Microvascular Decompression in the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Ectasia

• Published in: Neurosurgery Vol. 67; no. 2; pp. 330 - 337
• Main Author: El-Ghandour, Nasser M.F.
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.08.2010; Wolters Kluwer Health, Inc
• Subjects: Anesthesia; Cranial Nerve Diseases - etiology; Cranial Nerve Diseases - pathology; Cranial Nerve Diseases - surgery; Decompression, Surgical; Dilatation, Pathologic - complications; Dilatation, Pathologic - pathology; Female; Humans; Magnetic Resonance Imaging; Male; Medical imaging; Microsurgery; Middle Aged; Neurosurgical Procedures; NMR; Nuclear magnetic resonance; Pain Measurement; Treatment Outcome; Trigeminal Neuralgia - etiology; Trigeminal Neuralgia - pathology; Trigeminal Neuralgia - surgery; Vertebrobasilar Insufficiency - etiology; Vertebrobasilar Insufficiency - surgery; Vertebrobasilar ectasia; Microvascular decompression; Trigeminal neuralgia
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/01.NEU.0000371978.86528.60

Abstract BACKGROUND Vertebrobasilar ectasia (VBE) is a rare cause of trigeminal neuralgia (TN). It occurs in about 2% of all patients. OBJECTIVE This study reviewed the clinical features, radiological concomitants, and surgical findings of VBE and evaluate the microsurgical decompression procedure as a surgical line of treatment of the associated TN. METHODS Ten patients with TN caused by VBE and treated by microvascular decompression are the subject of this study. The study consisted of 6 men and 4 women with a mean age of 54 years. The mean duration of symptoms was 4.5 years. TN was the only symptom in 6 patients; it was associated with hemifacial spasm in 4. Arterial hypertension was present in 6 patients. Multiplanar high-resolution magnetic resonance imaging showed the accurate location and course of the ectatic vessel. Magnetic resonance angiography and digital subtraction angiography confirmed the diagnosis. Surgery demonstrated fifth nerve compression by an ectatic and tortuous vertebrobasilar artery in all cases and seventh nerve compression in 4 cases. Teflon felt was placed between the ectatic artery and compressed nerves. RESULTS There was complete resolution of TN in 8 patients (80%) and hemifacial spasm in 3 (75%) without medication. Four of 6 hypertensive patients (66.7%) achieved normotension without medication. There was no recurrence of symptoms in the mean follow-up period of 7.8 years. CONCLUSION Microvascular decompression is recommended for the treatment of TN caused by VBE if medical treatment has failed, if the patient is suitable for general anesthesia, and if there is evidence of vascular compression of the trigeminal nerve on magnetic resonance imaging.