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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2024; 85(03): e156-e160
DOI: 10.1055/a-2342-4086
Case Report

Microvascular Decompression: An Effective Approach for Trigeminal Neuralgia Caused by a Dolichoectatic Basilar Artery after Multiple Treatment Failures

Filippos Chelmis 
1   Faculty of Medicine, Sofia University “St. Kliment Ohridski,” Sofia, Bulgaria
,
Paraskevas Pakataridis
1   Faculty of Medicine, Sofia University “St. Kliment Ohridski,” Sofia, Bulgaria
,
Iliana Sorotou
1   Faculty of Medicine, Sofia University “St. Kliment Ohridski,” Sofia, Bulgaria
,
Anastasios Tzineris
1   Faculty of Medicine, Sofia University “St. Kliment Ohridski,” Sofia, Bulgaria
,
Christo Ranguelov
2   Department of Neurosurgery, University Hospital Sofiamed, Sofia, Bulgaria
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Abstract

Trigeminal neuralgia (TN), characterized by recurrent episodes of intense facial pain, poses diagnostic and therapeutic challenges. TN can be triggered by many factors, with rare cases (< 0.05% of the general population) associated with vertebrobasilar dolichoectasia (VBD). Our study analyzes a 74-year-old male patient with 10 years of constant unbearable left-sided facial pain, unresponsive to medications and multiple glycerol rhizotomies, performed in other centers which prompted the patient to seek care at our clinic. The confirmation of left-sided VBD by magnetic resonance imaging, computed tomography angiography, and the patient's overall satisfactory health status favored open surgery with microvascular decompression (MVD). We performed a retrosigmoid suboccipital craniotomy to reach the cerebellopontine angle, ensuring that it is the dolichoectatic basilar artery applying compression to the trigeminal nerve. We inserted a shredded Teflon implant into the trigeminal cistern following its opening. Care was exercised to ensure that there were no remaining factors causing compression. Postoperatively, pain relief was achieved, sustained at an 8-month follow-up. Treating TN arising from VBD can be difficult. The patient's overall health status and assessment play a key role in determining the appropriate course of treatment. Opting for MVD is the optimal and most effective choice, regardless of age, according to the recent literature. In cases where surgery is not feasible, the treatment options will involve medications and less invasive therapeutic approaches such as peripheral rhizotomies or stereotactic radiosurgery. Our case highlights the efficacy of MVD in addressing TN associated with VBD, underscoring the need for advanced treatment modalities and expertise in managing complex cases.

Keywords

trigeminal neuralgia - vertebrobasilar dolichoectasia - microvascular decompression - peripheral rhizotomies - surgical intervention - neuropathic pain


Publication History

Received: 02 March 2024

Accepted: 05 June 2024

Accepted Manuscript online:
12 September 2024

Article published online:
27 September 2024

© 2024. The Author(s). 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 Jones MR, Urits I, Ehrhardt KP. et al. A comprehensive review of trigeminal neuralgia. Curr Pain Headache Rep 2019; 23 (10) 74
    CrossrefPubMedGoogle Scholar
  • 2 Allam AK, Sharma H, Larkin MB, Viswanathan A. Trigeminal neuralgia: diagnosis and treatment. Neurol Clin 2023; 41 (01) 107-121
    PubMedGoogle Scholar
  • 3 Wang Y, Yu J. Prospects and dilemmas of endovascular treatment for vertebrobasilar dolichoectasia. Front Neurol 2022; 13: 895527
    PubMedGoogle Scholar
  • 4 Yuan YJ, Xu K, Luo Q, Yu JL. Research progress on vertebrobasilar dolichoectasia. Int J Med Sci 2014; 11 (10) 1039-1048
    CrossrefPubMedGoogle Scholar
  • 5 Menna G, Rapisarda A, Izzo A. et al. Surgical and clinical outcomes of microvascular decompression: a comparative study between young and elderly patients. Brain Sci 2022; 12 (09) 1216
    PubMedGoogle Scholar
  • 6 Chai S, Xu H, Wang Q. et al. Microvascular decompression for trigeminal neuralgia caused by vertebrobasilar dolichoectasia: interposition technique versus transposition technique. Acta Neurochir (Wien) 2020; 162 (11) 2811-2821
    PubMedGoogle Scholar
  • 7 Cruccu G, Di Stefano G, Truini A. Trigeminal neuralgia. N Engl J Med 2020; 383 (08) 754-762
    PubMedGoogle Scholar
  • 8 Förster A, Ssozi J, Al-Zghloul M, Brockmann MA, Kerl HU, Groden C. A comparison of CT/CT angiography and MRI/MR angiography for imaging of vertebrobasilar dolichoectasia. Clin Neuroradiol 2014; 24 (04) 347-353
    PubMedGoogle Scholar
  • 9 Xu R, Xie ME, Jackson CM. Trigeminal neuralgia: current approaches and emerging interventions. J Pain Res 2021; 14: 3437-3463
    PubMedGoogle Scholar
  • 10 Habibi H, Hajjar C, Bouchal S. et al. Complicated vertebrobasilar dolichoectasia. J Med Vasc 2020; 45 (03) 165-167
    PubMedGoogle Scholar
  • 11 Apra C, Lefaucheur J-P, Le Guérinel C. Microvascular decompression is an effective therapy for trigeminal neuralgia due to dolichoectatic basilar artery compression: case reports and literature review. Neurosurg Rev 2017; 40 (04) 577-582
    PubMedGoogle Scholar
  • 12 Ranguelov C. Modern Surgical Treatment of Trigeminal Neuralgia. Dissertation for Awarding the Scientific and Educational Degree “Doctor”/PhD; Acta Medica Bulgarica, Sofia, Bulgaria. 2013: 190
    Google Scholar
  • 13 Arai T, Yamaguchi K, Ishikawa T. et al. Decompression by cutting the tentorium for trigeminal neuralgia caused by vertebrobasilar dolichoectasia. World Neurosurg 2018; 120: 72-77
    PubMedGoogle Scholar
  • 14 Ranguelov C, Bussarsky A, Bussarsky V. et al. Prognosis and outcome of surgical treatment of Trigeminal Neuralgia depending on neuroimaging findings. 13th EANS Congress, Glascow, September 2–7, 2007. (Acta Neurochirurgica, Abstr. FP 35.7, suppl. 2007) oral presentation
    PubMedGoogle Scholar
  • 15 Uhl C, Faraj L, Fekonja L, Vajkoczy P. Transposition versus interposition method in microvascular decompression for trigeminal neuralgia: midterm analysis of both techniques in a single-center study. J Neurosurg 2024; 140 (06) 1777-1784
    PubMedGoogle Scholar
  • 16 Owashi E, Ohmura K, Shoda K. et al. Comparison of transposition and interposition methods in microvascular decompression for hemifacial spasm: an analysis of 109 cases performed by a single surgeon in a single-center retrospective study. Acta Neurochir (Wien) 2024; 166 (01) 213
    PubMedGoogle Scholar
  • 17 Rheaume AR, Pietrosanu M, Ostertag C, Sankar T. Repeat surgery for recurrent or refractory trigeminal neuralgia: a systematic review and meta-analysis. World Neurosurg 2024; 185: 370-380.e2
    PubMedGoogle Scholar
  • 18 Sekula Jr RF, Frederickson AM, Jannetta PJ, Quigley MR, Aziz KM, Arnone GD. Microvascular decompression for elderly patients with trigeminal neuralgia: a prospective study and systematic review with meta-analysis. J Neurosurg 2011; 114 (01) 172-179
    CrossrefPubMedGoogle Scholar