Microvascular decompression in trigeminal neuralgia following vertebrobasilar dolichoectasia

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OBJECTIVE

To analyze our own results with literature data and substantiate microvascular decompression in patients with trigeminal neuralgia (TN) following vertebrobasilar dolichoectasia (VBD).

MATERIAL AND METHODS

A total of 504 patients with TN underwent surgery in 1998-2018. Patients with TN following VBD were included into a retrospective study. There were 4 men and 10 women aged 66 years (range 51-80). Outcomes were evaluated using BNI (Barrow Neurological Institute) scale. PubMed database was used for literature review.

RESULTS

TN caused by VBD was diagnosed in 2.8% of patients. Left-sided trigeminal pain was observed in 10 patients, right-sided — in 4 cases. One patient had concomitant hemifacial spasm. MVD followed by shielding of trigeminal nerve root with shredded Teflon was performed in all patients. We did not perform fixation of vertebrobasilar vessels. In one case, open partial trigeminal nerve root rhizotomy was done in addition to MVD. All patients had pain-free early postoperative period. There were no deaths or major complications. There was transient cranial nerve dysfunction lasting no more than three months (facial numbness — 1, IV nerve dysfunction — 1, VI nerve dysfunction — 1, transient partial facial palsy (House-Brackmann II) — 2, hipoacusia — 2 patients). There was no facial pain recurrence in our group. Mean follow-up period was 5.5 years (range 6 months — 16 years).

CONCLUSION

MVD is an effective option in the treatment of TN following VBD. In these cases, operation is technically more difficult compared to MVD with intact vessels. However, surgery is much more effective than all the available alternatives. The possibilities of vessel transposition in VBD with or without fixation are limited and ineffective. Teflon wool interposition at the points of conflict is an effective and sufficient technique.

Keywords:

trigeminal neuralgia

microvascular decompression

vertebrobasilar dolichoectasia

Authors:

Shulev Yu.A.

St. Petersburg City Multi-Field Hospital No. 2

Gordienko K.S.

St. Petersburg City Multi-Field Hospital No. 2

Trashin A.V.

St. Petersburg City Multi-Field Hospital No. 2

Pechiborshch D.A.

St. Petersburg City Multi-Field Hospital No. 2

Received:

20.12.2018

Accepted:

03.07.2020

List of references:

Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrewska J. AAN-EFNS guidelines on trigeminal neuralgia ma-nagement. European Journal of Neurology. 2008;15(10):1013-1028. https://doi.org/10.1111/j.1468-1331.2008.02185.x
Linskey ME, Jho HD, Jannetta PJ. Microvascular decompression for trigeminal neuralgia caused by vertebrobasilar compression. Journal of Neurosurgery. 1994;81(1):1-9. https://doi.org/10.3171/jns.1994.81.1.0001
Yang XS, Li ST, Zhong J, Zhu J, Du Q, Zhou QM, Jiao W, Guan HX. Microvascular decompression on patients with trigeminal neuralgia caused by ectatic vertebrobasilar artery complex: technique notes. Acta Neurochirurgica. 2012;154(5):793-797. https://doi.org/10.1007/s00701-012-1320-6
Ma X, Sun X, Yao J, Ni S, Gong J, Wang J, Li X. Clinical analysis of trige-minal neuralgia caused by vertebrobasilar dolichoectasia. Neurosurgical Review. 2013;36(4):573-577. https://doi.org/10.1007/s10143-013-0468-8
Smoker WR, Corbett JJ, Gentry LR, Keyes WD, Price MJ, McKusker S. High-resolution computed tomography of the basilar artery: 2. Vertebrobasilar dolichoectasia: clinical-pathologic correlation and review. AJNR. American Journal of Neuroradiology. 1986;7(1):61-72.
Giang DW, Perlin SJ, Monajati A, Kido DJ. Hollander Vertebrobasilar do-lichoectasia: assessment using MR. Neuroradiology. 1988;30(6):518-523. https://doi.org/10.1007/bf00339693
Burchiel KJ. A new classification for facial pain. Neurosurgery. 2003;53(5):1164-1166; discussion 1166-1167. https://doi.org/10.1227/01.neu.0000088806.11659.d8
Flemming KD, Wiebers DO, Brown RD, Link M, Huston J, McClelland RL, Christianson T. The natural history of radiographically defined vertebrobasilar nonsaccular intracranial aneurysms. Cerebrovascular Diseases (Basel, Switzerland). 2005;20(4):270-279. https://doi.org/10.1159/000087710
Kumral E, Kisabay A, Atac C, Kaya C, Calli C. The mechanism of ischemic stroke in patients with dolichoectatic basilar artery. European Journal of Neurology. 2005;12(6):437-444. https://doi.org/10.1111/j.1468-1331.2005.00993.x
Ikeda K, Nakamura Y, Hirayama T, Sekine T, Nagata R, Kano O, Ka-wabe K, Kiyozuka T, Tamura M, Iwasaki Y. Cardiovascular risk and neuroradiological profiles in asymptomatic vertebrobasilar dolichoectasia. Cerebrovascular Diseases (Basel, Switzerland). 2010;30(1):23-28. https://doi.org/10.1159/000313440
Schievink WI, Torres VE, Wiebers DO, Huston J 3rd. Intracranial arterial dolichoectasia in autosomal dominant polycystic kidney disease. Journal of the American Society of Nephrology: JASN. 1997;8(8):1298-1303. https://doi.org/10.3171/jns.1995.83.6.1004
Laforet P, Petiot P, Nicolino M, Orlikowski D, Caillaud C, Pellegrini N, Froissart R, Petitjean T, Maire I, Chabriat H, Hadrane L, Annane D, Eymard B. Dilative arteriopathy and basilar artery dolichoectasia complicating late-onset Pompe disease. Neurology. 2008;70(22):2063-2066. https://doi.org/10.1212/01.wnl.0000313367.09469.13
Garzuly F, Marodi L, Erdos M, Grubits J, Varga Z, Gelpi E, Rohonyi B, Mázló M, Molnár A, Budka H. Megadolichobasilar anomaly with thrombosis in a family with Fabry’s disease and a novel mutation in the alphagalactosidase A gene. Brain. 2005;128(9):2078-2083. https://doi.org/10.1093/brain/awh546
Pico F, Labreuche J, Touboul PJ, Amarenco P. Intracranial arterial dolichoectasia and its relation with atherosclerosis and stroke subtype. Neurology. 2003;61:1736-1742. https://doi.org/10.1212/01.wnl.0000103168.14885.a8
Forrest KM, Siddiqui A, Lim M, Wraige E. Basilar artery dolichoectasia in childhood: evidence of vascular compromise. Child’s Nervous System. 2011;27(1):193-196. https://doi.org/10.1007/s00381-010-1267-y
Victor J, Del Brutto, Jorge G. Ortiz. Intracranial Arterial Dolichoectasia. Frontiers in Neurology. 2017;8:344. https://doi.org/10.3389/fneur.2017.00344
Passero S, Filosomi G. Posterior circulation infarcts in patients with vertebrobasilar dolichoectasia. Stroke. 1998;29(3):653-659. https://doi.org/10.1161/01.str.29.3.653.
Gutierrez J, Bagci A, Gardener H, Rundek T, Ekind M, Alperin N, Sacco R, Wright C. Dolichoectasia diagnostic methods in a multi-ethnic, stroke-free cohort: results from the northern Manhattan study. Journal of Neuroimaging. 2014;24(3):226-231. https://doi.org/10.1111/j.1552-6569.2012.00781.x
Vanaclocha V, Herrera JM, Martínez-Gómez D, Rivera-Paz M, Calabuig-Bayo C, Vanaclocha L. Is There a Safe and Effective Way to Treat Trigeminal Neuralgia Associated with Vertebrobasilar Dolichoectasia? Presentation of 8 Cases and Literature Review. World Neurosurgery. 2016;96:516-529. https://doi.org/10.1016/j.wneu.2016.08.085
Miyazaki S, Fukushima T, Tamagawa T, Morita A. Trigeminal neuralgia due to compression of the trigeminal root by a basilar artery trunk. Report of 45 cases. Neurologia Medico-Chirurgica. 1987;27(8):742-748. https://doi.org/10.2176/nmc.27.742
Passero SG, Rossi S. Natural history of vertebrobasilar dolichoectasia. Neurology. 2008;70:66-72. https://doi.org/10.1212/01.wnl.0000286947.89193.f3
Han IB, Chang JH, Chang JW, Huh R, Chung SS. Unusual causes and presentations of hemifacial spasm. Neurosurgery. 2009;65(1):130-137. https://doi.org/10.1227/01.neu.0000348548.62440.42
Alabri H, Lewis WD, Manjila S, Alkhachroum AM, Georgia M. Acute Bilateral Ophthalmoplegia Due to Vertebrobasilar Dolichoectasia: A Report of Two Cases. The American Journal of Case Reports. 2017;18:1302-1308. https://doi.org/10.12659/ajcr.904395
Kawasaki A, Purvin V. Isolated IVth (trochlear) nerve palsy due to basilar artery dolichoectasia. Klinische Monatsblatter fur Augenheilkunde. 2006;223(5):459-461. https://doi.org/10.1055/s-2006-926576
Giray S, Pelit A, Kizilkilic O, Karatas M. Isolated abducens nerve palsy caused by contralateral vertebral artery dolichoectasia. Neurology India. 2005;53(2):246-247. https://doi.org/10.4103/0028-3886.16433
Lin JY, Lin SY, Wu JI, Wang IH. Optic neuropathy and sixth cranial nerve palsy caused by compression from a dolichoectatic basilar artery. Journal of Neuro-Ophthalmology. 2006;26(3):190-191. https://doi.org/10.1097/01.wno.0000235579.57180.ae
Pham T, Wesolowski J, Trobe JD. Sixth cranial nerve palsy and ipsilateral trigeminal neuralgia caused by vertebrobasilar dolichoectasia. American Journal of Ophthalmology Case Reports. 2018;10:229-232. https://doi.org/10.1016/j.ajoc.2018.02.029
Holmes BB, Green WC, Kung NH, Goebel JA, Van Stavern GP. Vertebrobasilar Dolichoectasia Causing an Optic Tract Syndrome. Journal of Neuro-Ophthalmology. 2017;37(2):179-181. https://doi.org/10.1097/wno.0000000000000495
Ebrahimzadeh K, Bakhtevari MH, Shafizad M, Rezaei O. Hydrocephalus as a rare compilation of vertebrobasilar dolichoectasia: A case report and review of the literature. Surgical Neurology International. 2017;8:256. https://doi.org/10.4103/sni.sni_162_17
Mohammed K, Iqbal J, Kamel H, Mathew J, Al-Sulaiti G. Obstructive hydrocephalus and facial nerve palsy secondary to vertebrobasilar dolichoectasia: Case Report. Surgical Neurology International. 2018;9:60. https://doi.org/10.4103/sni.sni_37_17
Park KJ, Kondziolka D, Kano H, Berkowitz O, Ahmed SF, Liu X, Niranjan A, Flickinger JC, Lunsford LD. Outcomes of Gamma Knife surgery for trigeminal neuralgia secondary to vertebrobasilar ectasia. Journal of Neurosurgery. 2012;116(1):73-81. https://doi.org/10.3171/2011.8.jns11920
Lye RH. Basilar artery ectasia: an unusual cause of trigeminal neuralgia. Journal of Neurology, Neurosurgery, and Psychiatry. 1986;49(1):22-28. https://doi.org/10.1136/jnnp.49.1.22
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. https://doi.org/10.1007/s00701-002-1033-3
Noma N, Kobayashi A, Kamo H, Imamura Y. Trigeminal neuralgia due to vertebrobasilar dolichoectasia: three case reports. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2009;108(3):50-55. https://doi.org/10.1016/j.tripleo.2009.04.039
Lakhan SE. Teaching NeuroImages: concurrent hemifacial spasm and trigemi-nal neuralgia due to vertebrobasilar dolichoectasia. Neurology. 2013;81(8):e52. https://doi.org/10.1212/wnl.0b013e3182a1aaeb
Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. 1967. Journal of Neurosurgery. 2007;107(1):216-219. https://doi.org/10.3171/jns.1967.26.1part2.0159
Yoon S, Mascitelli JR, Mooney MA, Gandhi S, Chen T, Cole TS, Lawton M. Kawase Approach for Dolichoectactic Basilar Artery Macrovascular Decompression in a Patient With Trigeminal Neuralgia: Case Report. Operative Neurosurgery (Hagerstown, Md.). 2019;16(6):178-183. https://doi.org/10.1093/ons/opy215
Grigoryan YuA, Sitnikov AR, Grigoryan GYu. Trigeminal neuralgia and hemifacial spasm in convoluted vertebrobasilar artery. Zhurnal voprosy neirokhirurgii imeni N.N. Burdenko. 2016;80(1):44-56. (In Russ.) https://doi.org/10.17116/neiro201680144-56
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 — report of two cases. Neurologia Medico-Chirurgica. 1990;30(13):1020-1203. https://doi.org/10.2176/nmc.30.1020
El-Ghandour NM. Microvascular decompression in the treatment of trigeminal neuralgia caused by vertebrobasilar ectasia. Neurosurgery. 2010;67(2):330-337. https://doi.org/10.1227/01.neu.0000371978.86528.60
Zhong J, Zhu J, Li ST, Guan HX. Microvascular decompressions in patients with coexistent hemifacial spasm and trigeminal neuralgia. Neurosurgery. 2011;68(4):916-920. https://doi.org/10.1227/neu.0b013e318208f5ac
Ohta M, Komatsu F, Abe H, Sakamoto S, Tsugu S, Oshiro S, Fukushima T. Complication caused by use of fibrin glue in vessel transposition for trigeminal neuralgia. Neurologia Medico-Chirurgica. 2008;48(1):30-32. https://doi.org/10.2176/nmc.48.301
Tabani H, Yousef S, Burkhardt JK, Gandhi S, Benet A, Lawton MT. Macrovascular Decompression of Facial Nerve with Anteromedial Transposition of a Dolichoectatic Vertebral Artery: 3-Dimensional Operative Video. Operative Neurosurgery (Hagerstown, Md.). 2018;16(1):E4. https://doi.org/10.1093/ons/opy117

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