Skip to main content

Advertisement

SpringerLink
Log in

Diagnosis and management for trigeminal neuralgia caused solely by venous compression

  • Original Article - Functional
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Trigeminal neuralgia (TN) caused solely by venous compression is uncommon. An appropriate vein management protocol for microvascular decompression (MVD) has not been established. We evaluated the management of veins for TN solely due to venous involvement.

Method

We analyzed 31 patients with TN in whom only veins were manipulated during MVD. The culprit veins smaller in diameter than the vein of the cerebellopontine fissure (VCPF) were coagulated and divided in 20 patients (divided group), while transposition was performed for larger veins in the remaining 11 patients (non-divided group). Postoperative outcomes were assessed by Barrow Neurological Institute (BNI) pain intensity score and BNI facial numbness score.

Results

Preoperative contrast-enhanced T1 spoiled gradient recalled (SPGR) imaging exhibited higher detection rates for veins (93.5%) than non-contrast fast imaging employing a steady-state acquisition image (74.2%). The transverse pontine vein (TPV) was the most frequently involved vessel. All the divided veins were small TPVs except one. The non-divided group included seven cases of large TPVs and four involving the main trunk of the superior petrosal vein or its large tributaries. The median follow-up duration was 33 months. Pain relief was achieved immediately after the surgery in 28 (90.3%) and within a month in the remaining 3 (9.7%) patients. Numbness was present in seven (22.6%) patients at the final follow-up. Recurrence was observed in only two (10.0%) patients in the divided group compared with four (36.4%) patients in the non-divided group. Comparison at the final follow-up revealed that the divided group had superior outcome compared to the non-divided group.

Conclusions

Contrast-enhanced T1 SPGR imaging is crucial to detect small veins in the preoperative diagnosis. Division of the culprit veins is recommended if the diameter is smaller than the VCPF as it provides a better outcome and lower recurrence rate than transposition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083

    Article  PubMed  Google Scholar 

  2. Burchiel KJ (2016) Trigeminal neuralgia: new evidence for origins and surgical treatment. Neurosurgery 63:52–55

    Article  PubMed  Google Scholar 

  3. Dumot C, Sindou M (2015) Trigeminal neuralgia due to neurovascular conflicts from venous origin: an anatomical-surgical study (consecutive series of 124 operated cases). Acta Neurochir (Wien) 157:455–466

    Article  Google Scholar 

  4. Dumot C, Brinzeu A, Berthiller J, Sindou M (2016) Trigeminal neuralgia due to venous neurovascular conflicts: outcome after microvascular decompression in a series of 55 consecutive patients. Acta Neurochir (Wien)

  5. Feng B, Zheng X, Wang X, Wang X, Ying T, Li S (2015) Management of different kinds of veins during microvascular decompression for trigeminal neuralgia: technique notes. Neurol Res 37:1090–1095

    Article  PubMed  Google Scholar 

  6. Hong W, Zheng X, Wu Z, Li X, Wang X, Li Y, Zhang W, Zhong J, Hua X, Li S (2011) Clinical features and surgical treatment of trigeminal neuralgia caused solely by venous compression. Acta Neurochir (Wien) 153:1037–1042

    Article  Google Scholar 

  7. Leal PR, Hermier M, Froment JC, Souza MA, Cristino-Filho G, Sindou M (2010) Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging: a prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien) 152:817–825

    Article  Google Scholar 

  8. Li GW, Zhang WC, Yang M, Ma QF, Zhong WX (2014) Clinical characteristics and surgical techniques of trigeminal neuralgia caused simply by venous compression. J Craniofac Surg 25:481–484

    Article  PubMed  Google Scholar 

  9. Matsushima T, Huynh-Le P, Miyazono M (2004) Trigeminal neuralgia caused by venous compression. Neurosurgery 55:334–337

    Article  PubMed  Google Scholar 

  10. Matsushima T, Yamaguchi T, Inoue TK, Matsukado K, Fukui M (2000) Recurrent trigeminal neuralgia after microvascular decompression using an interposing technique. Teflon felt adhesion and the sling retraction technique. Acta Neurochir (Wien) 142:557–561

    Article  CAS  Google Scholar 

  11. Sindou M, Leston JM, Decullier E, Chapuis F (2008) Microvascular decompression for trigeminal neuralgia: the importance of a noncompressive technique—Kaplan-Meier analysis in a consecutive series of 330 patients. Neurosurgery 63:341–350

    PubMed  Google Scholar 

  12. Anichini G, Iqbal M, Rafiq NM, Ironside JW, Kamel M (2016) Sacrificing the superior petrosal vein during microvascular decompression. Is it safe? Learning the hard way. Case report and review of literature. Surg Neurol Int 7:S415–S420

    Article  PubMed  PubMed Central  Google Scholar 

  13. Miller J, Acar F, Hamilton B, Burchiel K (2008) Preoperative visualization of neurovascular anatomy in trigeminal neuralgia. J Neurosurg 108:477–482

    Article  PubMed  Google Scholar 

  14. Kondo A, Date I, Endo S, Fujii K, Fujii Y, Fujimaki T, Hasegawa M, Hatayama T, Hongo K, Inoue T, Ishikawa M, Ito M, Kayama T, Kohmura E, Matsushima T, Munemoto S, Nagahiro S, Ohno K, Okamura T, Ryu H, Shigeno T, Shirane R, Tagusagawa Y, Tanabe H, Yamada K, Yamakami I (2012) A proposal for standardized analysis of the results of microvascular decompression for trigeminal neuralgia and hemifacial spasm. Acta Neurochir (Wien) 154:773–778

    Article  Google Scholar 

  15. Han PP, Shetter AG, Smith KA, Fiedler JA, Rogers CL, Speiser B, Feiz-Erfan I (1999) Gamma knife radiosurgery for trigeminal neuralgia: experience at the Barrow Neurological Institute. Stereotact Funct Neurosurg 73:131–133

    Article  CAS  PubMed  Google Scholar 

  16. Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL (2000) Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47:1013–1019

    Article  CAS  PubMed  Google Scholar 

  17. Miller JP, Acar F, Hamilton BE, Burchiel KJ (2009) Radiographic evaluation of trigeminal neurovascular compression in patients with and without trigeminal neuralgia. J Neurosurg 110:627–632

    Article  PubMed  Google Scholar 

  18. Lee SH, Levy EI, Scarrow AM, Kassam A, Jannetta PJ (2000) Recurrent trigeminal neuralgia attributable to veins after microvascular decompression. Neurosurgery 46:356–361

    Article  CAS  PubMed  Google Scholar 

  19. Matsushima T, Rhoton AL, de Oliveira E, Peace D (1983) Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg 59:63–105

    Article  CAS  PubMed  Google Scholar 

  20. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Jho HD (1997) Trigeminal numbness and tic relief after microvascular decompression for typical trigeminal neuralgia. Neurosurgery 40:39–45

    PubMed  Google Scholar 

Download references

Acknowledgements

We thank Dr. Masayuki Yamaji and Ms. Satomi Fujimura for their assistance with data collection and statistical analysis.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan

    Takuro Inoue, Hisao Hirai, Ayako Shima, Fumio Suzuki & Masayuki Matsuda

  2. Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA

    Takanori Fukushima

Authors
  1. Takuro Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hisao Hirai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ayako Shima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fumio Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takanori Fukushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masayuki Matsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takuro Inoue.

Ethics declarations

Funding

No funding was received for this research.

Conflict of Interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Inoue, T., Hirai, H., Shima, A. et al. Diagnosis and management for trigeminal neuralgia caused solely by venous compression. Acta Neurochir 159, 681–688 (2017). https://doi.org/10.1007/s00701-017-3085-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-017-3085-4

Keywords

Search

Navigation