INTRODUCTION: Trigeminal neuralgia (TN) develops as a result of the trigger of one or more branches of the trigeminal nerve by stimuli. Most cases of TN are usually caused by compression of the trigeminal nerve root, within a few millimeters from its exit from the pons. In this study, we aimed to present our experience regarding the microvascular decompression surgical approach and itsresults in the treatment of patients who applied to the clinic with a diagnosis of TN and who did not respond to any of the treatments. METHODS: Microvascular decompression (MVD)surgery was performed on a total of 7 patients with TN who applied to the clinic between 2020 and 2021, and the information of the patients was retrospectively evaluated using surgery reports, epicrisis, and magnetic resonance images (MRI). RESULTS: It was observed that all 7 patients with TN were initially administrated carbamazepine and/or oxcarbazepine, implemented radiofrequency thermocoagulation treatment and gamma knife radiosurgery. Subsequently, all the patients underwent MVD surgery. No complications developed in the postoperative period and complaints of TN in all patients completely resolved in the early period. DISCUSSION AND CONCLUSION: In patients who are unresponsive to treatments, thin-section ‘constructive interference of steady state (CISS)’ sequence cranial MRI are useful to detect trigeminal nerve compression caused by intracranial pathologies, and MVD surgery is important in the treatment.
GİRİŞ ve AMAÇ: Trigeminal nevralji (TN), trigeminal sinirin bir veya daha fazla dalının uyaranlar tarafından tetiklenmesi sonucu gelişir. Çoğu TN vakası genellikle trigeminal sinir kökünün pons’tan çıkışından birkaç milimetre sonra kompresyonundan kaynaklanır. Bu çalışmada, TN tanısıyla kliniğe başvuran ve hiçbir tedaviye yanıt vermeyen hastaların tedavisinde mikrovasküler dekompresyon cerrahisi yaklaşımı ve sonuçları ile ilgili deneyimlerimizi sunmayı amaçladık. YÖNTEM ve GEREÇLER: 2020-2021 yılları arasında kliniğe başvuran toplam 7 TN’li hastaya mikrovasküler dekompresyon (MVD) cerrahisi uygulandı ve hastaların bilgileri geriye dönük olarak cerrahi raporları, epikrizleri ve manyetik rezonans görüntüleri (MRG) kullanılarak değerlendirildi. BULGULAR: TN’li 7 hastanın hepsine başlangıçta karbamazepin ve/veya okskarbazepin, radyofrekans termokoagülasyon tedavisi ve gamma knife radyocerrahi uygulandığı görüldü. Ardından tüm hastalara MVD cerrahisi uygulandı. Postoperatif dönemde komplikasyon gelişmedi ve tüm hastalarda TN şikayetleri erken dönemde tamamen düzeldi. TARTIŞMA ve SONUÇ: Tedaviye yanıt vermeyen hastalarda ince kesit ‘constructive interference of steady state (CISS)’ sekanslı kraniyal MRG intrakraniyal patolojilerin neden olduğu trigeminal sinir kompresyonunu saptamak için yararlıdır ve MVD cerrahisi tedavide önemlidir.
___
1. Kes VB, Matovina LZ. Accommodation to diagnosis of trigeminal neuralgıa. Acta Clin Croat. 2017; 56: 157-161. https://doi.org/10.20471/acc.2017.56.01.21
2. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd ed. (beta version). Cephalalgia. 2013; 33: 629-808. doi: 10.1177/0333102413485658.
3. Katusic S, Williams DB, Beard CM, Bergstralh EJ, Kurland LT. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glosso-pharyngeal neuralgia: similarities and di erences, Rochester, Minnesota, 1945- 1984. Neuroepidemiology. 1991; 10: 276-81. https://doi.org/10.1159/000110284
4. MacDonald BK, Cockerell OC, Sander JW, Shorvon SD. Incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain. 2000; 123: 665-676. https://doi.org/10.1093/brain/123.4.665
5. Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Leal PRL, Nurmikko T, et al.Advancesin diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol. 2020; 19: 784-796. https://doi.org/10.1016/S1474-4422(20)30233-7
6. Zakrzewska JM, Wu J, Mon-Williams M, Phillips N, Pavitt SH. Evaluating the impact of trigeminal neuralgia. Pain. 2017; 158: 1166-1174. https://doi.org/10.1097/j.pain.0000000000000853
7. Maarbjerg S, Gozalov A, Olesen J, Bendtsen L. Trigeminal neuralgia: a prospective systematic study of clinical characteristics in 158 patients. Headache. 2014; 54: 1574- 1582. https://doi.org/10.1111/head.12441
8. Love S, Coakham HB. Trigeminal neuralgia: pathology and pathogenesis. Brain. 2001; 124: 2347-2360. https://doi.org/10.1093/brain/124.12.2347
9. Hamlyn PJ. Neurovascular relationships in the posterior cranial fossa, with special reference to trigeminal neuralgia. 2. Neurovascular compression of the trigeminal nerve in cadaveric controls and patients with trigeminal neuralgia: quantification and influence of method. Clin Anat. 1997; 10: 380-38. https://doi.org/10.1002/(SICI)1098-2353(1997)10:6<380::AIDCA2>3.0.CO;2-T
10. Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Stefano GDi, Donnet A, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019; 26: 831-849. https://doi.org/10.1111/ene.13950
11. Huang Z, Pu B, Li F, Liu K, Hua C, Li C, et al. Analysis of failed microvascular decompression in patients with trigeminal neuralgia. J Neurol Surg B Skull Base. 2020; 81: 567-571. https://doi.org/10.1055/s-0039-1692683
12.Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. 1967. J Neurosurg. 2007; 107: 216-219. https://doi.org/10.3171/JNS-07/07/0216
13. Petty PG, Southby R, Siu K. Vascular compression: cause of trigeminal neuralgia. Med J Aust. 1980; 1: 166-167. https://doi.org/10.5694/j.1326-5377.1980.tb134736.x
14. Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, BurchielK,etal.Practiceparameter:thediagnosticevaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Sub-committee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008; 71: 1183-1190. https://doi.org/10.1212/01.wnl.0000326598.83183.04
15. Hatipoğlu HG, Durakoğlugil T, Cılız D, Yüksel E. Arka fossa sinirlerinin MR sisternografi ile değerlendirilmesi. Diagn Interv Radiol. 2007; 13: 56-60.
16. Yıldız S, Kaya A. Epidermoid tümörün görüntülenmesinde ve araknoid kistten ayırıcı tanısında CISS MRG sekansının rolü. Tani Girisim Radyol. 2002; 8: 3-9.
17. Casselman JW, Offeciers FE, Govaerts PJ, Kuhweide R, Geldof H, Somers T, et al. Aplasia and hypoplasia of the ves- tibulocochlear nerve: diagnosis with MR imaging. Radiology. 1997; 202: 773-781. https://doi.org/10.1148/radiology.202.3.9051033
18. Yousry I, Camelio S, Schmid UD, Horsfield MA, Wiesmann M, Bruckmann H, et al. Visualization of cranial nerves I-XII: value of 3D CISS and T2-weighted FSE sequences. Eur Radiol. 2000; 10: 1061-1067. https://doi.org/10.1007/s003300000452
19. KakızawaY,Hongo K,Takasawa H,MiyairiY,SatoA,Tanaka Y, et al. ‘Real’three dimensional constructive interference in steadystate imaging to discern microneurosurgical anatomy. Technical note. J Neurosurg. 2003; 98: 625-630. https://doi.org/10.3171/jns.2003.98.3.0625
20. Sweet WH, Wepsic SG. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. Part 1: Trigeminal neuralgia. J Neurosurg. 1977; 40: 143-156.
21. Hardy DG, Rhoton AL. Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve. J. Neurosurg. 1978; 49: 669-678. https://doi.org/10.3171/jns.1978.49.5.0669
22.Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg. 1967; 26: 159-162. https://doi.org/10.3171/jns.1967.26.1part2.0159
23. Xia L, Zhong J, Zhu J, Wang YN, Dou NN, Liu MX, et al. Effectiveness and safety of microvascular decompression surgery for treatment of trigeminal neuralgia: a systematic review. J Craniofac Surg. 2014; 25: 1413-1417. https://doi.org/10.1097/SCS.0000000000000984
24. Mendoza N, Illingworth RD. Trigeminal neuralgia treated by microvascular decompression: a long-term follow-up study. Br J Neurosurg. 1995; 9: 13-19. https://doi.org/10.1080/02688699550041692
25. Broggi G, Ferroli P, Franzini A, Servello D, Dones I. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2000; 68: 59-64. https://doi.org/10.1136/jnnp.68.1.59
26. Gao J, Fu Y, Guo SK, Li B, Xu ZX. Efficacy and prognostic value of partial sensory rhizotomy and microvascular decompression for primary trigeminal neuralgia: comparative study. Med Sci Monit. 2017; 23: 2284-2291. https://doi.org/10.12659/MSM.901510
27. Wei Y, Pu C, Li N, Cai Y, Shang H, Zhao W. Long-term therapeutic effect of microvascular decompression for trigeminal neuralgia: Kaplan-Meier analysis in a consecutive series of 425 patients. Turk Neurosurg. 2018; 28: 88-93.
28. HanakitaJ,KondoA.Seriouscomplicationsofmicrovascular decompression operations for trigeminal neuralgia and hemifacial spasm. Neurosurgery. 1988; 22: 348-352. https://doi.org/10.1227/00006123-198802000-00012