Paolini Sergio, Mancarella Cristina, Scafa Anthony Kevin, Arcidiacono Umberto, Morace Roberta, Chiarella Vito, Di Castelnuovo Augusto, Esposito Vincenzo
Department of Neurosurgery, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, 86077, Italy.
Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
Neurosurg Rev. 2025 Jan 10;48(1):32. doi: 10.1007/s10143-024-03100-w.
Microvascular decompression is considered a first-line treatment in classical trigeminal neuralgia. Teflon is the material commonly used. The use of autologous muscle has been occasionally reported. Failure may result from insufficient nerve decompression, inflammatory reaction to Teflon or late displacement of the offending vessel. In this paper, we illustrate an MVD technique that involves a modified muscle insertion method. In a series of 57 consecutive patients who underwent microvascular decompression, the trigeminal nerve was coated circumferentially with a substantial amount of autologous muscle graft. The coverage was extended well beyond the site of neurovascular conflict to create a cushioned environment and protect the nerve. Pain intensity was assessed using the Barrow-Neurological-Institute (BNI) grading scale. The mean follow-up period was 28.8 months (range: 12 to 75 months). Preoperatively, all patients experienced typical pain that was scored as BNI V. No postoperative mortality was observed. After surgery two patients developed incomplete facial nerve palsy, which resolved over 6-months and one patient experienced hearing loss (the only permanent complication). Ten patients (17.5%) developed mild hemifacial numbness, as detailed in the postoperative data and pain outcome section. There were no infections or cerebrospinal fluid leakages. Immediately after surgery, all patients achieved satisfactory pain control: 55 cases (96.5%) scoring as BNI grade I and 2 cases (3.5%) scoring as BNI grade II. At the latest follow-up, three patients (5.3%) experienced symptoms controlled by medications (grade III). Recurrence of pain BNI IV to V was observed in two cases (3.5%). Circumferential nerve wrapping using abundant autologous muscle resulted in immediate pain control in all patients treated, with a low recurrence rate.
微血管减压术被认为是经典三叉神经痛的一线治疗方法。常用的材料是特氟龙。偶尔也有使用自体肌肉的报道。手术失败可能是由于神经减压不充分、对特氟龙的炎症反应或致病血管的后期移位。在本文中，我们阐述了一种涉及改良肌肉植入方法的微血管减压术（MVD）技术。在连续57例接受微血管减压术的患者中，三叉神经周围被大量自体肌肉移植物包裹。覆盖范围远远超出神经血管冲突部位，以创造一个缓冲环境并保护神经。使用巴罗神经学研究所（BNI）分级量表评估疼痛强度。平均随访期为28.8个月（范围：12至75个月）。术前，所有患者均经历典型疼痛，BNI评分为V级。未观察到术后死亡病例。术后有2例患者出现不完全性面神经麻痹，6个月内恢复，1例患者出现听力丧失（唯一的永久性并发症）。如术后数据和疼痛结果部分所述，10例患者（17.5%）出现轻度面部麻木。没有感染或脑脊液漏。术后所有患者立即实现了满意的疼痛控制：55例（96.5%）BNI评分为I级，2例（3.5%）BNI评分为II级。在最近的随访中，3例患者（5.3%）症状由药物控制（III级）。2例患者（3.5%）观察到疼痛复发至BNI IV至V级。使用丰富的自体肌肉进行周围神经包裹，使所有接受治疗的患者立即实现疼痛控制，复发率低。
