Minim Invasive Neurosurg 2011; 54(2): 79-82
DOI: 10.1055/s-0031-1275334
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Microvascular Decompression for Trigeminal Neuralgia due to Compression by the Vertebral Artery: Report of 3 Cases

H. Yamahata1 , H. Tokimura2 , R. Hanaya2 , K. Tajitsu3 , M. Hirabaru1 , M. Yamagami4 , K. Arita2
  • 1Division of Neurosurgery, Hokusatsu Hospital, Kagoshima, Japan
  • 2Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
  • 3Division of Neurosurgery, Sendai Shimin Hospital, Kagoshima, Japan
  • 4Atsuchi Neurosurgical Hospital, Kagoshima, Japan
Further Information

Publication History

Publication Date:
07 June 2011 (online)

Abstract

Background: Trigeminal neuralgia elicited by the vertebral artery is unusual. According to a large trigeminal neuralgia series, only 4 of 1 404 (0.3%) consecutive patients with typical trigeminal neuralgia presented with vertebral artery compression. In such cases the vertebrobasilar system tends to be atherosclerotic, ectatic, and tortuous, requiring, in addition to an ordinary microvascular decompression method, technical modifications of this procedure. We report on 3 patients with trigeminal neuralgia due to compression by a tortuous vertebral artery.

Patients: All 3 patients underwent microvascular decompression via a small lateral suboccipital craniotomy. Operative exposure demonstrated that the root of the trigeminal nerve was compressed directly and stretched by a loop of the vertebral artery. The compression was successfully released by dislocation of the loop using Teflon (polytetrafluoroethene) slings. Immediately after the operation all 3 patients became pain-free.

Conclusion: Among the surgical procedures used in microvascular decompression surgery, dislocation of the offending vessel with Teflon slings is a useful surgical technique to treat trigeminal neuralgia due to a tortuous vertebral artery.

References

  • 1 Linskey ME, Jho HD, Jannetta PJ. Microvascular decompression for trigeminal neuralgia caused by vertebrobasilar compression.  J Neurosurg. 1994;  81 1-9
  • 2 Bejjani GK, Sekhar LN. Repositioning of the vertebral artery as treatment for neurovascular decompression syndromes. Technical note.  J Neurosurg. 1997;  86 728-732
  • 3 Fukuda M, Kameyama S, Takahashi H. et al . Trigeminal neuralgia caused by the vertebral artery associated with primitive trigeminal artery and agenesis of the internal carotid artery.  Neurol Med Chir (Tokyo). 1998;  38 367-370
  • 4 Kyoshima K, Watanabe A, Toba Y. et al . Anchoring method for hemifacial spasm associated with vertebral artery.  Neurosurgery. 1999;  45 1487-1491
  • 5 Perkin GD, Illingworth RD. The association of hemifacial spasm and facial pain.  J Neurol Neurosurg Psychiatry. 1989;  52 663-665
  • 6 Taki W, Matsushima S, Hori K. et al . Repositioning of the vertebral artery with titanium bone fixation plate for trigeminal neuralgia.  Acta Neurochir. 2003;  145 55-61
  • 7 Charalampaki P, Kafadar AM, Grunert P. et al . Vascular decompression of trigeminal and facial nerves in the posterior fossa under endoscope-assisted keyhole conditions.  Skull Base. 2008;  18 117-128
  • 8 Fukushima T. Microvascular decompression for hemifacial spasm: Results in 2 890 cases. In: Carter LP, Spetzler RF, Hamilton MG (eds): Neurovascular Surgery New York: McGraw-Hill; 1995: 1133-1147
  • 9 Hassler O. Arterial pattern of human brainstem: Normal appearance and deformation in expanding supratentorial conditions.  Neurology. 1967;  17 368-375

Correspondence

H. Yamahata

Department of Neurosurgery

Graduate School of Medical and

Dental Sciences

Kagoshima University

8–35– Sakuragaoka

Kagoshim-shi

890-8520 Kagoshima

Japan

Phone: +81/99/275 5375

Fax: +81/99/265 4041

Email: yamahata-nsu@umin.net