trigeminal nerve is indispensable for workup of trigeminal neuralgia (TN) before microvascular decompression; however, the evaluation is often subjective and prone to variability. We aim to develop and assess sequential thresholding-based automated reconstruction of the trigeminal nerve (STAR-TN) as an algorithm for segmenting the trigeminal nerve and contacting structures that will allow for a structured method for assessing neurovascular conflict. ⋯ STAR-TN allows for 3-dimensional visualization and identification of neurovascular conflict with improved sensitivity compared with neuroradiologist assessments from MRI slices.
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Hemifacial spasm (HFS) is a rare condition, characterized by unilateral, paroxysmal and involuntary contraction of the muscles innervated by the facial nerve (FN). The most common cause is a vascular conflict in the exit zone of the FN. The objective of this work is to demonstrate the efficacy and safety of neurovascular decompression (NVD). ⋯ Most of our patients with HFS (85%) obtained a total improvement, along with a low rate of permanent morbidity (4%) and no cases of mortality. NVD should be considered as the first line of treatment in patients with primary HFS with evidence of neurovascular conflict on MRI.
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Frailty predicts worse pain outcomes for older TN patients treated with microvascular decompression.
Trigeminal neuralgia (TN) is a debilitating orofacial pain disorder. Recent data from a national database suggest that microvascular decompression (MVD) in frail patients is associated with more postoperative complications. However, the long-term pain outcomes for frail TN patients are not known. We aimed to elucidate the relationship between frailty and long-term pain outcomes after MVD for TN. ⋯ Frail patients undergoing MVD are at risk of worse long-term pain outcomes. Our results provide clinicians with useful information pertaining to the influence of frailty on the long-term efficacy of MVD in treating TN.
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Microvascular decompression (MVD) as a treatment for trigeminal neuralgia (TGN) has high success rate but is associated with risks of complication. This study analyzes Twitter to provide insights into discussions surrounding MVD for patients with TGN. ⋯ This study provides a comprehensive review of Twitter use discussing MVD in TGN and is the first to assess patient satisfaction after treatment using SA. The data presented on patient perspectives on social media could help physicians establish direct lines of communication with patients, fostering a more patient-focused care.
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A persistent primitive trigeminal artery (PPTA) is a rare embryonic cerebrovascular anomaly. Hemifacial spasm (HFS) refers to involuntary contractions of facial muscles caused by the compression of blood vessels against the root exit zone of the facial nerve. There have been no reported cases of PPTA causing neurovascular contact and HFS. Microvascular decompression surgery effectively treats HFS, but operating on strong PPTA vessels poses challenges. We aim to introduce a more efficient approach for overcomes these difficulties and facilitates surgery. ⋯ In cases where the vessel causing HFS is particularly strong and thick, the proximal Teflon transposition with interposition technique for transposition may be advantageous. This method could simplify and enhance the efficacy of microvascular decompression, without compromising the quality of surgical outcomes.