Browsing by Subject "microvascular decompression"

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    Geniculate neuralgia successfully treated with microvascular decompression
    (Elsevier, 2020-03) Pecoraro, Nathan C.; Zaazoue, Mohamed A.; Koivuniemi, Andrew S.; Savage, Jesse J.; Neurological Surgery, School of Medicine
    Background First described by John Nottingham in 1857, geniculate neuralgia remains a rare condition associated with vascular compression of the nervus intermedius by the anterior inferior cerebellar artery (AICA), which results in paroxysmal unilateral periauricular pain. Furthermore, limited and controversial treatment options for symptom relief exist given the rarity of the condition and limited cases reported in the literature. Case description This is a case of a 37-year-old one-pack-per-day smoker with diabetes mellitus who presented to our clinic for evaluation of episodic lancinating pain localizing to the right periauricular region. The patients symptoms were attempted to be managed medically, however, remained refractory to medical management for a period greater than one year. The patient’s exam demonstrated a trigger point slightly anterior and inferior to the right tragus, and the pain was reproducible when touched or tapped. The patient was otherwise neurologically intact. Magnetic resonance imaging (MRI) was performed and demonstrated a loop of the AICA in contact with the root entry zone of the facial nerve. This patient was offered an elective microvascular decompression (MVD) for treatment of geniculate neuralgia. Conclusions Surgical microvascular decompression is a safe and effective treatment option for patients suffering from neuralgia refractory to medical therapy. Furthermore, our case report demonstrates that MVD is an effective treatment option for patients suffering from geniculate neuralgia with imaging evidence of AICA compression of the nervus intermedius that is refractory to medical management.
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    Prospective comparison of long-term pain relief rates after first-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia
    (AANS, 2018-01) Wang, Doris D.; Raygor, Kunal P.; Cage, Tene A.; Ward, Mariann M.; Westcott, Sarah; Barbaro, Nicholas M.; Chang, Edward F.; Neurological Surgery, School of Medicine
    OBJECTIVE Common surgical treatments for trigeminal neuralgia (TN) include microvascular decompression (MVD), stereotactic radiosurgery (SRS), and radiofrequency ablation (RFA). Although the efficacy of each procedure has been described, few studies have directly compared these treatment modalities on pain control for TN. Using a large prospective longitudinal database, the authors aimed to 1) directly compare long-term pain control rates for first-time surgical treatments for idiopathic TN, and 2) identify predictors of pain control. METHODS The authors reviewed a prospectively collected database for all patients who underwent treatment for TN between 1997 and 2014 at the University of California, San Francisco. Standardized collection of data on preoperative clinical characteristics, surgical procedure, and postoperative outcomes was performed. Data analyses were limited to those patients who received a first-time procedure for treatment of idiopathic TN with > 1 year of follow-up. RESULTS Of 764 surgical procedures performed at the University of California, San Francisco, for TN (364 SRS, 316 MVD, and 84 RFA), 340 patients underwent first-time treatment for idiopathic TN (164 MVD, 168 SRS, and 8 RFA) and had > 1 year of follow-up. The analysis was restricted to patients who underwent MVD or SRS. Patients who received MVD were younger than those who underwent SRS (median age 63 vs 72 years, respectively; p < 0.001). The mean follow-up was 59 ± 35 months for MVD and 59 ± 45 months for SRS. Approximately 38% of patients who underwent MVD or SRS had > 5 years of follow-up (60 of 164 and 64 of 168 patients, respectively). Immediate or short-term (< 3 months) postoperative pain-free rates (Barrow Neurological Institute Pain Intensity score of I) were 96% for MVD and 75% for SRS. Percentages of patients with Barrow Neurological Institute Pain Intensity score of I at 1, 5, and 10 years after MVD were 83%, 61%, and 44%, and the corresponding percentages after SRS were 71%, 47%, and 27%, respectively. The median time to pain recurrence was 94 months (25th–75th quartiles: 57–131 months) for MVD and 53 months (25th–75th quartiles: 37–69 months) for SRS (p = 0.006). A subset of patients who had MVD also underwent partial sensory rhizotomy, usually in the setting of insignificant vascular compression. Compared with MVD alone, those who underwent MVD plus partial sensory rhizotomy had shorter pain-free intervals (median 45 months vs no median reached; p = 0.022). Multivariable regression demonstrated that shorter preoperative symptom duration (HR 1.005, 95% CI 1.001–1.008; p = 0.006) was associated with favorable outcome for MVD and that post-SRS sensory changes (HR 0.392, 95% CI 0.213–0.723; p = 0.003) were associated with favorable outcome for SRS. CONCLUSIONS In this longitudinal study, patients who received MVD had longer pain-free intervals compared with those who underwent SRS. For patients who received SRS, postoperative sensory change was predictive of favorable outcome. However, surgical decision making depends upon many factors. This information can help physicians counsel patients with idiopathic TN on treatment selection.