Resection of the suprameatal tubercle in microvascular decompression for trigeminal neuralgia
Background The suprameatal tubercle (SMT) may obscure the neurovascular compression (NVC) in microvascular decompression (MVD) for trigeminal neuralgia (TGN). The aim of this study is to address the necessity of resecting SMT in MVD for TGN. Methods We retrospectively analyzed radiological findings...
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Veröffentlicht in: | Acta neurochirurgica 2020-05, Vol.162 (5), p.1089-1094 |
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description | Background
The suprameatal tubercle (SMT) may obscure the neurovascular compression (NVC) in microvascular decompression (MVD) for trigeminal neuralgia (TGN). The aim of this study is to address the necessity of resecting SMT in MVD for TGN.
Methods
We retrospectively analyzed radiological findings of 461 MVDs in patients with TGN, focusing on the relation between SMT and the NVC site. Three-dimensional (3D) images were used for preoperative evaluation. The NVC sites were obscured by SMT in 48 patients (10.4%) via the retrosigmoid approach. This study was conducted to review the management of SMT among these patients. Resection of SMT was performed in 8 patients (resected group) for direct visualization of the NVC site. On the other hand, nerve decompression was achieved without resecting SMT for the rest of the 40 patients (non-resected group). Biographical data, radiological findings, intraoperative findings, and surgical outcomes were retrospectively evaluated.
Results
The mean height of SMT obscuring NVC was 5.0 mm (2.8–13.9 mm) above the petrous surface. The NVC was located at a mean of 1.9 mm (0–5.9 mm) from the porous trigeminus. The most common offending vessel was the superior cerebellar artery (SCA, 56.3%), followed by the transverse pontine vein (TPV, 29.2%). In the resected group, the transposing culprit vessels were feasibly performed after direct visualization of the NVC site, whereas in the non-resected group, the SCA was successfully transposed using curved instruments after thorough dissection around the nerve. TPV having contact with the nerve was coagulated and divided. Immediate pain relief was obtained in all patients except one who experienced delayed pain relief 1 month after surgery. Facial numbness at discharge was noted in 9 patients (18.8%); thereafter, numbness diminished over time. Numbness at the final visit was observed in 5 patients (10.4%) at mean of 49 months after MVD. Recurrent pain occurred in 4 patients (8.3%) in total. Statistical analysis showed no significant differences in surgical outcomes between both groups.
Conclusions
Direct visualization of the NVC site by resecting the SMT does not affect surgical outcomes in the immediate and long term. Resecting the SMT is not always necessary to accomplish nerve decompression in most cases by use of suitable instruments and techniques. |
doi_str_mv | 10.1007/s00701-020-04242-8 |
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The suprameatal tubercle (SMT) may obscure the neurovascular compression (NVC) in microvascular decompression (MVD) for trigeminal neuralgia (TGN). The aim of this study is to address the necessity of resecting SMT in MVD for TGN.
Methods
We retrospectively analyzed radiological findings of 461 MVDs in patients with TGN, focusing on the relation between SMT and the NVC site. Three-dimensional (3D) images were used for preoperative evaluation. The NVC sites were obscured by SMT in 48 patients (10.4%) via the retrosigmoid approach. This study was conducted to review the management of SMT among these patients. Resection of SMT was performed in 8 patients (resected group) for direct visualization of the NVC site. On the other hand, nerve decompression was achieved without resecting SMT for the rest of the 40 patients (non-resected group). Biographical data, radiological findings, intraoperative findings, and surgical outcomes were retrospectively evaluated.
Results
The mean height of SMT obscuring NVC was 5.0 mm (2.8–13.9 mm) above the petrous surface. The NVC was located at a mean of 1.9 mm (0–5.9 mm) from the porous trigeminus. The most common offending vessel was the superior cerebellar artery (SCA, 56.3%), followed by the transverse pontine vein (TPV, 29.2%). In the resected group, the transposing culprit vessels were feasibly performed after direct visualization of the NVC site, whereas in the non-resected group, the SCA was successfully transposed using curved instruments after thorough dissection around the nerve. TPV having contact with the nerve was coagulated and divided. Immediate pain relief was obtained in all patients except one who experienced delayed pain relief 1 month after surgery. Facial numbness at discharge was noted in 9 patients (18.8%); thereafter, numbness diminished over time. Numbness at the final visit was observed in 5 patients (10.4%) at mean of 49 months after MVD. Recurrent pain occurred in 4 patients (8.3%) in total. Statistical analysis showed no significant differences in surgical outcomes between both groups.
Conclusions
Direct visualization of the NVC site by resecting the SMT does not affect surgical outcomes in the immediate and long term. Resecting the SMT is not always necessary to accomplish nerve decompression in most cases by use of suitable instruments and techniques.</description><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-020-04242-8</identifier><identifier>PMID: 31993750</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Cerebellum ; Compression ; Decompression ; Functional Neurosurgery – Pain ; Interventional Radiology ; Medicine ; Medicine & Public Health ; Microvasculature ; Minimally Invasive Surgery ; Neuralgia ; Neurology ; Neuroradiology ; Neurosurgery ; Original Article - Functional Neurosurgery - Pain ; Pain ; Statistical analysis ; Surgery ; Surgical Orthopedics ; Surgical outcomes ; Trigeminal nerve ; Visualization</subject><ispartof>Acta neurochirurgica, 2020-05, Vol.162 (5), p.1089-1094</ispartof><rights>Springer-Verlag GmbH Austria, part of Springer Nature 2020</rights><rights>Springer-Verlag GmbH Austria, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-6eb827936f20595118a40b98e7c3dd5b27dd3ad6c8dfaa28059958c57986b7af3</citedby><cites>FETCH-LOGICAL-c441t-6eb827936f20595118a40b98e7c3dd5b27dd3ad6c8dfaa28059958c57986b7af3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00701-020-04242-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00701-020-04242-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31993750$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Inoue, Takuro</creatorcontrib><creatorcontrib>Goto, Yukihiro</creatorcontrib><creatorcontrib>Prasetya, Mustaqim</creatorcontrib><creatorcontrib>Fukushima, Takanori</creatorcontrib><title>Resection of the suprameatal tubercle in microvascular decompression for trigeminal neuralgia</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir</addtitle><addtitle>Acta Neurochir (Wien)</addtitle><description>Background
The suprameatal tubercle (SMT) may obscure the neurovascular compression (NVC) in microvascular decompression (MVD) for trigeminal neuralgia (TGN). The aim of this study is to address the necessity of resecting SMT in MVD for TGN.
Methods
We retrospectively analyzed radiological findings of 461 MVDs in patients with TGN, focusing on the relation between SMT and the NVC site. Three-dimensional (3D) images were used for preoperative evaluation. The NVC sites were obscured by SMT in 48 patients (10.4%) via the retrosigmoid approach. This study was conducted to review the management of SMT among these patients. Resection of SMT was performed in 8 patients (resected group) for direct visualization of the NVC site. On the other hand, nerve decompression was achieved without resecting SMT for the rest of the 40 patients (non-resected group). Biographical data, radiological findings, intraoperative findings, and surgical outcomes were retrospectively evaluated.
Results
The mean height of SMT obscuring NVC was 5.0 mm (2.8–13.9 mm) above the petrous surface. The NVC was located at a mean of 1.9 mm (0–5.9 mm) from the porous trigeminus. The most common offending vessel was the superior cerebellar artery (SCA, 56.3%), followed by the transverse pontine vein (TPV, 29.2%). In the resected group, the transposing culprit vessels were feasibly performed after direct visualization of the NVC site, whereas in the non-resected group, the SCA was successfully transposed using curved instruments after thorough dissection around the nerve. TPV having contact with the nerve was coagulated and divided. Immediate pain relief was obtained in all patients except one who experienced delayed pain relief 1 month after surgery. Facial numbness at discharge was noted in 9 patients (18.8%); thereafter, numbness diminished over time. Numbness at the final visit was observed in 5 patients (10.4%) at mean of 49 months after MVD. Recurrent pain occurred in 4 patients (8.3%) in total. Statistical analysis showed no significant differences in surgical outcomes between both groups.
Conclusions
Direct visualization of the NVC site by resecting the SMT does not affect surgical outcomes in the immediate and long term. Resecting the SMT is not always necessary to accomplish nerve decompression in most cases by use of suitable instruments and techniques.</description><subject>Cerebellum</subject><subject>Compression</subject><subject>Decompression</subject><subject>Functional Neurosurgery – Pain</subject><subject>Interventional Radiology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Microvasculature</subject><subject>Minimally Invasive Surgery</subject><subject>Neuralgia</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Original Article - Functional Neurosurgery - Pain</subject><subject>Pain</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Surgical outcomes</subject><subject>Trigeminal nerve</subject><subject>Visualization</subject><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kEtLxDAUhYMozjj6B1xIwI2bah5Nmyxl8AWCILqUkCa3Y4e-TFrBf2_Gjgou3NzccL9zbnIQOqbknBKSX4RYCE0IIwlJWcoSuYPmRMUmFrIbexLHGcvkDB2EsI43lqd8H804VYrngszRyyMEsEPVtbgr8fAKOIy9Nw2YwdR4GAvwtgZctbiprO_eTbBjbTx2YLum9xDCRlp2Hg--WkFTtVHWwuhNvarMIdorTR3gaHsu0PP11dPyNrl_uLlbXt4nNk3pkGRQSJYrnpWMCCUolSYlhZKQW-6cKFjuHDcus9KVxjAZISWkFbmSWZGbki_Q2eTb--5thDDopgoW6tq00I1BM55KxqlQaURP_6DrbvTx1RtKKsGYYDxSbKLin0PwUOreV43xH5oSvQlfT-HrGL7-Cl_LKDrZWo9FA-5H8p12BPgEhDhqV-B_d_9j-wnUBI_k</recordid><startdate>20200501</startdate><enddate>20200501</enddate><creator>Inoue, Takuro</creator><creator>Goto, Yukihiro</creator><creator>Prasetya, Mustaqim</creator><creator>Fukushima, Takanori</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20200501</creationdate><title>Resection of the suprameatal tubercle in microvascular decompression for trigeminal neuralgia</title><author>Inoue, Takuro ; Goto, Yukihiro ; Prasetya, Mustaqim ; Fukushima, Takanori</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-6eb827936f20595118a40b98e7c3dd5b27dd3ad6c8dfaa28059958c57986b7af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Cerebellum</topic><topic>Compression</topic><topic>Decompression</topic><topic>Functional Neurosurgery – Pain</topic><topic>Interventional Radiology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Microvasculature</topic><topic>Minimally Invasive Surgery</topic><topic>Neuralgia</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Original Article - Functional Neurosurgery - Pain</topic><topic>Pain</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Surgical outcomes</topic><topic>Trigeminal nerve</topic><topic>Visualization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Inoue, Takuro</creatorcontrib><creatorcontrib>Goto, Yukihiro</creatorcontrib><creatorcontrib>Prasetya, Mustaqim</creatorcontrib><creatorcontrib>Fukushima, Takanori</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Inoue, Takuro</au><au>Goto, Yukihiro</au><au>Prasetya, Mustaqim</au><au>Fukushima, Takanori</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Resection of the suprameatal tubercle in microvascular decompression for trigeminal neuralgia</atitle><jtitle>Acta neurochirurgica</jtitle><stitle>Acta Neurochir</stitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2020-05-01</date><risdate>2020</risdate><volume>162</volume><issue>5</issue><spage>1089</spage><epage>1094</epage><pages>1089-1094</pages><issn>0001-6268</issn><eissn>0942-0940</eissn><abstract>Background
The suprameatal tubercle (SMT) may obscure the neurovascular compression (NVC) in microvascular decompression (MVD) for trigeminal neuralgia (TGN). The aim of this study is to address the necessity of resecting SMT in MVD for TGN.
Methods
We retrospectively analyzed radiological findings of 461 MVDs in patients with TGN, focusing on the relation between SMT and the NVC site. Three-dimensional (3D) images were used for preoperative evaluation. The NVC sites were obscured by SMT in 48 patients (10.4%) via the retrosigmoid approach. This study was conducted to review the management of SMT among these patients. Resection of SMT was performed in 8 patients (resected group) for direct visualization of the NVC site. On the other hand, nerve decompression was achieved without resecting SMT for the rest of the 40 patients (non-resected group). Biographical data, radiological findings, intraoperative findings, and surgical outcomes were retrospectively evaluated.
Results
The mean height of SMT obscuring NVC was 5.0 mm (2.8–13.9 mm) above the petrous surface. The NVC was located at a mean of 1.9 mm (0–5.9 mm) from the porous trigeminus. The most common offending vessel was the superior cerebellar artery (SCA, 56.3%), followed by the transverse pontine vein (TPV, 29.2%). In the resected group, the transposing culprit vessels were feasibly performed after direct visualization of the NVC site, whereas in the non-resected group, the SCA was successfully transposed using curved instruments after thorough dissection around the nerve. TPV having contact with the nerve was coagulated and divided. Immediate pain relief was obtained in all patients except one who experienced delayed pain relief 1 month after surgery. Facial numbness at discharge was noted in 9 patients (18.8%); thereafter, numbness diminished over time. Numbness at the final visit was observed in 5 patients (10.4%) at mean of 49 months after MVD. Recurrent pain occurred in 4 patients (8.3%) in total. Statistical analysis showed no significant differences in surgical outcomes between both groups.
Conclusions
Direct visualization of the NVC site by resecting the SMT does not affect surgical outcomes in the immediate and long term. Resecting the SMT is not always necessary to accomplish nerve decompression in most cases by use of suitable instruments and techniques.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>31993750</pmid><doi>10.1007/s00701-020-04242-8</doi><tpages>6</tpages></addata></record> |
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subjects | Cerebellum Compression Decompression Functional Neurosurgery – Pain Interventional Radiology Medicine Medicine & Public Health Microvasculature Minimally Invasive Surgery Neuralgia Neurology Neuroradiology Neurosurgery Original Article - Functional Neurosurgery - Pain Pain Statistical analysis Surgery Surgical Orthopedics Surgical outcomes Trigeminal nerve Visualization |
title | Resection of the suprameatal tubercle in microvascular decompression for trigeminal neuralgia |
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