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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

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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