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Hydrocephalus: an underrated long-term complication of microvascular decompression for trigeminal neuralgia. A single institute experience

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Abstract

Background

Hydrocephalus is a common complication of posterior fossa surgery, but its real incidence after microvascular decompression (MVD) for idiopathic trigeminal neuralgia (TN) still remains unclear. The aim of this study was to focus on the potential association between MVD and hydrocephalus as a surgery-related complication.

Methods

All patients who underwent MVD procedure for idiopathic TN at our institute between 2009 and 2014 were reviewed to search for early or late postoperative hydrocephalus.

Results

There were 259 consecutive patients affected by idiopathic TN who underwent MVD procedure at our institution between 2009 and 2014 (113 men, 146 women; mean age 59 years, range 30–87 years; mean follow-up 40.92 months, range 8–48 months). Nine patients (3.47 %) developed communicating hydrocephalus after hospital discharge and underwent standard ventriculo-peritoneal shunt. No cases of acute hydrocephalus were noticed.

Conclusions

Our study suggests that late communicating hydrocephalus may be an underrated potential long-term complication of MVD surgery.

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Contributors

F.M., G.T., V.L., G.K.I.L., V.N. and A.F. contributed to the conception and design of the article, to the data acquisition, analysis and interpretation. All the authors were involved in critically drafting/revising the article for important intellectual content. Finally, they all gave final approval of the version to be published.

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Authors and Affiliations

  1. Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Nazionale Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy

    Francesco Muratorio, G. Tringali, V. Levi, G. K. I. Ligarotti, V. Nazzi & A. A. Franzini

Authors
  1. Francesco Muratorio
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  2. G. Tringali
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  3. V. Levi
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  4. G. K. I. Ligarotti
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  5. V. Nazzi
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  6. A. A. Franzini
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Corresponding author

Correspondence to Francesco Muratorio.

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Competing interests

None.

Funding

No funding was received for this research.

Conflict of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Comments

The aim of the authors was to find out whether hydrocephalus, which not infrequently can be seen as a complication to posterior fossa surgery, is a consequence of the procedure per se, or whether it is caused by a combination of the condition and the procedure. As more “bloody” procedures, where elements of blood, tumour tissue, etc., may contaminate the CSF and thus contribute to the development of hydrocephalus, the authors have chosen to study one of the “purest"” procedures (and condition) in the posterior fossa: microvascular decompression (MVD) for idiopathic trigeminal neuralgia (TN). They analysed retrospectively the results of 259 patients who underwent an MVD procedure for idiopathic TN in their institution during a 5-year period. None of the procedures was complicated by acute hydrocephalus, but nine patients (3.47 %) developed communicating hydrocephalus requiring ventriculo-peritoneal shunting after they were discharged from the hospital, within a postoperative range of 10–183 (mean 96) days.

In my view, this is an original approach to the problem—I cannot find any other similar publications. Although one can never rule out intraoperative extravasation of blood during this procedure as a cause, I believe the authors have provided relatively strong indications that the MVD procedure in itself may yield hydrocephalus, perhaps by an acute altering of the hydrodynamic conditions.

Knut Wester

Bergen, Norway

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Muratorio, F., Tringali, G., Levi, V. et al. Hydrocephalus: an underrated long-term complication of microvascular decompression for trigeminal neuralgia. A single institute experience. Acta Neurochir 158, 2203–2206 (2016). https://doi.org/10.1007/s00701-016-2911-4

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  • DOI: https://doi.org/10.1007/s00701-016-2911-4

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