Microvascular Decompression for Glossopharyngeal Neuralgia Through the Transcondylar Fossa (Supracondylar Transjugular Tubercle) Approach

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons275-ons280 ◽  
Author(s):  
Masatou Kawashima ◽  
Toshio Matsushima ◽  
Tooru Inoue ◽  
Toshihiro Mineta ◽  
Jun Masuoka ◽  
...  
Keyword(s):  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Glossopharyngeal Nerve ◽  
Glossopharyngeal Neuralgia ◽  
Anterior Inferior Cerebellar Artery ◽  
Vascular Compression ◽  
Surgical Results ◽  
Vagus Nerves ◽  
Cerebellar Artery ◽  
Offending Artery

Abstract OBJECTIVE Our surgical results were reviewed to clarify the cause of glossopharyngeal neuralgia (GPN) and the effects of the microvascular decompression (MVD) procedure. METHODS Fourteen cases of idiopathic GPN were operated on through the transcondylar fossa (supracondylar transjugular tubercle) approach. Their clinical data and operative records were retrospectively reviewed. RESULTS In every case, vascular compression on the glossopharyngeal nerve was found and MVD was performed without any major complications. In 13 of the 14 cases the neuralgia completely disappeared postoperatively. Recurrence of pain was found in 1 case. Offending vessels were the posterior inferior cerebellar artery (PICA) in 10 cases, the anterior inferior cerebellar artery (AICA) in 2 cases, and both arteries in 2 cases. In 10 of the 14 cases, the high-origin PICA formed an upward loop between the glossopharyngeal and vagus nerves, compressing the glossopharyngeal nerve upward. In those cases, the PICA was transposed and fixed to the dura mater by the stitched sling retraction technique, and MVD was very effective. CONCLUSION The offending artery was the PICA in most cases. MVD is expected to be very effective, especially when the radiological images show the following 3 findings: 1) high-origin PICA, 2) the PICA making an upward loop, and 3) the PICA coursing the supraolivary fossette. The transcondylar fossa approach is suitable for transposing the PICA by the stitched sling retraction technique, and provides sufficient surgical results.

Microvascular decompression for hemifacial spasm

1991 ◽  
Vol 75 (3) ◽  
pp. 388-392 ◽  
Author(s):  
Shinji Nagahiro ◽  
Akira Takada ◽  
Yasuhiko Matsukado ◽  
Yukitaka Ushio
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Anterior Inferior Cerebellar Artery ◽  
Vascular Compression ◽  
Content Type ◽  
Seventh Cranial Nerve ◽  
Cerebellar Artery

✓ To determine the causative factors of unsuccessful microvascular decompression for hemifacial spasm, the follow-up results in 53 patients were assessed retrospectively. The mean follow-up period was 36 months. There were 32 patients who had compression of the seventh cranial nerve ventrocaudally by an anterior inferior cerebellar artery (AICA) or a posterior inferior cerebellar artery. Of these 32 patients, 30 (94%) had excellent postoperative results. Of 14 patients with more severe compression by the vertebral artery, nine (64%) had excellent results, three (21%) had good results, and two (14%) had poor results; in this group, three patients with excellent results experienced transient spasm recurrence. There were seven patients in whom the meatal branch of the AICA coursed between the seventh and eighth cranial nerves and compressed the dorsal aspect of the seventh nerve; this was usually associated with another artery compressing the ventral aspect of the nerve (“sandwich-type” compression). Of these seven patients, five (71%) had poor results including operative failure in one and recurrence of spasm in four. The authors conclude that the clinical outcome was closely related to the patterns of vascular compression.

Neurovascular compression findings in hemifacial spasm

2008 ◽  
Vol 109 (3) ◽  
pp. 416-420 ◽  
Author(s):  
Mauricio Campos-Benitez ◽  
Anthony M. Kaufmann
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Nerve Root ◽  
Posterior Inferior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Exit Point ◽  
Root Exit Zone ◽  
Cerebellar Artery

Object It is generally accepted that hemifacial spasm (HFS) is caused by pulsatile vascular compression upon the facial nerve root exit zone. This 2–3 mm area, considered synonymous with the Obersteiner–Redlich zone, is a transition zone (TZ) between central and peripheral axonal myelination that is situated at the nerve's detachment from the pons. Further proximally, however, the facial nerve is exposed on the pontine surface and emerges from the pontomedullary sulcus. The incidence and significance of neurovascular compression upon these different segments of the facial nerve in patients with HFS has not been previously reported. Methods The nature of neurovascular compression was determined in 115 consecutive patients undergoing their first microvascular decompression (MVD) for HFS. The location of neurovascular compression was categorized to 1 of 4 anatomical portions of the facial nerve: RExP = root exit point; AS = attached segment; RDP = root detachment point that corresponds to the TZ; and CP = distal cisternal portion. The severity of compression was defined as follows: mild = contact without indentation of nerve; moderate = indentation; and severe = deviation of the nerve course. Success in alleviating HFS was documented by telephone interview conducted at least 24 months following MVD surgery. Results Neurovascular compression was found in all patients, and the main culprit was the anterior inferior cerebellar artery (in 43%), posterior inferior cerebellar artery (in 31%), vertebral artery (in 23%), or a large vein (in 3%). Multiple compressing vessels were found in 38% of cases. The primary culprit location was at RExP in 10%, AS in 64%, RDP in 22%, and CP in 3%. The severity of compression was mild in 27%, moderate in 61%, and severe in 12%. Failure to alleviate HFS occurred in 9 cases, and was not related to compression location, severity, or vessel type. Conclusions The authors observed that culprit neurovascular compression was present in all cases of HFS, but situated at the RDP or Obersteiner–Redlich zone in only one-quarter of cases and rarely on the more distal facial nerve root. Since the majority of culprit compression was found more proximally on the pontine surface or even pontomedullary sulcus origin of the facial nerve, these areas must be effectively visualized to achieve consistent success in performing MVD for HFS.

Glossopharyngeal neuralgia

1977 ◽  
Vol 47 (3) ◽  
pp. 316-320 ◽  
Author(s):  
Ranjit K. Laha ◽  
Peter J. Jannetta
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Glossopharyngeal Neuralgia ◽  
Vascular Compression ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Sporadic Cases ◽  
Fine Print

✓ Various factors have been considered in the etiology and pathogenesis of glossopharyngeal neuralgia. Vascular compression of the involved cranial nerves has been demonstrated in sporadic cases. In this series of six patients, it was noted with the aid of the operating microscope that the ninth and tenth cranial nerves were compressed by a tortuous vertebral artery or posterior inferior cerebellar artery at the nerve root entry zone in five cases. In selected patients, microvascular decompression without section of the nerves may result in a cure.

Follow-up results of using microvascular decompression for treatment of glossopharyngeal neuralgia

1998 ◽  
Vol 88 (2) ◽  
pp. 221-225 ◽  
Author(s):  
Akinori Kondo
Keyword(s):  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Petrous Bone ◽  
Glossopharyngeal Neuralgia ◽  
Content Type ◽  
Cerebellar Artery ◽  
Lancinating Pain ◽  
Fine Print ◽  
Partial Destruction

Glossopharyngeal neuralgia (GPN) is an uncommon disorder that is characterized by a severe lancinating pain commonly induced by swallowing. There has been some debate among various authors as to which surgical procedure should be adopted to treat cases of GPN: microvascular decompression (MVD) or partial rhizotomy. The latter necessitates the partial destruction of normal neural structures. Object. The purpose of this paper is to present follow-up results in patients with GPN who underwent MVD. Methods. Between 1980 and 1995, 20 patients underwent MVD for GPN. Results were studied to verify the effectiveness of MVD performed in 16 patients before 1991 who participated in follow-up evaluation for more than 5 years postoperatively. The follow-up period ranged from 5 to 16 years (mean ± standard deviation 11.6 ± 2.8 years). The method adopted for MVD was to reposition the offending vessel, such as a troublesome vertebral artery or posterior inferior cerebellar artery that is commonly ectatic and arteriosclerotic, by lifting the loop of the artery and using glue to affix it to the nearby dura mater of the petrous bone. Conclusions. Pain was relieved in all cases. Two patients complained of persistent mild hoarseness, causing the inability to speak loudly, and two patients complained of occasional coughing episodes that occurred for a couple of years after the surgery. No other complications were reported and no recurrence of pain was noted during the follow-up period. This procedure provided satisfactory results by preserving important perforating arteries in this area and by repositioning offending arteries in a safer and surer fashion, thus reducing complications and recurrence of GPN.

Long-term Outcomes of Microvascular Decompression in the Treatment of Hemifacial Spasm Based on Different Offending Vessels

2019 ◽  
Vol 80 (04) ◽  
pp. 285-290 ◽  
Author(s):  
Hua Zhao ◽  
Yinda Tang ◽  
Xin Zhang ◽  
Jin Zhu ◽  
Yan Yuan ◽  
...  
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Study Groups ◽  
Effective Rate ◽  
Anterior Inferior Cerebellar Artery ◽  
Long Term Outcomes ◽  
Root Exit Zone ◽  
Cerebellar Artery

Objective To evaluate clinical features, outcomes, and complications in patients with hemifacial spasm (HFS) after microvascular decompression (MVD) of different offending vessels. Methods Clinical data were collected from 362 patients with HFS treated with MVD between January 2013 and January 2014. Patients were divided into five groups based on the offending vessel: A (anterior inferior cerebellar artery [AICA] compression), B (posterior inferior cerebellar artery [PICA] compression), C (AICA plus PICA compression), D (vertebral artery [VA] compression), and E (VA plus small vessel compression). Results The most common offending vessel was the AICA (51.38%). The most common compression site was the root exit zone. During the follow-up period, the effective rate was 95.48% in group A, 92.15% in group B, 93.10% in group C, 90.14% in group D, and 91.45% in group E. Twenty-nine patients exhibited delayed facial palsy, the most common complication. Conclusion No statistically significant differences were found in long-term outcomes or MVD-related complications among the study groups. The type of offending vessel was not a prognostic factor for MVD in patients with HFS.

Hyperactive rhizopathy of the vagus nerve and microvascular decompression

1999 ◽  
Vol 90 (3) ◽  
pp. 580-582 ◽  
Author(s):  
Daniel K. Resnick ◽  
Peter J. Jannetta
Keyword(s):  
Vagus Nerve ◽  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Magnetic Resonance Images ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Brainstem Lesion ◽  
Content Type ◽  
Positional Vertigo ◽  
Cerebellar Artery

✓ A 37-year-old woman underwent microvascular decompression of the superior vestibular nerve for disabling positional vertigo. Immediately following the operation, she noted severe and spontaneous gagging and dysphagia. Multiple magnetic resonance images were obtained but failed to demonstrate a brainstem lesion and attempts at medical management failed. Two years later she underwent exploration of the posterior fossa. At the second operation, the vertebral artery as well as the posterior inferior cerebellar artery were noted to be compressing the vagus nerve. The vessels were mobilized and held away from the nerve with Teflon felt. The patient's symptoms resolved immediately after the second operation and she has remained symptom free. The authors hypothesize that at least one artery was shifted at the time of her first operation, or immediately thereafter, which resulted in vascular compression of the vagus nerve. To the authors' knowledge, this is the first reported case of a hyperactive gagging response treated with microvascular decompression. The case also illustrates the occurrence of a possibly iatrogenic neurovascular compression syndrome.

The Epidemiology, Cause, and Prognosis of Painful Tic Convulsif Syndrome: An Individual Patient Data Analysis of 192 Cases

2020 ◽  
Author(s):  
Zixiao Yin ◽  
Yuye Liu ◽  
Yutong Bai ◽  
Hua Zhang ◽  
Huanguang Liu ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Posterior Inferior Cerebellar Artery ◽  
Open Science ◽  
Older Age ◽  
Cochrane Library ◽  
Anterior Inferior Cerebellar Artery ◽  
Vascular Compression ◽  
Vertebrobasilar Artery ◽  
Cerebellar Artery ◽  
Painful Tic Convulsif

Abstract Background Characterized by the coexistence of trigeminal neuralgia and ipsilateral hemifacial spasm (HFS), painful tic convulsif (PTC) is a rare entity not yet been systematically studied.Objective To systematically explore the epidemiology, cause, prognosis, and prognosis predictors of PTC.Method We searched PubMed, Web of Science, and the Cochrane Library for relevant studies published between the library establishment time and July 1st, 2020. Information on demographics, causes, specific interventions, and intervention outcomes was extracted. We first made descriptive analyses for demographics, causes, and surgical outcomes of PTC. Univariate and multivariate regression methods were utilized to explore potential prognosis predictors. Further, a two-step meta-analysis method was employed to validate the identified factors.Results Overall, 57 reports including 192 cases with PTC were included in the analysis. The median age of PTC patient is 54 (44-62), with more patients being female (p < 0.001), initiated as HFS (p = 0.005), and affected left side (p = 0.045). Vertebrobasilar artery (VBA) contributes to over-65% of the causes of single vascular compression for PTC. Anterior inferior cerebellar artery (AICA)/posterior inferior cerebellar artery (PICA) involvement (OR = 4.050, 95% CI = 1.091-15.031) and older age (p = 0.008) predicts symptom-free and recurrence after microvascular decompression (MVD), respectively.Conclusions PTC more occurs in middle-age women between 40 to 60, initiates as HFS, and affects left side. VBA compression is the most common single cause for PTC. MVD could effectively treat PTC with an over-80% cure rate. AICA/PICA involvement predicts successful surgery and older age predicts recurrence.Registration: the protocol of this study is registered in the Open Science Framework (DOI 10.17605/OSF.IO/X9G3R) on July 10th, 2020.

Mobilization of the Anterior/Posterior Inferior Cerebellar Artery on the Cerebellar Surface in Microvascular Decompression Surgery for Hemifacial Spasm: Potential Effect on Hearing Preservation

2018 ◽  
Vol 16 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Kenichi Amagasaki ◽  
Saiko Watanabe ◽  
Atushi Hosono ◽  
Hiroshi Nakaguchi
Keyword(s):  
Hearing Impairment ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Auditory Evoked Potentials ◽  
Posterior Inferior Cerebellar Artery ◽  
Decompression Surgery ◽  
Surgical Results ◽  
Cerebellar Artery ◽  
Significant Difference ◽  
Anterior Posterior

Abstract BACKGROUND The infrafloccular approach in microvascular decompression (MVD) for hemifacial spasm (HFS) reduces the risk of postoperative hearing impairment. However, location of the anterior/posterior inferior cerebellar artery (AICA/PICA) on the cerebellar surface in the surgical route requires mobilization to maintain the approach direction for the protection of hearing function. OBJECTIVE To evaluate the effectiveness of mobilization of the AICA/PICA on the cerebellar surface in the surgical route. METHODS Retrospective review of 101 patients dividing their cases into 2 groups, the mobilized group and nonmobilized group. Surgical results, brainstem auditory evoked potentials (BAEPs), age, and duration of microsurgery were compared. In the mobilized group, whether the artery was responsible for the HFS or not, and whether the artery branched perforators to the cerebellar surface or choroid plexus or not, were analyzed. RESULTS No permanent hearing impairment occurred in any patient. The AICA/PICA was mobilized in 26 patients. No significant difference was found in surgical results, BAEP findings, and duration of microsurgery between the 2 groups, but age was younger in the mobilized group (P &lt; .01). The mobilized artery was responsible in 14 cases and branched perforators in 7 cases in the mobilized group. The perforators did not obstruct mobilization. CONCLUSION Mobilization of the AICA/PICA from the cerebellar surface is a useful technique to maintain the infrafloccular approach in MVD for HFS. This technique reduces the risk of postoperative hearing impairment.

Glossopharyngeal Neuralgia Due to Vascular Compression by Tortuous Left Posterior Inferior Cerebellar Artery: A High Strength (1.5 T) MRI Study

2007 ◽  
Vol 20 (5) ◽  
pp. 513-516
Author(s):  
B. Mudalgi ◽  
A. Gaikwad ◽  
S. Prabhu ◽  
J. Patil
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Rare Condition ◽  
High Strength ◽  
Glossopharyngeal Neuralgia ◽  
Vascular Compression ◽  
Mri Imaging ◽  
Effective Treatment Option ◽  
Left Posterior ◽  
Cerebellar Artery ◽  
Mri Study

Glossopharyngeal neuralgia is a rare condition with a frequency about 1% of that of trigeminal neuralgia. Vascular compression is a common and treatable cause of glossopharyngeal neuralgia. Microvascular decompression of the glossopharyngeal nerve is an effective treatment option for patients in whom the disease is caused by compression of the nerve by a blood vessel. Pre-operative detection of the pathology on imaging has become possible with high strength MRI imaging. We describe the case of a 54-year-old man with left glossopharyngeal neuralgia. Constructive interference in steady-state (CISS) and flow sensitive Gradient Echo MRI sequences clearly demonstrated the compression of the IX nerve by the left posterior inferior cerebellar artery (PICA). The patient was operated upon and a Teflon graft was put in between the nerve and the vessel. The intra-operative photographs and post-operative images are also presented here. After surgery, the patient improved symptomatically with no recurrence of the symptoms in the follow-up period of about eight months.

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