Skip to main content
SpringerLink
Log in

Traitement de la névralgie trigéminale essentielle par décompression vasculaire microchirurgicale

Treatment of trigeminal neuralgia due to neurovascular compression with microvascular decompression

  • Mise Au Point / Update
  • Published:
Douleur et Analgésie

Résumé

La névralgie trigéminale, bien que qualifiée d’essentielle, est due dans une grande majorité de cas (96 %) à une compression vasculaire au niveau de la racine trigéminale. Cette compression pulsatile entraîne des lésions de démyélinisation responsables de foyers d’influx ectopiques qui sont à l’origine de douleurs paroxystiques intenses. La décompression vasculaire microchirurgicale (DVMC) consiste – après constatation à l’imagerie d’un (probable) conflit vasculaire – à lever la compression. L’intervention, d’une durée de 3h environ, est réalisée sous anesthésie générale. L’étude des résultats montre une efficacité, avec sédation complète des douleurs à long terme, dans 62 % à 89 % des cas selon les séries. La DVMC est une chirurgie curative et conservatrice qui traite la cause des douleurs et pour laquelle les résultats à long terme sont le plus souvent durables et stables, comme le montrent les études statistiques sur courbe de Kaplan-Meyer à 16 ans. C’est la première option chirurgicale lorsque les traitements médicamenteux sont insuffisants ou mal supportés et lorsque l’imagerie met en évidence une compression vasculaire.

Abstract

Trigeminal neuralgia is, in a large majority of cases (96%), due to a neurovascular compression at the level of the trigeminal root. Chronic pulsatile compression creates focal demyelination, with short-circuits between fibers and generation of ectopic influxes responsible for intense paroxysmal pain. Microvascular decompression (MVD), in those cases in whom high-resolution MRI shows evidence of a neurovascular compression, obtains long-term relief in a significant number of patients, 62% to 89% of the cases according to series. MVD, because it is a curative and conservative treatment of TN, is the first surgical option. Lesioning techniques with percutaneous approaches or stereotactic radiosurgical methods are alternatives for patient with precarious general conditions or in whom MRI cannot demonstrate neurovascular compression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. Headache classification Committee of International Headache Society (2004) The International classification of Headache Disorders. Cephalalgia 24:126-35

  2. Dandy WE (1934) Concerning the cause of trigeminal neuralgia. Amer J Surg 24:444–55

    Article  Google Scholar 

  3. Gardner WJ, Miklos MV (1959) Response of trigeminal neuralgia to decompression of sensory root. Discussion of cause of trigeminal neuralgia. JAMA 170:1773–6

    CAS  Google Scholar 

  4. Guclu B, Sindou M, Meyronet D, et al (2011) Cranial nerve vascular compression syndromes of the trigeminal, facial and vagoglossopharyngeal nerves: comparative anatomical study of the central myelin portion and transitional zone; correlations with incidences of corresponding hyperactive dysfunctional syndromes. Acta Neurochirurgica 153:2365–75

    Article  PubMed  Google Scholar 

  5. Jannetta PJ (1967) Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26:159–62

    Article  PubMed  Google Scholar 

  6. Sindou M, Keravel Y (2009) Neurochirurgie fonctionnelle dans les syndromes d’hyperactivité des nerfs crâniens. Rapport à la Société de Neurochirurgie de Langue Française. Neurochirurgie 55:75–292

    Article  CAS  PubMed  Google Scholar 

  7. Jannetta PJ (1976) Microsurgical approach to the trigeminal nerve for tic douloureux. Prog Neurol Surg 7:180–200

    Article  Google Scholar 

  8. Provost J, Hardy J (1970) Microchirurgie du trijumeau: anatomie fonctionnelle. Neurochirurgie 16:459–70

    CAS  PubMed  Google Scholar 

  9. Sindou M, Howeidy T, Acevedo G (2002) Anatomical observations during Micro-Vascular Decompression for Idiopathic Trigeminal Neuralgia (with correlations between topogaphy of pain and site of the neurovascular conflicts). Prospective study in a series of 579 patients. Acta Neurochir 144:1–3

    Article  CAS  PubMed  Google Scholar 

  10. Sindou M, Leston J, Le Guerinel C, Keravel Y (2009) Traitement de la névralgie trigéminale par décompression vasculaire microchirurgicale. Neurochirurgie 55:185–96

    Article  CAS  PubMed  Google Scholar 

  11. 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 decompresion. J Neurosurg 107:1144–53

    Article  PubMed  Google Scholar 

  12. Sindou M, Amrani F, Mertens P (1990) Microsurgical vascular decompression in trigeminal neuralgia. Comparison of two technical modalities and physiopathologic deductions. A study of 120 cases. Neurochirurgie 36:16–26

    CAS  PubMed  Google Scholar 

  13. Sindou M, Leston J, Decullier E, Chapuis F (2008) Microvascular decompression for trigeminal neuralgia: the importance of a non-compressive technique–Kaplan-Meier analysis in a consecutive series of 330 patients. Neurosurgery ONS 63:341–51

    Article  Google Scholar 

  14. Sindou M, Mertens P, Amrani F (1991) Does microsurgical vascular decompression for trigeminal neuralgia work through a neocompressive mechanism ? Anatomical-surgical evidence for a decompressive effect. Acta Neurochirurgica 52:124–7

    Google Scholar 

  15. Tatli M, Satici O, Kanpolat Y, Sindou M (2008) Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir 150:243–55

    Article  CAS  PubMed  Google Scholar 

  16. Barker FG, Jannetta PJ, Bissonnette DJ, et al (1996) The longterm outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–83

    Article  PubMed  Google Scholar 

  17. Broggi G, Ferroli P, Franzini A, et al (2000) Microvascular decompression for trigeminal neuralgia. Comments on a series of 250 cases including 10 patients with multiple sclerosis. J Neurol Psychiatry 58:59–64

    Article  Google Scholar 

  18. Sindou M, Leston J, Decullier E, Chapuis F (2006). Microvascular decompression for primary trigeminal neuralgie (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients. Acta Neurochir 148:1235–45

    Article  CAS  PubMed  Google Scholar 

  19. Tronnier VM, Rasche D, Hamer J, et al (2001) Treatment of idiopathic trigeminal neuralgia. Comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery 48:1261–8

    CAS  PubMed  Google Scholar 

  20. Keravel Y, Gaston A, Ciampi de Andrade D, et al (2009) Traitement de la névralgie trigéminale par la compression par ballon. Neurochirurgie 55:197–202

    Article  CAS  PubMed  Google Scholar 

  21. Pollock BE (2006) Radiosurgery for trigeminal neuralgia: is sensory disturbance required for pain relief? J Neurosurg (suppl) 105:103–6

    Article  PubMed  Google Scholar 

  22. Pollock BE, Schoeberl KA (2010) Prospective comparison of posterior fossa exploration and stereotactic radiosurgery dorsal root entry zone target as primary surgery for patients with idiopathic trigeminal neuralgia. Neurosurgery 67:633–8

    Article  PubMed  Google Scholar 

  23. Sindou M, Tatli M (2009) Traitement de la névralgie trigéminale par thermorhizotomie. Neurochirurgie 55:203–10

    Article  CAS  PubMed  Google Scholar 

  24. Sindou M, Tatli M (2009) Traitement de la névralgie trigéminale par injection de glycérol au niveau du ganglion de Gasser. Neurochirurgie 55:211–2

    Article  CAS  PubMed  Google Scholar 

  25. Leal P, Froment JC, Sindou M (2009) Valeur prédictive de l’IRM dans la détection et la caractérisation de la compression vasculaire dans les syndromes d’hyperactivité des nerfs crâniens (trijumeau et facial). Neurochirurgie 55:174–80

    Article  CAS  PubMed  Google Scholar 

  26. Leal PR, Hermier M, Froment JC, et al (2010) Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the magnetic resonance imaging: a prospective study with comparison to surgical findings in 100 consecutive patients who underwent Micro-Vascular Decompression for trigeminal neuralgia. Acta Neurochirurgica 152:817–25

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Département de neurochirurgie, CHU de Saint Étienne, avenue Albert Raimond, F-42270, St Priest en Jarez, France

    M. Sindou

  2. Service de neurochirurgie, centre hospitalier universitaire Nord, avenue Albert Raimond, F-42270, St Priest en Jarez, France

    P. Antherieu & C. Nuti

Authors
  1. M. Sindou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Antherieu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Nuti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Sindou.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sindou, M., Antherieu, P. & Nuti, C. Traitement de la névralgie trigéminale essentielle par décompression vasculaire microchirurgicale. Douleur analg 28, 131–138 (2015). https://doi.org/10.1007/s11724-015-0428-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11724-015-0428-x

Mots clés

Keywords

Search

Navigation