Acta Neurochirurgica

, Volume 161, Issue 8, pp 1589–1598 | Cite as

Arachnoiditis as an outcome factor for microvascular decompression in classical trigeminal neuralgia

  • Edoardo Mazzucchi
  • Andrei BrinzeuEmail author
  • Marc Sindou
Original Article - Functional Neurosurgery - Pain
Part of the following topical collections:
  1. Functional Neurosurgery – Pain



Neurovascular conflict is considered a key element of classical trigeminal neuralgia (TN) and consequently, microvascular decompression (MVD) is an effective treatment. Nevertheless, failures of MVD are described by many authors. In some patients, the arachnoid membranes surrounding the trigeminal nerve and neighbouring vessels may be thickened and adhesive. Here we analyse the impact of such focal arachnoiditis on outcome after MVD for TN.


A cohort of prospectively followed patients after their MVD was reviewed for intraoperative, imaging and clinical data if findings of arachnoiditis during MVD were described. Long-term outcome assessment was the main endpoint.


We reviewed data from 395 MVD procedures, performed for TN from 2001 to 2014. Intraoperative evidence of focal arachnoiditis, as described by the surgeon, has been noted in 51 patients (13%). In 35 (68.6%), neuralgia was typical and in the other 17 (31.4%) it was atypical.

As expected by definition, neurovascular conflict was found in 49 interventions (96%); it was predominantly arterial in 27 (52.9%). Accompanying arachnoiditis was encountered: mild in 20 interventions (39.2%), severe in 31 (60.8%).

A successful result (BNI I or II) was achieved in 29 patients (56.9%). The other 22 patients (43.1%) had persistence or recurrence of pain. Overall KM probability of being pain free at 15 years was 72%.


Intraoperative finding of arachnoiditis during MVD for classical trigeminal neuralgia is associated with poorer outcome than that of classical trigeminal neuralgia in general. This is particularly true for low grades of conflict.


Trigeminal neuralgia Microvascular decompression Outcome Arachnoiditis Prognostic factors Neurovascular conflict 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethics committee of the “Hopital Neurologique de Lyon”.

Informed consent

All patients signed an informed consent form with the surgeon prior to the procedure.


  1. 1.
    Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334(17):1077–1083. CrossRefPubMedGoogle Scholar
  2. 2.
    Burchiel KJ (2016) Trigeminal neuralgia: new evidence for origins and surgical treatment. Neurosurgery 63(Suppl 1):52–55. CrossRefPubMedGoogle Scholar
  3. 3.
    Cevizci R, Dilci A, Tekin AM, Bayazıt Y (2017) Recovery of tinnitus and sensorineural hearing loss due to lysis of arachnoid adhesions in the posterior cranial fossa: is there a novel etiology in neurotological disorders? J Int Adv Otol 13(2):295–297. CrossRefPubMedGoogle Scholar
  4. 4.
    Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P et al (2016) Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology 87(2):220–228. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Dumot C, Brinzeu A, Berthiller J, Sindou M (2017) Trigeminal neuralgia due to venous neurovascular conflicts: outcome after microvascular decompression in a series of 55 consecutive patients. Acta Neurochir 159(2):237–249. CrossRefPubMedGoogle Scholar
  6. 6.
    Gardner WJ (1953) The mechanism of tic douloureux. In: Transactions of the American Neurological Association, 3(78th meeting), pp 168–171 discussion, 171–173Google Scholar
  7. 7.
    Gardner WJ (1962) Concerning the mechanism of trigeminal neuralgia and hemifacial spasm. J Neurosurg 19:947–958. CrossRefPubMedGoogle Scholar
  8. 8.
    Gudmundsson K, Rhoton AL Jr, Rushton JG (1971) Detailed anatomy of the intracranial portion of the trigeminal nerve. J Neurosurg 35(5):592–600CrossRefGoogle Scholar
  9. 9.
    Hardaway FA, Holste K, Ozturk G, Pettersson D, Pollock JM, Burchiel KJ (2019) Raslan AM sex-dependent posterior fossa anatomical differences in trigeminal neuralgia patients with and without neurovascular compression: a volumetric MRI age- and sex-matched case-control study. J Neurosurg:1–8. Epub ahead of print
  10. 10.
    Jannetta PJ (1967) Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26(1), Suppl):159–162. CrossRefGoogle Scholar
  11. 11.
    Killeen T, Kamat A, Walsh D, Parker A, Aliashkevich A (2012) Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review. Anaesthesia 67(12):1386–1394. CrossRefPubMedGoogle Scholar
  12. 12.
    Ko AL, Ozpinar A, Lee A, Raslan AM, McCartney S, Burchiel KJ (2015) Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression. J Neurosurg 122(5):1048–1057. Epub 2015 Feb 13CrossRefPubMedGoogle Scholar
  13. 13.
    Leal PRL, Hermier M, Froment JC, Souza MA, Cristino-Filho G, Sindou M (2010) Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging: a prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Acta Neurochir 152(5):817–825. CrossRefPubMedGoogle Scholar
  14. 14.
    Leal PRL, Hermier M, Souza MA, Cristino-Filho G, Froment JC, Sindou M (2011) Visualization of vascular compression of the trigeminal nerve with high-resolution 3T MRI: a prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Neurosurgery 69(1):15–25; discussion 26. CrossRefPubMedGoogle Scholar
  15. 15.
    Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G (2017) Trigeminal neuralgia - diagnosis and treatment. Cephalalgia: Int J Headache 37(7):648–657. CrossRefGoogle Scholar
  16. 16.
    Maarbjerg S, Sørensen MT, Gozalov A, Bendtsen L, Olesen J (2015) Field-testing of the ICHD-3 beta diagnostic criteria for classical trigeminal neuralgia. Cephalalgia: Int J Headache 35(4):291–300. CrossRefGoogle Scholar
  17. 17.
    Maarbjerg S, Wolfram F, Gozalov A, Olesen J, Bendtsen L (2015) Significance of neurovascular contact in classical trigeminal neuralgia. Brain J Neurol 138(Pt 2:311–319. CrossRefGoogle Scholar
  18. 18.
    Miller JP, Magill ST, Acar F, Burchiel KJ (2009) Predictors of long-term success after microvascular decompression for trigeminal neuralgia. J Neurosurg 110(4):620–626. CrossRefPubMedGoogle Scholar
  19. 19.
    Rongxun Z (1982) Chronic arachnoiditis in the posterior fossa: a study of 82 cases. J Neurol Neurosurg Psychiatry 45(7):598–602. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Sindou M, Howeidy T, Acevedo G (2002a) Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients. Acta Neurochir 144(1):1–12; discussion 12-13. CrossRefPubMedGoogle Scholar
  21. 21.
    Sindou M, Leston J, Decullier E, Chapuis F (2007) Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg 107(6):1144–1153. CrossRefPubMedGoogle Scholar
  22. 22.
    Sindou M, Leston J, Howeidy T, Decullier E, Chapuis F (2006) Micro-vascular decompression for primary trigeminal neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients. Acta Neurochir 148(12):1235–1245; discussion 1245. CrossRefPubMedGoogle Scholar
  23. 23.
    Sindou M, Leston JM, Decullier E, Chapuis F (2008) Microvascular decompression for trigeminal neuralgia: the importance of a noncompressive technique—Kaplan-Meier analysis in a consecutive series of 330 patients. Neurosurgery 63(4 Suppl 2):341–350; discussion 350-351. CrossRefPubMedGoogle Scholar
  24. 24.
    Xia L, Zhong J, Zhu J, Wang Y-N, Dou N-N, Liu M-X et al (2014) Effectiveness and safety of microvascular decompression surgery for treatment of trigeminal neuralgia: a systematic review. J Craniofac Surg 25(4):1413–1417. CrossRefPubMedGoogle Scholar
  25. 25.
    Zakrzewska JM, Coakham HB (2012) Microvascular decompression for trigeminal neuralgia: update. Curr Opin Neurol 25(3):296–301. CrossRefPubMedGoogle Scholar
  26. 26.
    Zakrzewska JM, Lopez BC, Kim SE, Coakham HB (2005) Patient reports of satisfaction after microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia. Neurosurgery 56(6):1304–1311 discussion 1311-1312CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Catholic University of Sacred HeartRomeItaly
  2. 2.University de Lyon 1LyonFrance
  3. 3.University of Medicine and Pharmacy Victor Babes TimisoaraTimisoaraRomania
  4. 4.Service de Neurochirugie FonctionelleLyonFrance

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