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Introducción: La Academia Americana de Neurología propone que, para que un paciente sea candidato a descompresiva neurovascular trigeminal (DNV), se debe demostrar la presencia de contacto neurovascular a través de la resonancia magnética (RM). Sin embargo, recientes estudios han demostrado que la sensibilidad de la RM para diagnosticar un conflicto neurovascular (CNV) es muy variable. Estos conceptos antagónicos ubican al neurocirujano ante un verdadero dilema a la hora de tomar decisiones. El objetivo del presente estudio es evaluar la utilidad de la clínica y la RM como factor predictor de un verdadero CNV. Materiales y Métodos: Estudio analítico retrospectivo que incluye a 81 pacientes a los que se les realizó una DNV por neuralgia trigeminal (NT), desde enero de 2013 hasta abril de 2019, en la provincia de Tucumán. Resultados: Al considerar la serie completa: A) Un total de 65 pacientes cursaron con NT Típicas; de estos, 64 (98,5%) presentaron CNV durante la cirugía y B) De las 16 Atípicas, ninguna presentó CNV en el intraoperatorio. Al considerar los pacientes con NT primaria: A) un 98% de los pacientes con clínica de NT típica presentaran CNV en el intraoperatorio y B) hubo un grupo de pacientes donde se evidencio un CNV en el intraoperatorio pero en su RM preoperatoria no se objetivo el mismo (n=15), el valor predictivo negativo de la RM fue sólo un 6%. Conclusión: La clínica del paciente es más efectiva que la RM para decidir si realizar o no una cirugía de DNV.
Introduction: The American Academy of Neurology proposes that, for a patient to be a candidate for trigeminal neurovascular decompression (NVD), the presence of neurovascular contact must be demonstrated through magnetic resonance imaging (MRI). However, recent studies have shown that the sensitivity of MRI to diagnose a neurovascular conflict (NVC) is highly variable. These antagonistic concepts put, the neurosurgeon, in a real dilemma when making decisions about this entity. The aim of this study is to evaluate the usefulness of clinical and MRI as a predictor of a real NVC. Methods: This is a retrospective analytical study including 81 patients undergoing NVD to treat trigeminal neuralgia (TN), from January 2013 to April 2019, in Tucumán. Results: When considering the complete series: A) Of the total of 65 patients who had typical TN, 64 (98.5%) presented NVC during surgery and B) Of the 16 atypical TN, none of then presented NVC during the surgery. When considering patients with primary TN: A) 98% of the patients with typical NT presented a NVC during surgery and B) there was a group of patients where NVC was evidenced during surgery but it wasn`t noticed during the preoperative MRI (n=15), the negative predictive value of the MRI was only 6%. Conclusion: The patient's clinic is more effective than the MRI deciging whether or not to perform NVD surgery.
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Humanos , Neuralgia del Trigémino , Terapéutica , NeuralgiaRESUMEN
[ABSTRACT]OBJECTIVETo evaluate the diagnostic value and curative effect of keyhole neurovascular decompression with local anesthesia for vestibular paroxysmia.METHODSOf 40 patients with trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia, 8 of them combined with vestibular paroxysmia underwent keyhole neurovascular decompression under local anesthesia to explore the vascular compression of acoustic nerve root and have the neurovascular decompression. The evaluation of the vertigo after operation was performed with symptom report card. The patients were followed-up for 36 to 61 months. RESULTSThe vessels compressing the root zone of the vestibular nerve were found in 8 patients with vestibular paroxysmia, of whom 7 patients had the vascular compression vertigo induced during operation and the vertigo was disappeared after operation, moreover, one patient had no vascular compression vertigo induced during operation and the vertigo was not changed after operation. With the average follow-up of 57 months, of 8 patients with vestibular paroxysmia, 7 patients had no recurrence of the vertigo, and the effective control rate was 87.5%.CONCLUSION Local anesthesia keyhole neurovascular decompression was not only an effective way for treating vestibular paroxysmia and controlling the vertigo, but also had certain clinical significance in the diagnosis of vestibular paroxysmia.
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To preserve function of the acoustic nerve and brainstem during posterior fossa surgery, the authors monitored(brainstem auditory evoked potentials) in 42 cases of posterior fossa surgery who were operated at the Department of Neurosurgery of Yonsei University College of Medicine from March, 1983 to February, 1987. The results were summarized as followings : 1) There were 28 cases of hemifacial spasm, 13 cases of trigeminal neuralgia and 1 case of cerebellopontine angle tumor. 2) Among the 41 cases of neurovascular decompression, there were 10 cases(24%) with hearing impairment postoperatively. But there was no postoperative auditory dysfunction in 13 cases of hemifacial spasm in which caudal approach was utilized. 3) There was no postoperative auditory dysfunction in the patients who showed intraoperative BAEPs of Types I, II, and III which were characterized by no loss of waves, but 10 cases(77%) who showed BAEPs of types IV, V and VI which were characterized by loss of the waves showed auditory dysfunction postoperatively.