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Microvascular decompression for trigeminal neuralgia attributable to the vertebrobasilar artery: decompression technique and significance of separation from the nerve root

  • Original Article - Functional Neurosurgery - Pain
  • Published:
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Abstract

Background

Separation of the vertebrobasilar artery (VBA) from the trigeminal nerve root in microvascular decompression (MVD) is technically challenging. This study aimed to review the clinical features of VBA involvement in trigeminal neuralgia and evaluate surgical decompression techniques in the long term.

Methods

We retrospectively reviewed the surgical outcomes of 26 patients (4.4%) with VBA involvement in 585 consecutive MVDs for TGN using a Teflon roll for repositioning the VBA. The final operative status of the nerve decompression was categorized into two groups: the separation group and the contact group. Separation of the VBA from the nerve root was completed in 13 patients in the separation group, and slight vascular contact remained in the remaining 13 patients of the contact group. The clinical features of VBA-related TGN were investigated and the operative results were analyzed.

Results

Multiple arteries are involved in neurovascular compression (NVC) in most cases. The anterior inferior cerebellar artery was the most common concomitant artery (69%). The site of the NVC varies from the root entry zone to the distal portion of the root. All patients were pain-free immediately after surgery and maintained medication-free status during the follow-up period, except for one patient (3.8%) who had recurrent facial pain 8 years after surgery. Postoperative facial numbness was observed in six patients (23%). Of these, one patient showed improvement within 3 months and the other five patients had persistent facial numbness (19.2%). Other neurological deficits include one dry eye, one diplopia due to trochlear nerve palsy, two decreased hearing (< 50 db), two facial weaknesses, and two cerebellar ataxia. Although most of them were transient, one dry eye, two hearing impairments, and one cerebellar ataxia became persistent deficits. Statistical analyses revealed no difference in surgical efficacy or complications in the long term between the two groups.

Conclusions

Slightly remaining vascular contact does not affect pain relief in the long term. Our study indicated that once the tense trigeminal nerve is loosened, further attempts to mobilize the VBA are not necessary.

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Acknowledgments

We thank Ms. Satomi Fujimura and Ms. Lori Radcliffe for assistance with data collection and English language editing.

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Authors and Affiliations

  1. Department of Neurosurgery, Subarukai Koto Kinen Hospital, 2-1 Hiramatsu-cho, Higashiomi-shi, Shiga, 527-0134, Japan

    Takuro Inoue & Satoshi Shitara

  2. Department of Neurosurgery, Saiseikai Shiga Hospital, Ritto, Shiga, Japan

    Yukihiro Goto

  3. Department of Neurosurgery, National Brain Center Hospital, Jakarta, Indonesia

    Mustaqim Prasetya

  4. Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA

    Takanori Fukushima

Authors
  1. Takuro Inoue
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  2. Satoshi Shitara
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  3. Yukihiro Goto
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  5. Takanori Fukushima
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Correspondence to Takuro Inoue.

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This article is part of the Topical Collection on Functional Neurosurgery - Pain

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Inoue, T., Shitara, S., Goto, Y. et al. Microvascular decompression for trigeminal neuralgia attributable to the vertebrobasilar artery: decompression technique and significance of separation from the nerve root. Acta Neurochir 163, 1037–1043 (2021). https://doi.org/10.1007/s00701-020-04563-8

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  • DOI: https://doi.org/10.1007/s00701-020-04563-8

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