Vascular compression syndromes: our 24 year endoscope-assisted microvascular decompression experiences

Abstract

Objectives: This study aims to report our experience on endoscope-assisted microvascular decompression experiences performed due to vascular compression syndromes such as hemifacial spasm, trigeminal neuralgia, and cochleovestibular nerve compression. Patients and Methods: Between March 1999 and June 2013, 55 patients 34 females, 21 males; mean age 44 years; range 24 to 77 years underwent endoscope-assisted microvascular decompression surgery through a retrosigmoid approach due to vascular compression syndromes in our clinic. The diagnosis was based on history, neurological examination, magnetic resonance imaging findings and audio-vestibular tests. Results: A total of 49 patients 89.1% had complete relief of the symptoms and two had 3.6% a partial relief, while four had 7.3% no relief of the symptoms. Only two patients had 3.6% cerebrospinal fluid leakages as a perioperative complication. The major offending vessels were anterior and inferior cerebellar arteries in 14 patients. Four patients with essential hypertension became normotensive after decompression of the left medulla oblongata as well. Conclusion: Microvascular decompression surgery provides a significant relief of the symptoms in patients with vascular compression syndromes. An angled endoscope as an adjunct to microscope contributes to the diagnosis of the offending vessel in the root entry zone of the cranial nerve.

Keywords

• Endoscope-assisted retrosigmoid approach, posterior cranial fossa, retrosigmoid approach, root entry zone, vascular compression syndrome

Vasküler kompresyon sendromları: 24 yıllık endoskop yardımlı mikrovasküler dekompresyon deneyimlerimiz

Abstract

Amaç: Bu çalışmada hemifasiyal spazm, trigeminal nevralji, kokleovestibüler sinir kompresyonu gibi vasküler kompresyon sendromları nedeniyle yapılan endoskop yardımlı mikrovasküler dekompresyon deneyimlerimiz sunuldu.Hastalar ve Yöntemler: Mart 1999 - Haziran 2013 tarihleri arasında kliniğimizde vasküler kompresyon sendromları nedeniyle 55 hastaya 34 kadın, 21 erkek; ort. yaş 44 yıl; dağılım 24-77 yıl endoskop yardımlı retrosigmoid yaklaşımla mikrosvasküler dekompresyon ameliyatı uygulandı. Tanı öykü, nörolojik muayene, manyetik rezonans görüntüleme bulguları ve odyovestibüler testler ile konuldu.Bulgular: Toplam 49 hastada %89.1 tam iyileşme, iki hastada %3.6 kısmi iyileşme, dört hastada %7.3 ise semptomlarda düzelmeme görüldü. Sadece iki %3.6 hastada ameliyat sırası komplikasyon olarak beyin omurilik sıvısı kaçağı gelişti. En sık bası yapan damarsal yapı ön ve alt serebellar arter olup, 14 hastada gözlendi. Esansiyel hipertansiyonlu dört hasta eş zamanlı sol medulla oblongata basısı dekomprese edildikten sonra normotansif oldu.Sonuç: Mikrovasküler kompresyon ameliyatı ile vasküler kompresyon sendromlu hastaların semptomlarında anlamlı iyileşme sağlanır. Ameliyat mikroskobuna yardımcı olarak açılı teleskopların kullanılması kraniyal sinire root entry zone bölgesinde bası nedenini saptamada önemli yardım sağlamaktadır

Keywords

• Endoskop yardımlı retrosigmoid yaklaşım, arka kraniyal fossa, retrosigmoid yaklaşım, root entry zone, vasküler kompresyon sendromları

References

1. Dandy WE. Concerning the cause of trigeminal neuralgia. Am J Surg 1934;24:447-55.
2. 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.
3. Jannetta PJ. Microsurgical exploration and decompression of the facial nerve in hemifacial spasm. Curr Topics Surg Res 1970;2:217-20.
4. Wilkins RH. Neurovascular compression syndromes. Neurol Clin 1985;3:359-72.
5. Mİller AR. Vascular compression of cranial nerves: II: pathophysiology. Neurol Res 1999;21:439-43.
6. Rasminsky M. Ectopic impulse generation in pathologic nerve fibers. In: Dyck PJ, Thomas PK, Lambert EH, Bunge R, editors. Peripheral neuropathy. 2nd ed. Philadelphia: W.B. Saunders; 1984. p. 911-8.
7. Digre K, Corbett JJ. Hemifacial spasm: differential diagnosis, mechanism, and treatment. Adv Neurol 1988;49:151-76.
8. Jannetta PJ. Hemifacial spasm. In: Samii M, Jannetta P, editors. The cranial nerves. Berlin: Springer-Verlag; 1981. p. 484–92.

9. Zhong J, Li ST, Zhu J, Guan HX, Zhou QM, Jiao W, et al. A clinical analysis on microvascular decompression surgery in a series of 3000 cases. Clin Neurol Neurosurg 2012;114:846-51.
10. Jannetta PJ. Microsurgery of cranial nerve cross- compression. Clin Neurosurg 1979;26:607-15.
11. 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.
12. Balansard ChF, Meller R, Bruzzo M, Chays A, Girard N, Magnan J. Trigeminal neuralgia: results of microsurgical and endoscopic-assisted vascular decompression. Ann Otolaryngol Chir Cervicofac 2003;120:330-7. [Abstract]
13. Magnan J, Garem H, Deveze A, Lavieille JP. The value of endoscopy in the surgical management of vertigo. Mediterr J Otol 2006:2;1-8.
14. Mİller AR, Jannetta PJ. Microvascular decompression in hemifacial spasm: intraoperative electrophysiological observations. Neurosurgery 1985;16:612-8.
15. Mooij JJ, Mustafa MK, van Weerden TW. Hemifacial spasm: intraoperative electromyographic monitoring as a guide for microvascular decompression. Neurosurgery 2001;49:1365-70.
16. Jannetta PJ. Microvascular decompression for hemifacial spasm. In: May M, editor. The facial nerve. New York: Thieme-Stratton; 1985. p. 499-508.
17. 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.