Kulkarni Aniruddh
Department of Neuro and Spine Surgery, Neuro World and Suchirayu Hospital, Hubli, Karnataka, India.
J Neurosci Rural Pract. 2022 Mar 28;13(2):283-289. doi: 10.1055/s-0042-1744125. eCollection 2022 Apr.
To describe and correlate the clinical, radiological, and intraoperative findings in patients with refractory neurovascular syndromes (NVS) not responding to conventional medical management and to determine the surgical outcome of the microvascular decompression (MVD) procedure. Medical records of 17 patients with NVS (trigeminal neuralgia [TN] = 14 and hemifacial spasm = 3) who underwent surgery for symptom relief from January 2018 to July 2021 with follow-up data (1-36 months) were retrospectively analyzed. Patient demographics (age, sex), clinical features (site, duration of symptoms, distribution), magnetic resonance imaging (MRI) findings, micro-neurosurgical details (type of surgery, obstructive vessel), and postoperative outcome and complications were recorded. Descriptive analysis was performed. Variables were presented as either mean and standard deviation or frequency and percentages. The mean (standard deviation) age of patients in our study cohort was 52.6 (12.2) years. TN was common in females (64.3%). The mean duration of symptoms was longer in patients with hemifacial spasms than in patients with TN (3.3 vs. 2.7 years). While the right side was commonly affected in TN (64.3%), the left side was common in hemifacial spasm (66.7%). Most common neuralgia symptoms were distributed along the V2V3 (maxillary and mandibular division) branches (42.9%). MRI revealed neurovascular conflict in nine patients, epidermoid tumor in three patients, classical vestibular schwannoma in two patients, and short cisternal segments in three patients. Intraoperatively, superior cerebellar artery was the main offending vessel in TN followed by anterior inferior cerebellar artery (AICA) and venous compression, while tortuous vertebral artery and AICA along with thickened entangled arachnoid were seen in hemifacial spasms. Almost all patients (88.2%) reported immediate postoperative complete pain relief. One patient died secondary to chest infection after a month. Arachnoid entanglement around the neurovascular bundle along with vascular compression over the cranial nerves is the main cause of NVS. Advanced micro-neurosurgical techniques used in MVD achieve excellent outcomes with improved quality of life. However, identifying the refractory NVS not responding to conventional medical management and early surgical management are paramount.
描述并关联对常规药物治疗无反应的难治性神经血管综合征（NVS）患者的临床、放射学和术中表现，并确定微血管减压术（MVD）的手术效果。回顾性分析了2018年1月至2021年7月期间17例因症状缓解而接受手术且有随访数据（1 - 36个月）的NVS患者（三叉神经痛[TN]=14例，面肌痉挛=3例）的病历。记录患者的人口统计学特征（年龄、性别）、临床特征（部位、症状持续时间、分布）、磁共振成像（MRI）表现、显微神经外科手术细节（手术类型、阻塞血管）以及术后结果和并发症。进行描述性分析。变量以均值和标准差或频率和百分比表示。我们研究队列中患者的平均（标准差）年龄为52.6（12.2）岁。TN在女性中更为常见（64.3%）。面肌痉挛患者的平均症状持续时间比TN患者更长（3.3年对2.7年）。TN患者右侧常受累（64.3%），而面肌痉挛患者左侧常见（66.7%）。最常见的神经痛症状沿V2V3（上颌支和下颌支）分支分布（42.9%）。MRI显示9例患者存在神经血管冲突，3例患者有表皮样肿瘤，2例患者有典型的前庭神经鞘瘤，3例患者有短的脑池段。术中，TN的主要责任血管是小脑上动脉，其次是小脑前下动脉（AICA）和静脉压迫，而面肌痉挛患者可见迂曲的椎动脉和AICA以及增厚缠结的蛛网膜。几乎所有患者（88.2%）术后立即报告疼痛完全缓解。1例患者在术后1个月因肺部感染死亡。神经血管束周围的蛛网膜缠结以及颅神经上的血管压迫是NVS的主要原因。MVD中使用的先进显微神经外科技术取得了优异的效果，提高了生活质量。然而，识别对常规药物治疗无反应的难治性NVS并进行早期手术治疗至关重要。
