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Usefulness of the endoscope in microvascular decompression for trigeminal neuralgia and MRI-based prediction of the need for endoscopy

  • Clinical Article - Vascular
  • Published:
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Abstract

Background

Microvascular decompression (MVD) is a documented effective treatment of trigeminal neuralgia (TN). Lately, reports on endoscopy-assisted microvascular decompression (eaMVD) with better outcome and less risk have emerged. This study was undertaken to verify under which circumstances the endoscope proved essential in identifying the neurovascular conflict (NVC) during eaMVD for TN, and to assess the possibility to predict the need for the endoscope on preoperative magnetic resonance imaging (MRI).

Methods

Retrospective analysis of 97 patients with TN undergoing eaMVD at the Oslo University Hospital – Rikshospitalet, 1999–2009. To assess the NVC and anatomical variations, surgical reports were evaluated. MRI was available in 66 patients. The MRIs were evaluated by a blinded neuroradiologist.

Results

In 27 of the 97 patients (27.8 %), the endoscope was a significant aid in identifying the NVC, due to a bony ridge obscuring the view of the fifth nerve, a very distal vascular compression, or a combination of both. The preoperative MRI over-diagnosed the presence of a bony ridge. However, the MRI-based fraction of microscopically visible trigeminal nerve (FVN) in the cerebellopontine angle cistern proved diagnostic (ROC curve, AUC 0.89, p = <0.001) with an optimal cut-off value of 0.35. Hence, if less than 35 % of the trigeminal nerve is visible on preoperative MRI, the endoscope will be needed to identify the NVC.

Conclusions

The endoscope is a valuable tool during MVD for TN, especially under anatomical circumstances such as a bony ridge hiding the direct microscopic view of the NVC. These anatomical circumstances can be predicted with good accuracy on preoperative MRI.

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Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Pb 4950, Nydalen, N-0424, Oslo, Norway

    Tiril Sandell & Per Kristian Eide

  2. Department of Radiology and Nuclear Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway

    Geir Andre Ringstad

  3. Faculty of Medicine, University of Oslo, Oslo, Norway

    Per Kristian Eide

Authors
  1. Tiril Sandell
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  2. Geir Andre Ringstad
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  3. Per Kristian Eide
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Corresponding author

Correspondence to Tiril Sandell.

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Comment

This report deals with the usefulness of the endoscope in MVD for TN and the value of MRI-based prediction of the need for endoscopy. The findings will be useful to neurosurgeons who perform MVD for TN.

Yoichi Katayama

Nihon, Japan

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Sandell, T., Ringstad, G.A. & Eide, P.K. Usefulness of the endoscope in microvascular decompression for trigeminal neuralgia and MRI-based prediction of the need for endoscopy. Acta Neurochir 156, 1901–1909 (2014). https://doi.org/10.1007/s00701-014-2171-0

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  • DOI: https://doi.org/10.1007/s00701-014-2171-0

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