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Objective To evaluate the efficacy and safety of nerve combing for trigeminal neuralgia without neurovascular decompression.Methods A retrospective review of clinical data of 281 patients with trigeminal neuralgia,admitted to our hospital from January 2008 to January 2016,was performed.The patients were divided into two groups:patients from group A were treated by nerve combing (n=32),and patients from group B were treated by microvascular decompression (n=249).The two groups were compared in terms of surgical outcomes and postoperative complications.Results The pain was completely relieved in 90.6％ patients of group A (29/32) and 94.4％ patients of group B (235/249),respectively;the mean follow-up duration was 62.5 months in group A,and 78.1％ patients (25/32) were completely relieved;the mean follow-up duration was 59.8 months in group B,and 84.1％ patients (201/239)were completely relieved;no statistically significant differences existed in the surgical outcomes and long-term outcomes between the two groups (P＞0.05).No complications related to severe disability or death were noted in the two groups.The rate of facial numbness in patients from group A (71.9％) was significant higher than that in group B (2.5％,P＜0.05).Conclusions Nerve combing is a safe and effective treatment for trigeminal neuralgia without neurovascular decompression.Most patients treated with nerve combing experienced some degrees of facial numbness.
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Objective To study the findings and clinical application of the diffusion tensor imaging (DTI) of the trigeminal nerve root in patients with trigeminal neuralgia (TN). Methods Forty-nine patients with unilateral TN caused by vascular compression and surgically confirmed were collected in this study. The subjects were divided into group A (contact, n=22), group B (displacement, n=11) and group C (atrophy, n=16), according to the relationship between blood vessels and nerves. Conventional MRI and horizontal DTI were performed to measure cross-sectional area (CSA), mean diffusivity (MD) value, fractional anisotropy (FA) value, axial diffusivity (AD) value and radial diffusivity (RD) value in nerve roots of affected side and unaffected side. The trigeminal indexes of both affected and unaffected trigeminal nerves and data of the affected trigeminal indexes of TN patients were compared between the groups. Results The CSA and FA values were significantly lower, MD and RD values of trigeminal nerves were significantly higher in affected side than those of unaffected side ( P<0.05). But there was no significant difference in AD value between affected side and unaffected side of TN patients ( P>0.05). Values of CSA and FA were significantly higher in group A than those of group C. The value of RD was significantly lower in group A than that of group C. FA value was significantly higher in group B than that of group C (P<0.05). Conclusion The magnetic resonance DTI sequence can reflect changes in trigeminal nerve microstructure, suggesting that trigeminal demyelination is caused by vascular compression, and altered diffusion indexes of trigeminal nerve are reliable basis for the pathogenesis and the severity evaluation of TN.
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Dysphagia aortica is a rare condition defined by difficulty in swallowing and is caused by extrinsic compression of the esophagus due to an ectatic, tortuous, or aneurysmatic atherosclerotic thoracic aorta. It is easy to miss the diagnosis if the clinician does not consider the possibility of dysphagia caused by a thoracic aortic aneurysm. We present the case of an 82-year-old man who developed dysphagia aortica associated with a large thoracic aortic aneurysm. Extrinsic compression of the esophagus caused by an enlarged thoracic aorta was seen on upper gastrointestinal endoscopy, barium esophagogram, and chest computed tomography. With dietary modifications, his symptoms of dysphagia gradually improved.
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Anciano de 80 o más Años , Humanos , Aorta Torácica , Aneurisma de la Aorta Torácica , Bario , Deglución , Trastornos de Deglución , Diagnóstico , Endoscopía Gastrointestinal , Esófago , Conducta Alimentaria , TóraxRESUMEN
Pupil-involving oculomotor nerve palsy (ONP) is frequently associated with compressive lesion such as intracranial aneurysm originating from the posterior communicating arteries. Vascular variant of posterior intracranial circulation is regarded as an uncommon cause and association between these vascular variants and intracranial hypertension has not been reported. We present an 18-year-old girl with pupil-involving ONP combined with idiopathic intracranial hypertension who revealed compression of oculomotor nerve by a vascular variant of superior cerebellar artery (SCA). This is a rare case of an ONP attributed to compressive effect from an aberrant SCA affected by intracranial hypertension.
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Adolescente , Femenino , Humanos , Arterias , Aneurisma Intracraneal , Hipertensión Intracraneal , Enfermedades del Nervio Oculomotor , Nervio Oculomotor , Seudotumor CerebralRESUMEN
Abstract: Introduction: Multiple vascular compression aimed for transradial access have been developed. We aimed to compare the time required to achieve hemostasis in three different radial vascular compression devices. Methods: ST and non-ST elevation MI, unstable and stable angina as well as diagnostic coronary angiograms patients with transradial vascular access (TVA) in 2 centers were enrolled between June 2010-November 2010. Patients were divided according the TVA compression device (TAVCD) used. Group I received TR Band(tm) (Terumo, Tokyo, Japan), Group II received Neptuno(tm) (Biotronik, Berlin, Deutschland) and Group III received Finale(tm) (Merit Medical, South Jordan, UT).Patients were evaluated immediately after TVACD implantation and 24 hour post-procedure follow up. Results: 60 patients were enrolled in this observational study (Group I = 22 patients; Group II = 18; Group III = 20). All patients demonstrated evidence of radial pulse after hemostasis. 28% developed a superficial hematoma (Group I, 31%; Group II, 30%; Group III, 22%). Pain at the access site was uncommon among patients in both immediate and follow-up evaluations, however, 3% (Group I and II) presented paresthesia immediately following the procedure that resolved by the 24-hour evaluation. Conclusion: In our study, all three evaluated radial compression devices successfully achieved hemostasis regardless of the slight alterations of mechanism, yet similarity in aim of non-occlusive compression. Group I (TR band) had a slight increase in compression time recorded but all groups required an approximate three hours to display no evidence of bleeding. None of the patients in the study presented major vascular complications. We consider that further investigation of radial compression devices as compared to manual compression are necessary to evaluate their advantages and may further simplify the procedure
Resumen: Introducción: Múltiples dispositivos de compresión vascular para el acceso radial han sido desarrollados. Nuestro objetivo es comparar el tiempo requerido para lograr la hemostasis con tres diferentes dispositivos de compresión vascular radial. Métodos: Pacientes de angiografía coronaria de diagnóstico, con elevación y no elevación del ST, con angina de pecho inestable y estable, así como pacientes con acceso vascular radial (AVR) en dos centros, fueron incluidos entre junio y noviembre de 2010. Los pacientes fueron divididos según el dispositivo de compresión AVR (DCAVR) usado. Al Grupo I se le dio el TR Band(tm) (Terumo, Tokio, Japón), el Grupo II recibió el Neptuno(tm) (Biotronik, Berlín, Alemania) y el grupo III recibió el Final(tm) (Merit Medica, South Jordan, UT). Los pacientes fueron evaluados inmediatamente después de la implantación del DCAVR y a las 24 horas de postprocedimiento para seguimiento. Resultados: 60 pacientes fueron incluidos en este estudio observacional (Grupo I = 22 pacientes; Grupo II = 18; Grupo III = 20). Todos los pacientes mostraron evidencia de pulso radial después de la hemostasis. 28% desarrolló un hematoma superficial (Grupo I, 31%; Grupo II, 30%; Grupo III, 22%). El dolor en el sitio de acceso fue poco común entre los pacientes de los dos evaluaciones inmediatas y de seguimiento, sin embargo, el 3% (Grupo I y II) presentó parestesias inmediatamente después del procedimiento que se resolvieron para la evaluación de 24 horas. Conclusión: En nuestro estudio, los tres dispositivos de compresión radiales evaluados lograron con éxito la hemostasis sin importar las pequeñas variaciones del mecanismo, dando resultados similares en el objetivo de la compresión no oclusiva. Grupo I (Banda TR) tuvo un ligero aumento en el tiempo de compresión registrado pero todos los grupos requieren un tiempo aproximado de tres horas para mostrar ninguna evidencia de sangrado. Ninguno de los pacientes en el estudio presentó mayores complicaciones vasculares. Consideramos necesario hacer investigación adicional de los dispositivos de compresión radiales, en comparación con la compresión manual para evaluar sus ventajas y poder simplificar aún más el procedimiento.
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Objective To analyze the clinical efficacy of hemifacial spasm (HFS) treated with microvascular decompression (MVD). Methods Six hundred and thirty patients with HFS, admitted to our hospital and underwent MVD from January 2008 to March 2014 were enrolled, including 16 patients having reoperation. Their clinical data were respectively analyzed and the clinical efficacies were recorded. Results In these 630 patients with HFS, 579 patients (91.9%) were cured. In 463 patients with small vascular compression, 428 were cured (92.4%); in 167 patients with vertebral-basal artery complex compression, 151 were cured (90.4%). In 15 without improvement effect and 21 with relapse after surgery, 16 of them underwent second surgery, and HFS symptoms disappeared in all the 16 patients. Conclusions The clinical efficacy of MVD for HFS is positive. For patients with recurrence or without improvement effect after surgery, a secondary surgery is recommended.
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Objective To investigate the diagnostic value and the efficacy of magnetic resonance tomographic angiography(MRTA) in identifying the relationship between nerves and blood vessels of the patients with idiopathic trigeminal neuralgia.Methods Clinical and MR data of 280 ITN patients were analyzed retrospectively,and then were compared with operation results by using blind con-trol trials.Results Of the 280 ITN patients,there were a total of 267 patients with neurovascular contact,dubious contact or com-pression in affected sides (positive rate:95.3%),and 66 patients in normal sides (false positive rate:23.6%).And of 120 surgical patients,1 18 were found to have neurovascular contact or compression during the operation.There was significant statistical differ-ence between the neurovascular contact or compression in affected sides and that in normal sides (P <0.05).Using operation results as the gold standard,the specificity,sensitivity and the diagnostic accordance rate of MRTA in diagnosing neurovascular contact or compression were 100%,96.6% and 96.7% respectively.Conclusion MRTA can reliably display the relationship between nerves and blood vessels with higher diagnostic sensitivity and accuracy,thus providing the objective basis for the etiological diagnosis of and surgical treatment for ITN.
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Background: Trigeminal neuralgia is the most common facial pain syndrome characterized by severe, brief recurrent episodes of electric shock like pain in the distribution of one or more branches of trigeminal nerve on one side of the face. In the present paper we present our experience with MVD for trigeminal neuralgia in a series of 20 patients during the last 4 years. Methods: All the patients presented to the neurosurgery department with features suggestive of Trigeminal Neuralgia during the last 4 years were evaluated with 3D FIESTA imaging. All those patients eligible for surgical decompression underwent a standard MVD in the form of a small retromastoid suboccipital craniotomy and Microvascular decompression done using a sheet of Teflon to intervene between the vessel and the Vth nerve. Any arachnoid bands across the nerve were carefully divided. Standard post-operative care given. The results were evaluated and tabulated. Results: 65% (N=13) of the patients had immediate postoperative relief. 15% (N=3) showed delayed but good pain relief in 3 weeks period. 20% (N=4) 20% pts did not show any pain relief at all post operatively. There were no mortalities in the series and no redo surgeries were performed in the series. Conclusion: Micro-vascular decompression is safe and effective in producing good pain relief over a long term in patients with Trigeminal neuralgias refractive to medical treatment.
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OBJECTIVE: The aim of this prospective study was to demonstrate the influence of some factors on the prognosis of microvascular decompression in 37 patients with trigeminal neuralgia. METHODS: The results of microvascular decompression (MVD) in 37 patients with trigeminal neuralgia were evaluated at 6 months after surgery and were compared with clinical and operative findings. RESULTS: The sex of the patient, the patient's age at surgery, the side of the pain, and the duration of symptoms before surgery did not play any significant roles in prognosis. Also, the visual analogue scale (VAS) of the patient, the duration of each pain attack, and the frequency of pain over 24 hours did not play any significant roles in prognosis. In addition, intraoperative detection of the type of conflicting vessel, the degree of severity of conflict, and the location of the conflict around the circumference of the root did not play any roles in prognosis. The only factors affecting the prognosis in MVD surgery were intraoperative detection of the site of the conflict along the root and neuroradiological compression signs on preoperative magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA). CONCLUSION: These findings demonstrated that if neurovascular compression is seen on preoperative MRI/MRA and/or compression is found intraoperative at the root entry zone, then the patient will most likely benefit from MVD surgery.
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Humanos , Angiografía , Estudios de Seguimiento , Glicosaminoglicanos , Imagen por Resonancia Magnética , Cirugía para Descompresión Microvascular , Pronóstico , Estudios Prospectivos , Neuralgia del TrigéminoRESUMEN
Objective To study the vascular compression on the ponline cistern of the trigeminal with magnetic resonance diffusion tensor imaging (DTI) and explore the clinical application value of DTI.Methods Sixty patients who were conformed by operation as having trigeminal neuralgia (TN) caused by responsible vascular compression (TN group) and 50 healthy volunteers (control group) were performed conventional MRI and horizontal DTI to measure the apparent diffusion coefficient (ADC)value and fractional anisotropy (FA) value. Results The ADC value and FA value of trigeminal nerve in control group were (1.76±0.98)×10-3 mm2/s, and (0.40±18), respectively, no significant differences of the ADC value and FA value between the left and right trigeminal nerves were found (P>0.05). The ADC and FA values of the trigeminal nerve among the controls, patients with mild or severe compression and the patients with compression combined with neuratrophia were statistically difrerent(P<0.05). The ADC value in the oppression region was increased in 28 patients and unchanged in 4; the average ADC value in the NT group was significantly higher than that in the control group. FA value in the oppression region decreased in 15 patients, unchanged in11 and increased in 5; the average FA value in the NT group was lower than that in the control group. Conclusion DTI has its value in determining the vascular compression of the trigeminal nerve; the greater the degree of trigeminal nerve compression is, the higher the ADC value and the lower the FA value are.
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Vertebral artery loop formation causing encroachment on cervical neural foramen and canal is a rare cause of cervical radiculopathy. We report a case of 61-year-old woman with vertebral artery loop formation who presented with right shoulder pain radiating to her arm for 2 years. Plain radiograph and computed tomography scan revealed widening of the right intervertebral foramen at the C5-6 level. Magnetic resonance imaging and angiogram confirmed the vertebral artery loop formation compressing the right C6 nerve root. We had considered microdecompressive surgery, but the patient's symptoms resolved after conservative management. Clinician should keep in mind that vertebral artery loop formation is one of important causes of cervical radiculopathy. Vertebral artery should be visualized using magnetic resonance angiography in suspected case.
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Femenino , Humanos , Persona de Mediana Edad , Brazo , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Radiculopatía , Dolor de Hombro , Arteria VertebralRESUMEN
The hemifacial spasm has been proved a state of compression usually by blood vessels to the facial nerve. The vascular compression is usually obvious at operation. Since 1980 we have operated microsurgical decompression of 42 hemifacial spasm. Recently we have experienced a case in which venous running in an anterior posterior direction across the caudal aspect of the root entry zone of the facial nerve caused the spasm was coagulated and divided. After operation the patient improved and he free of facial spasm.