Trigeminal neuralgia and hemifacial spasm associated with vertebrobasilar artery tortuosity

Grigoryan Yu.A.; Sitnikov A.R.; Grigoryan G.Yu.

doi:https://doi.org/10.17116/neiro201680144-56

Close metadata

Recommended articles:

Localization of neurovascular conflict in trigeminal neuralgia. Burdenko's Journal of Neurosurgery. 2025;(5):37-44

Origins of trigeminal neuralgia surgery (standing on the shoulders of giants). Burdenko's Journal of Neurosurgery. 2025;(5):103-108

Origins of trigeminal neuralgia surgery (era of microvascular decompression). Burdenko's Journal of Neurosurgery. 2025;(5):109-114

Surgical treatment of secondary trigeminal neuralgia. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11):203-209

Topographic and anatomical features of cranial bones in patients with classical trigeminal neuralgia. Russian Journal of Pain. 2025;(3):33-41

Abstract:

Background. The tortuous vertebrobasilar artery (TVBA) often causes neurovascular conflicts in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS). Implementation of microvascular decompression (MVD) in these circumstances is hindered due to stiffness of the enlarged and dilated arteries and is often accompanied by poor outcomes. The surgical strategy in cases of trigeminal neuralgia and hemifacial spasm associated with the TVBA should be clarified in order to achieve good outcomes. Material and methods. MVD was performed in 268 TN patients and 71 HFS patients. The TVBA as a compressing vessel was identified in 30 cases (11 cases of TN, 18 cases of HFS, and 1 patient with painful tic convulsif). All patients underwent MVD and a retrospective analysis of clinical outcomes. Results. Compression caused by the vertebral artery was found in all HFS patients and 4 TN patients, and compression caused by the basilar artery was observed in 7 TN cases. Additional compression of the cranial nerve root entry/exit zone by cerebellar vessels was observed in 21 cases. The TVBA was mobilized by dissection of arachnoid adhesions between the vessel and the brainstem and retracted laterally. Then, the TVBA was retracted from the brainstem to the caudorostral direction. These manipulations resulted is "spontaneous" decompression of the cranial nerves without placing prostheses between the artery and the nerve root entry/exit zone. In all cases (except two), the displaced TVBA was fixed between the enlarged artery and brainstem using pieces of the patient’s muscle and adipose tissues, followed by application of fibrin glue. A cylindrical silicone prosthesis was used in 1 case. In another case, the TVBA was retracted using a fascial loop fixed to the dura mater of the petrous pyramid by means of a suture. After application of MVD, TN and HFS symptoms completely regressed. There were several transient complications and 2 cases of permanent hearing loss. No clinical symptom recurrence was observed. Conclusion. MVD is the most effective surgical treatment of TN and HFS caused by the TVBA. The TVBA should be retracted from the brainstem without placing prostheses in the nerve root entry/exit zone.

Keywords:

trigeminal neuralgia

hemifacial spasm

tortuous vertebrobasilar artery

microvascular decompression

Authors:

Grigoryan Yu.A.

Federal Center of Medicine and Rehabilitation of the Ministry of Health of the Russian Federation, Moscow, Russia

Sitnikov A.R.

Federal Center of Medicine and Rehabilitation of the Ministry of Health of the Russian Federation, Moscow, Russia

Grigoryan G.Yu.

Federal Center of Medicine and Rehabilitation of the Ministry of Health of the Russian Federation, Moscow, Russia

Close metadata

References:

Cook B, Jannetta P. Tic convulsif: results in 11 cases treated with microvascular decompression of the fifth and seventh cranial nerves. J of Neurosurgery. 1984;61(5):949-951. doi: 10.3171/jns.1984.61.5.0949
Fukushima T. Microvascular decompression for hemifacial spasm: results of 2890 cases. Neurovascular Surgery 1995. In: Carter L.P., Spetzler R.F., Hamilton M.G. (eds). New York: McGraw-Hill 1995;1133-1147.
Linskey M, Jho H, Jannetta P. Microvascular decompression for trigeminal neuralgia caused by vertebrobasilar compression. J of Neurosurgery 1994;81(1):1-9. doi: 10.3171/jns.1994.81.1.0001
Lye R. Basilar artery ectasia: an unusual cause of trigeminal neuralgia. J of Neurology, Neurosurgery & Psychiatry. 1986;49(1):22-28. doi: 10.1136/jnnp.49.1.22
Miyazaki S, Fukushima T, Tamagawa T, Morita A. (1987). Trigeminal Neuralgia due to Compression of the Trigeminal Root by a Basilar Artery Trunk. Neurol Med Chir (Tokyo). 1987;27(8):742-748. doi: 10.2176/nmc.27.742
Nagahiro S, Takada A, Matsukado Y, UshioY. Microvascular decompression for hemifacial spasm. J of Neurosurgery. 1991;75(3):388-392. doi: 10.3171/jns.1991.75.3.0388
Samii M, Gunther T, Iaconetta G, Muehling M, Vorkapic P, Samii A. Microvascular Decompression to Treat Hemifacial Spasm: Long-term Results for a Consecutive Series of 143 Patients. Neurosurgery. 2002;50(4):712-719. doi: 10.1097/00006123-200204000-00005
Takamiya Y, Toya S, Kawase T, Takenaka N, Shiga H. Trigeminal neuralgia and hemifacial spasm caused by a tortuous vertebrobasilar system. Surgical Neurology. 1985;24(5):559-562. doi: 10.1016/0090-3019(85)90274-5
Zhong J, Zhu J, Li S, Guan H. Microvascular Decompressions in Patients with Coexistent Hemifacial Spasm and Trigeminal Neuralgia. Neurosurgery. 2011;68(4):916-920. doi: 10.1227/neu.0b013e318208f5ac
Gutierrez J, Sacco R, Wright C. Dolichoectasia - an evolving arterial disease. Nat Rev Neurol. 2011;7(1):41-50. doi: 10.1038/nrneurol.2010.181
Ubogu EE, Zaidat OO. Vertebrobasilar dolichoectasia diagnosed by magnetic resonance angiography and risk of stroke and death: a cohort study. J Neurol Neurosurg Psychiatr. 2004;75(1):22-26.
Yuan Y, Xu K, Luo Q, Yu J. Research Progress on Vertebrobasilar Dolichoectasia. International J of Medical Sciences. 2014;11(10):1039-1048. doi: 10.7150/ijms.8566
Attabib N, Kaufmann A. Use of fenestrated aneurysm clips in microvascular decompression surgery. J of Neurosurgery. 2007;06(5):929-931. doi: 10.3171/jns.2007.106.5.929
Banczerowski P, Czigleczki G, Nyary I. Long-term effectiveness of an ad hoc tailored titanium implant as a spacer for microvascular decompression in the treatment of trigeminal neuralgia caused by megadolichoectatic basilar artery anomaly: 9-year follow-up. J of Neurosurgery. 2014;121(6):1492-1496. doi: 10.3171/2014.8.jns132445
Bejjani G, Sekhar L. Repositioning of the vertebral artery as treatment for neurovascular compression syndromes. J of Neurosurgery. 1997;86(4):728-732. doi: 10.3171/jns.1997.86.4.0728
Campos W, Guasti A, da Silva B, Guasti J. Trigeminal Neuralgia due to Vertebrobasilar Dolichoectasia. Case Reports in Neurological Medicine. 2012;2012:1-3. doi: 10.1155/2012/367304
Choi H, Choi S, Rhee B. Microvascular decompression for hemifacial spasm due to four offending vessels: a case report. Turkish Neurosurgery. 2010. doi: 10.5137/1019-5149.JTN.3853-10.1
El-Ghandour N. Microvascular Decompression in the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Ectasia. Neurosurgery. 2010;67(2):330-337. doi: 10.1227/01.neu.0000371978.86528.60
Ferreira M, Walcott B, Nahed B, Sekhar L. Vertebral artery pexy for microvascular decompression of the facial nerve in the treatment of hemifacial spasm. J of Neurosurgery. 2011;114(6):1800-1804. doi: 10.3171/2010.12.jns10891
Fukuda M, Kameyama S, Takahashi H, Tanaka R. Trigeminal Neuralgia Caused by the Vertebral Artery Associated with Primitive Trigeminal Artery and Agenesis of the Internal Carotid Artery. Neurol Med Chir (Tokyo). 1998;38(6):367-370. doi: 10.2176/nmc.38.367
Furuse M, Ishikawa M, Nishida N, Aoki T, Takahashi J. Transposition of the Vertebral Artery With Fibrin Glue Adhesive in Microvascular Decompression. Neurosurgery Quarterly. 2010;20(3):170-172. doi: 10.1097/wnq.0b013e3181ebaee3
Grigoryan Y, Dreval O, Michailova S. Painful tic convulsif caused by a contralateral vertebral artery. Surgical Neurology. 1991;35(6):471-474. doi: 10.1016/0090-3019(91)90182-9
Grigoryan Y, Goncharov M, Lazebny V. Hemifacial spasm caused by a contralateral vertebral artery: case report. Surgical Neurology. 2000;53(5):493-497. doi: 10.1016/s0090-3019(00)00193-2
Ichikawa T, Agari T, Kurozumi K, Maruo T, Satoh T, Date I. Double-Stick Tape» Technique for Transposition of an Offending Vessel in Microvascular Decompression: Technical Case Report. Neurosurgery. 2011;68:377-382. doi: 10.1227/neu.0b013e318217141c
Kang J, Kang D, Chung S, Chang J. The Effect of Microvascular Decompression for Hemifacial Spasm Caused by Vertebrobasilar Dolichoectasia. J of Korean Neurosurgical Society 2012;52(2):85. doi: 10.3340/jkns.2012.52.2.85
Kim J, Chung J, Chang W, Chung S, Chang J. Outcomes of surgical treatment for hemifacial spasm associated with the vertebral artery: severity of compression, indentation, and color change. Acta Neurochirurgica. 2011;154(3):501-508. doi: 10.1007/s00701-011-1247-3
Kraemer J, Pereira Filho A, David G, Faria M. Vertebrobasilar dolichoectasia as a cause of trigeminal neuralgia: the role of microvascular decompression. Case report. Arquivos de Neuro-Psiquiatria. 2006;64(1):128-131. doi: 10.1590/s0004-282x2006000100027
Kurokawa Y, Maeda Y, Toyooka T, Inaba K. Microvascular decompression for hemifacial spasm caused by the vertebral artery: a simple and effective transposition method using surgical glue. Surgical Neurology. 2004;61(4):398-403. doi: 10.1016/s0090-3019(03)00425-7
Kyoshima K, Watanabe A, Toba Y, Nitta J, Muraoka S, Kobayashi S. Anchoring Method for Hemifacial Spasm Associated with Vertebral Artery: Technical Note. Neurosurgery. 1999;45(6):1487. doi: 10.1097/00006123-199912000-00048
Laws E, Kelly P, Sundt T. Clip-grafts in microvascular decompression of the posterior fossa. J of Neurosurgery. 1986;64(4):679-681. doi: 10.3171/jns.1986.64.4.0679
Lin C, Chen H, Hernesniemi J, Lee C, Liao C, Chen S, Chen M, Shih Y, Hsu S. . An easy adjustable method of ectatic vertebrobasilar artery transposition for microvascular decompression. Clinical Neurology and Neurosurgery. 2012;114(7):951-956. doi: 10.1016/j.clineuro.2012.02.02
Masuoka J, Matsushima T, Kawashima M, Nakahara Y, Funaki T, Mineta T. Stitched sling retraction technique for microvascular decompression: procedures and techniques based on an anatomical viewpoint. Neurosurgical Review. 2011;34(3):373-380. doi: 10.1007/s10143-011-0310-0
Ming K, Yoshimine T, Taki T. A «Sling Swing Transposition» Technique With Pedicled Dural Flap for Microvascular Decompression in Hemifacial Spasm. Neurosurgery. 2012;71(3):25-31. doi: 10.1227/neu.0b013e318246aa74
Miyazono M, Inoue T, Matsushima TA. Surgical case of hemifacial spasm caused by a tortuous, enlarged, and calcified vertebral artery. No Shinkei Geka. 2003;31(4):437-441.
Niwa J, Fujishige M, Nakagawa T, Hashi K. Use of a fenestrated aneurysm clip for transposition of the tortuous vertebral artery. No Shinkei Geka. 1998;16(5):621-624.
Ogawa A, Suzuki M, Shirane R, Yoshimoto T. Repositioning of the tortuous vertebrobasilar artery for trigeminal neuralgia: A technical note. Surgical Neurology. 1992;38(3):232-235. doi: 10.1016/0090-3019(92)90174-l
Perlmutter D, Petraglia A, Barbano R, Schwalb J. Microvascular Decompression in Patient With Atypical Features of Hemifacial Spasm Secondary to Compression by a Tortuous Vertebrobasilar System. Neurosurgery. 2010;66(6):E1212. doi: 10.1227/01.neu.0000369518.49077.d7
Rawlinson J, Coakham H. The Treatment of Hemifacial Spasm by Sling Retraction. Br J Neurosurg. 1998;2(2):173-178. doi: 10.3109/02688698808992667
Ryu H, Yamamoto H. A simple technique for neurovascular decompression of the cranial nerves. Br J Neurosurg. 2000;14(2):132-134. doi: 10.1080/02688690050004561
Shigeno T, Kumai J, Horikawa H, Aihara K, Endo M, Oya S, Ishikawa O, Nishido H, Sakamoto M. Transposition technique of microvascular decompression for hemifacial spasm without using a brain retractor. No Shinkei Geka. 2009;37(1):35-42.
Stone J, Lichtor T, Crowell R. Microvascular sling decompression for trigeminal neurolgia secondary to ectatic vertebrobasilar compression. J of Neurosurgery. 1993;79(6):943-945. doi: 10.3171/jns.1993.79.6.0943
Suzuki I, Sasaki A, Yanagibashi K, Tsuchida T, Hayakawa I, Kobayashi T. Surgical treatment of hemifacial spasm associated with tortuous vertebrobasilar system. No Shinkei Geka. 1978;69(12):1207-1212.
Suzuki S, Tsuchita H, Kurokawa Y, Kitami K, Sohma T, Takeda T. New Method of MVD Using a Vascular Tape for Neurovascular Compression Involving the Vertebrobasilar Artery. Neurol Med Chir (Tokyo). 1990;30(13):1020-1023. doi: 10.2176/nmc.30.1020
Taki W, Matsushima S, Hori K, Mouri G, Ishida F. Repositioning of the vertebral artery with titanium bone fixation plate for trigeminal neuralgia. Acta Neurochirurgica. 2003;145(1):55-61. doi: 10.1007/s00701-002-1033-3
Waga S, Morikawa A, Kojima T. Trigeminal neuralgia: compression of the trigeminal nerve by an elongated and dilated basilar artery. Surg Neurol. 1979;11(1):13-16.
Yamahata H, Tokimura H, Hanaya R, Tajitsu K, Hirabaru M, Yamagami M, Arita K. Microvascular Decompression for Trigeminal Neuralgia due to Compression by the Vertebral Artery: Report of 3 Cases. Minim Invasive Neurosurg. 2011;54(02):79-82. doi: 10.1055/s-0031-1275334
Yang X, Li S, Zhong J, Zhu J, Du Q, Zhou Q, Jiao W, Guan H. Microvascular decompression on patients with trigeminal neuralgia caused by ectatic vertebrobasilar artery complex: technique notes. Acta Neurochirurgica. 2012;154(5):793-797. doi: 10.1007/s00701-012-1320-6
Yoshimoto Y, Noguchi M, Tsutsumi Y. Encircling method of trigeminal nerve decompression for neuralgia caused by tortuous vertebrobasilar artery: technical note. Surgical Neurology. 1995;43(2):151-153. doi: 10.1016/0090-3019(95)80126-2
Dandy W. Concerning the cause of trigeminal neuralgia. The American Journal of Surgery. 1934;24(2):447-455. doi: 10.1016/s0002-9610(34)90403-7
Campbell E, Keedy C. Hemifacial Spasm: A Note on the Etiology in Two Cases*. J of Neurosurgery. 1947;4(4):342-347. doi: 10.3171/jns.1947.4.4.0342
Gardner W, Sava G. Hemifacial Spasm - a Reversible Pathophysiologic State. Journal of Neurosurgery. 1962;19(3):240-247. doi: 10.3171/jns.1962.19.3.0240