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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(01): 111-117
DOI: 10.4103/ajns.AJNS_266_17
Original Article

Microvascular decompression in patients aged 30 years or younger

Authors

  • Prasanna Karki

    1   Department of Neurosurgery, Nepalgunj Medical College and Teaching Hospital, Nepalgunj, Nepal
    2   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
    3   Division of Neurosurgery, Atsuchi Neurosurgical Hospital, Kagoshima, Japan

  • Masayuki Yamagami

    2   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
    3   Division of Neurosurgery, Atsuchi Neurosurgical Hospital, Kagoshima, Japan

  • Koji Takasaki

    2   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
    3   Division of Neurosurgery, Atsuchi Neurosurgical Hospital, Kagoshima, Japan

  • Manoj Bohara

    1   Department of Neurosurgery, Nepalgunj Medical College and Teaching Hospital, Nepalgunj, Nepal
    2   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University

  • Hiroshi Hosoyama

    2   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University

  • Tomoko Hanada

    2   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University

  • Fumiyuki Yamasaki

    4   Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima

  • Ryosuke Hanaya

    2   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University

  • Kazunori Arita

    2   Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
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Objective: The aim of this study was to identify the etiology of hemifacial spasm (HFS) and trigeminal neuralgia (TN) in patients aged 30 years or younger and to examine the efficacy of microvascular decompression (MVD). Patients and Methods: Between 1996 and 2012, 228 HFS and 190 TN patients underwent MVD at Atsuchi Neurosurgical Hospital. Of these, 7 patients were 30 years of age or younger at the time of treatment (HFS: n = 6, TN: n = 1). Assessments were based on their medical history and on magnetic resonance imaging, magnetic resonance angiography, surgical, and follow-up findings. Results: The age of the 6 HFS patients ranged from 23 to 30 years (mean 27.8 ± 1.8 [standard deviation] years) at the time of surgery; the earliest symptom onset was in an 11-year-old boy. We noted vascular variations in 5 patients, a duplicate posterior inferior cerebellar artery in 2 patients, a short basilar artery in 1 patient, and an aberrant arterial course in 2 patients. At the latest follow-up, 1–69 months after MVD, 5 of the HFS patients were asymptomatic and the 6th had mild residual symptoms. A 23-year-old TN female underwent straightening of the trigeminal nerve by separation of a thickened arachnoid membrane from the nerve and dislocation of a small branch of the superior cerebellar artery from the distal end of the root exit zone. While she continued to experience occasional facial pain 48 months after the operation, she required no medication because surgery yielded significant pain amelioration. Conclusion: Although the pathogenesis of early-onset HFS and TN remains unclear, our findings suggest that vascular variations may be related to the etiology of vascular compression symptoms in patients with HFS or TN. MVD was useful for the treatment of neurovascular compression symptoms in young patients.

Key-words:

Hemifacial spasm - surgical outcome - trigeminal neuralgia - vascular variation - young

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Gardner WJ, Miklos MV. Response of trigeminal neuralgia to decompression of sensory root; discussion of cause of trigeminal neuralgia. J Am Med Assoc 1959;170:1773-6.
  • 2 Gardner WJ, Sava GA. Hemifacial spasm: A reversible pathophysiologic state. J Neurosurg 1962;19:240-7.
  • 3 Jannetta PJ. Neurovascular compression in cranial nerve and systemic disease. Ann Surg 1980;192:518-25.
  • 4 Jannetta PJ. Treatment of trigeminal neuralgia by microoperative decompression. In: Youmans JR, editors. Neurological Surgery. 2nd ed. Vol. 6. Philadelphia, USA: W.B. Saunders Co.; 1982. p. 3589-603.
  • 5 Jannetta PJ. Microsurgical management of trigeminal neuralgia. Arch Neurol 1985;42:800.
  • 6 Barba D, Alksne JF. Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia. J Neurosurg 1984;60:104-7.
  • 7 Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996;334:1077-83.
  • 8 Choi SJ, Sung KW, Sung WH, Lee JS, Kang JK, Choi CR. The clinical analysis of 75 patients which were operated on MVD. J Korean Neurosurg Soc 1990;19:506-12.
  • 9 Huang CI, Chen IH, Lee LS. Microvascular decompression for hemifacial spasm: Analyses of operative findings and results in 310 patients. Neurosurgery 1992;30:53-6.
  • 10 Huh R, Han IB, Moon JY, Chang JW, Chung SS. Microvascular decompression for hemifacial spasm: Analyses of operative complications in 1582 consecutive patients. Surg Neurol 2008;69:153-7.
  • 11 Jang IH, Lee YH, Chung UW. Intraoperative electromyographic monitoring of the facial nerve during microvascular decompression for hemifacial spasm. J Korean Acad Rehabil Med 1994;18:142-51.
  • 12 Jannetta PJ. Hemifacial spasm. Neurol Neurosurg Update Ser 1982;3:1-7.
  • 13 Loeser JD, Chen J. Hemifacial spasm: Treatment by microsurgical facial nerve decompression. Neurosurgery 1983;13:141-6.
  • 14 Wilkins RH. Hemifacial spasm: A review. Surg Neurol 1991;36:251-77.
  • 15 Ehni G, Woltman HW. Hemifacial spasm: Review of one hundred and six cases. Arch Neurol Psychiatry 1945;53:205-11.
  • 16 Jho HD, Jannetta PJ. Hemifacial spasm in young people treated with microvascular decompression of the facial nerve. Neurosurgery 1987;20:767-70.
  • 17 Langston JW, Tharp BR. Infantile hemifacial spasm. Arch Neurol 1976;33:302-3.
  • 18 Milani N, Scaioli V, Giombini S, Grisoli M, Angelini L. Hemifacial spasm in a child. Childs Nerv Syst 1991;7:466-8.
  • 19 Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 1967;26 Suppl:159-62.
  • 20 Feng B, Zheng X, Zhang W, Yang M, Tang Y, Zhong J, et al. Surgical treatment of pediatric hemifacial spasm patients. Acta Neurochir (Wien) 2011;153:1031-5.
  • 21 Chang JW, Chang JH, Park YG, Chung SS. Microvascular decompression of the facial nerve for hemifacial spasm in youth. Childs Nerv Syst 2001;17:309-12.
  • 22 Kobata H, Kondo A, Kinuta Y, Iwasaki K, Nishioka T, Hasegawa K, et al. Hemifacial spasm in childhood and adolescence. Neurosurgery 1995;36:710-4.
  • 23 Liang J, Guo Z, Zhang L, Yu Y. Adolescent-onset idiopathic hemifacial spasm. Neurol India 2014;62:175-7.
  • 24 Levy EI, Resnick DK, Jannetta PJ, Lovely T, Bissonette DJ. Pediatric hemifacial spasm: The efficacy of microvascular decompression. Pediatr Neurosurg 1997;27:238-41.
  • 25 Kamiguchi H, Ohira T, Ochiai M, Kawase T. Computed tomographic analysis of hemifacial spasm: Narrowing of the posterior fossa as a possible facilitating factor for neurovascular compression. J Neurol Neurosurg Psychiatry 1997;62:532-4.
  • 26 Felício AC, de Godeiro C Jr., Borges V, de Azevedo Silva SM, Ferraz HB. Young onset hemifacial spasm in patients with Chiari type I malformation. Parkinsonism Relat Disord 2008;14:66-8.
  • 27 Mason WE, Kollros P, Jannetta PJ. Trigeminal neuralgia and its treatment in a 13-month-old child: A review and case report. J Craniomandib Disord 1991;5:213-6.
  • 28 Resnick DK, Levy EI, Jannetta PJ. Microvascular decompression for pediatric onset trigeminal neuralgia. Neurosurgery 1998;43:804-7.
  • 29 Matsushima T, Huynh-Le P, Miyazono M. Trigeminal neuralgia caused by venous compression. Neurosurgery 2004;55:334-7.
  • 30 Bahgat D, Ray DK, Raslan AM, McCartney S, Burchiel KJ. Trigeminal neuralgia in young adults. J Neurosurg 2011;114:1306-11.
  • 31 Bender MT, Pradilla G, James C, Raza S, Lim M, Carson BS, et al. Surgical treatment of pediatric trigeminal neuralgia: Case series and review of the literature. Childs Nerv Syst 2011;27:2123-9.
  • 32 Mousavi SH, Sekula RF, Gildengers A, Gardner P, Lunsford LD. Concomitant depression and anxiety negatively affect pain outcomes in surgically managed young patients with trigeminal neuralgia: Long-term clinical outcome. Surg Neurol Int 2016;7:98.
  • 33 Kondo A, Ishikawa J, Konishi T. The pathogenesis of hemifacial spasm: Characteristic changes of vasculature in vertebra-basilar artery system. In: Samii M, Jannetta PJ, editors. The Cranial Nerves: Anatomy, Pathology, Pathophysiology, Diagnosis, Treatment. Berlin: Springer-Verlag; 1987. p. 494-501.
  • 34 Pai BS, Varma RG, Kulkarni RN, Nirmala S, Manjunath LC, Rakshith S, et al. Microsurgical anatomy of the posterior circulation. Neurol India 2007;55:31-41.
  • 35 Wankhede HA, Hosmani PB, Nimje DA. Morphological study of the basilar artery in adult human cadavers. Int J Anat Res 2014;2:497-502.
  • 36 Saeki N, Rhoton AL Jr. Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis. J Neurosurg 1997;46:563-78.
  • 37 Ohta M, Kobayashi M, Terano N, Wakiya K, Suzuki K, Fujimaki T, et al. Does arteriosclerosis contribute to hemifacial spasm? Acta Neurochir (Wien) 2016;158:181-7.
  • 38 Samii M, Günther T, Iaconetta G, Muehling M, Vorkapic P, Samii A, et al. Microvascular decompression to treat hemifacial spasm: Long-term results for a consecutive series of 143 patients. Neurosurgery 2002;50:712-8.
  • 39 Han IB, Chang JH, Chang JW, Huh R, Chung SS. Unusual causes and presentations of hemifacial spasm. Neurosurgery 2009;65:130-7.
  • 40 Sindou M, Leston J, Decullier E, Chapuis F. Microvascular decompression for primary trigeminal neuralgia: Long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg 2007;107:1144-53.