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Tentorial sling for microvascular decompression in patients with trigeminal neuralgia: a description of operative technique and clinical outcomes.
J Neurosurg. 2018 Apr 01 [Online ahead of print]JN

Abstract

OBJECTIVETrigeminal neuralgia is a debilitating pain disorder most often caused by arterial compression of the trigeminal nerve, although there are other etiologies. Microvascular decompression (MVD) remains the most definitive treatment for this disorder, with cure rates reported between 60% and 80%. Traditional MVD techniques involve a retrosigmoid craniotomy with placement of an inert foreign material, such as Teflon, between the nerve and compressive vessel. Recurrence of trigeminal neuralgia after MVD has been associated with vessel migration, adhesion formation, and arterial pulsation against the Teflon abutting the nerve. Additionally, foreign materials such as Teflon have been reported to trigger inflammatory responses, resulting in recurrence of trigeminal pain. An alternative method for decompression involves the use of a sling to transpose the compressive vessel away from the nerve. Results of various sling techniques as a decompressive strategy are limited to small series and case reports. In this study, the authors present their experience utilizing a tentorial sling for MVD in patients with trigeminal neuralgia.METHODSInstitutional review board approval was obtained in order to contact patients who underwent MVD for trigeminal neuralgia via the tentorial sling technique. Clinical outcomes were assessed utilizing the Barrow Neurological Institute (BNI) pain intensity score immediately after surgery and at the time of the study.RESULTSThe tentorial sling technique was performed in 45 patients undergoing MVD for trigeminal neuralgia. In 41 of these patients, this procedure was their first decompressive surgery. Immediate postoperative relief of pain (BNI score I) was achieved in 80% of patients undergoing their first decompressive procedure. At last follow-up, 73% of these patients remained pain free. Three patients experienced recurrent trigeminal pain, with surgical exploration demonstrating an intact tentorial sling. The complication rate was 6.6%.CONCLUSIONSTransposition techniques for MVD have been described previously in small series and case reports. This study represents the largest experience in which the utilization of a tentorial sling for MVD in patients with trigeminal neuralgia is described. The technique represents a novel method for decompression of the trigeminal nerve by transposition of the offending vessel without the use of foreign material. Although the authors' preliminary results parallel the historical cure rate, further outcome data are required to assess long-term durability of this method.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

29676696

Citation

Steinberg, Jeffrey A., et al. "Tentorial Sling for Microvascular Decompression in Patients With Trigeminal Neuralgia: a Description of Operative Technique and Clinical Outcomes." Journal of Neurosurgery, 2018, pp. 1-6.
Steinberg JA, Sack J, Wilson B, et al. Tentorial sling for microvascular decompression in patients with trigeminal neuralgia: a description of operative technique and clinical outcomes. J Neurosurg. 2018.
Steinberg, J. A., Sack, J., Wilson, B., Weingarten, D., Carter, B., Khalessi, A., Ben-Haim, S., & Alksne, J. (2018). Tentorial sling for microvascular decompression in patients with trigeminal neuralgia: a description of operative technique and clinical outcomes. Journal of Neurosurgery, 1-6. https://doi.org/10.3171/2017.10.JNS17971
Steinberg JA, et al. Tentorial Sling for Microvascular Decompression in Patients With Trigeminal Neuralgia: a Description of Operative Technique and Clinical Outcomes. J Neurosurg. 2018 Apr 1;1-6. PubMed PMID: 29676696.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tentorial sling for microvascular decompression in patients with trigeminal neuralgia: a description of operative technique and clinical outcomes. AU - Steinberg,Jeffrey A, AU - Sack,Jayson, AU - Wilson,Bayard, AU - Weingarten,David, AU - Carter,Bob, AU - Khalessi,Alexander, AU - Ben-Haim,Sharona, AU - Alksne,John, Y1 - 2018/04/01/ PY - 2017/04/22/received PY - 2017/10/06/accepted PY - 2018/4/21/pubmed PY - 2018/4/21/medline PY - 2018/4/21/entrez KW - BNI = Barrow Neurological Institute KW - MVD KW - MVD = microvascular decompression KW - SCA = superior cerebellar artery KW - Teflon granuloma KW - microvascular decompression KW - pain KW - surgical technique KW - tentorial sling KW - trigeminal neuralgia SP - 1 EP - 6 JF - Journal of neurosurgery JO - J Neurosurg N2 - OBJECTIVETrigeminal neuralgia is a debilitating pain disorder most often caused by arterial compression of the trigeminal nerve, although there are other etiologies. Microvascular decompression (MVD) remains the most definitive treatment for this disorder, with cure rates reported between 60% and 80%. Traditional MVD techniques involve a retrosigmoid craniotomy with placement of an inert foreign material, such as Teflon, between the nerve and compressive vessel. Recurrence of trigeminal neuralgia after MVD has been associated with vessel migration, adhesion formation, and arterial pulsation against the Teflon abutting the nerve. Additionally, foreign materials such as Teflon have been reported to trigger inflammatory responses, resulting in recurrence of trigeminal pain. An alternative method for decompression involves the use of a sling to transpose the compressive vessel away from the nerve. Results of various sling techniques as a decompressive strategy are limited to small series and case reports. In this study, the authors present their experience utilizing a tentorial sling for MVD in patients with trigeminal neuralgia.METHODSInstitutional review board approval was obtained in order to contact patients who underwent MVD for trigeminal neuralgia via the tentorial sling technique. Clinical outcomes were assessed utilizing the Barrow Neurological Institute (BNI) pain intensity score immediately after surgery and at the time of the study.RESULTSThe tentorial sling technique was performed in 45 patients undergoing MVD for trigeminal neuralgia. In 41 of these patients, this procedure was their first decompressive surgery. Immediate postoperative relief of pain (BNI score I) was achieved in 80% of patients undergoing their first decompressive procedure. At last follow-up, 73% of these patients remained pain free. Three patients experienced recurrent trigeminal pain, with surgical exploration demonstrating an intact tentorial sling. The complication rate was 6.6%.CONCLUSIONSTransposition techniques for MVD have been described previously in small series and case reports. This study represents the largest experience in which the utilization of a tentorial sling for MVD in patients with trigeminal neuralgia is described. The technique represents a novel method for decompression of the trigeminal nerve by transposition of the offending vessel without the use of foreign material. Although the authors' preliminary results parallel the historical cure rate, further outcome data are required to assess long-term durability of this method. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/29676696/Tentorial_sling_for_microvascular_decompression_in_patients_with_trigeminal_neuralgia:_a_description_of_operative_technique_and_clinical_outcomes_ DB - PRIME DP - Unbound Medicine ER -
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