• Neurosurgery · May 2022

    Treatment Strategies for Different Types of Intraneural Offending Vessels in Microvascular Decompression Surgery for Trigeminal Neuralgia: An Analytic Report of 58 Cases.

    • Zhaoli Shen, Feng Yu, Fei Xue, Yuhai Wang, Sze Chai Kwok, and Jia Yin.
    • Department of Neurosurgery, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.
    • Neurosurgery. 2022 May 1; 90 (5): 562-568.

    BackgroundMicrovascular decompression (MVD) surgery is the treatment of choice for trigeminal neuralgia (TGN). However, decompression becomes difficult when the offending vessel penetrates the trigeminal nerve root.ObjectiveTo estimate the rates and patterns of different types of intraneural offending vessels in patients with TGN for MVD and to discuss respective management strategies.MethodsAll patients with TGN undergoing MVD in our center from January 1, 2015, to December 31, 2019, were analyzed retrospectively. The intraneural offending vessels included veins and arteries. The postoperative pain relief rate, complications, and recurrences were evaluated.ResultsOf the 302 TGN cases, the intraneural offending vessels were identified in 58 of the cases (19.2%). The 9 cases (15.5%) of intraneural offending arteries were decompressed using shredded Teflon wrapping interposition. Of the 49 cases (84.5%) of intraneural offending veins (INOVs), 29 were not considered true offending vessels, and the treatment only addressed the offending artery in these patients. Of the remaining 20 INOVs, 15 were electrocoagulated and divided, and 5 were decompressed with shredded Teflon. Complete pain relief was achieved in all 58 patients. However, the pain recurred in 5 patients (8.6%), and transient hemifacial numbness occurred in 4 patients (6.9%).ConclusionIntraneural offending vessels requiring treatment are uncommon and are seen in less than 1 in 10 patients undergoing MVD for TGN. For intraneural offending artery, decompression by shredded Teflon wrapping interposition is recommended. Management of the INOV depends on the individual situations, and the management includes sacrifice, wrapping decompression, or leaving them untreated.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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