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Clinical analysis of trigeminal neuralgia caused by vertebrobasilar dolichoectasia

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Abstract

Our objective is to explore the clinical manifestations, imaging features, and therapy of trigeminal neuralgia (TN) caused by vertebrobasilar dolichoectasia (VBD). Clinical and imaging data of 11 cases with trigeminal neuralgia caused by VBD were retrospectively analyzed, and relevant literatures were reviewed. Of these 11 patients, 8 were male, and 10 suffered from hypertension. Imaging findings revealed that the vertebrobasilar arteries were pathologically enlarged and tortuous. Facial pain disappeared or was relieved after the microvascular decompression (MVD) in all 11 patients; no recrudescence was found with an average of 22-month follow-up. We concluded that TN caused by VBD, a rare clinical disease, mainly occurred in older men with a history of hypertension. CT, MRI, and MRA have great significance in the diagnosis of this disease; MVD is a preferred treatment method.

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Acknowledgments

The work was supported by a Fellowship from Qilu Hospital. The authors are thankful to the neurosurgery staffs for their careful linguistic assistance with this article.

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Authors and Affiliations

  1. Department of Neurosurgery, Qilu Hospital of Shandong University, 107 Wenhua West Road, Jinan, 250012, China

    Xiangyu Ma, Xinguo Sun, Jun Yao, Shilei Ni, Jie Gong, Jiangang Wang & Xingang Li

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  1. Xiangyu Ma
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  2. Xinguo Sun
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  3. Jun Yao
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  4. Shilei Ni
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  5. Jie Gong
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  6. Jiangang Wang
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  7. Xingang Li
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Corresponding authors

Correspondence to Jiangang Wang or Xingang Li.

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Comments

Ludwig Benes, Arnsberg, Germany

The authors have written a clear clinical analysis of trigeminal neuralgia caused by the rare event of vertebrobasilar dolichoectasia in a series of 11 patients. The data in the present paper was collected from 458 patients treated with idiopathic trigeminal neuralgia at one hospital. A PubMed search only identifies around 20 published papers, mainly case reports, on this topic. They appropriately used microvascular decompression for the treatment of dolichoectasia and combined decompression with trigeminal nerve selective partial posterior rhizotomy in two patients. Although the authors describe a 100 % facial pain relief in their treatment group, the reader should keep in mind that transposing the vertebrobasilar-vessel-complex for microvascular decompression might cause some problems during surgery in terms of vessel-kinking, preservation of perforators, and difficulties to transpose the vessel complex due to arteriosclerotic plaques.

Selcuk Peker, Istanbul, Turkey

Vertebrobasilar dolichoectasia (VBD) related trigeminal neuralgia (TN) is difficult to treat with microvascular decompression. Ma et al. reported very high success rate in their series. VBD related TN is infrequently reported in the literature due to most of the cases being treated with non-surgical techniques. Because this condition is mostly seen in old-age patients with hypertension, the recommended treatment for these patients is medical treatment, percutaneous methods, or radiosurgery.

Surgical technique in these patients differs, such as simple decompression or decompression with Teflon placement, glue application, or microplate assisted repositioning of the VB artery. Due to risk of recurrent compression of the artery, repositioning techniques seem to be logical. Patients in this series did not have postoperative control imaging, so we are not able to obtain the rate of recurrent compression. The success rate for pain disappearance in this series does not give us sufficient information about this issue.

The mean and median follow-up is short for TN in this series. The high success rate should be evaluated carefully. They reported that two patients had decompression plus rhizotomy. We cannot be sure that the success in these patients related to decompression or rhizotomy.

Peter T. Ulrich, Darmstadt, Germany

Vertebrobasilar dolichoectasia is a rare cause of trigeminal neuralgia. The authors present and analyze 11 cases out of 485 patients (2.4 %) with idiopathic trigeminal neuralgia treated in a period of 3 years. In nine cases, they performed a microvascular decompression alone, in two cases combined with a partial rhizotomy. In both cases, a facial numbness occurred after surgery. The rationality in applying this destructive measure additionally is questionable, all the more because the authors do not provide an argumentation. In both cases, facial hypoesthesia was present before surgery. Nevertheless in all cases, freedom of pain was achieved during follow-up.

In our experience, the huge tortuous and ectatic artery may be hampering the access to the trigeminal root insomuch that the root entry zone cannot be visualized even less be decompressed by a targeted positioning of a Teflon patch. In such cases, the artery may be moved away from the nerve root by a silicone sling sutured to the dura over the petrous pyramid, a method first described by Stone et al. 1993.

It seems remarkable that complications like facial numbness, hemifacial spasm, facial palsy, and ataxia occurred in 5 of 11 cases (45 %) albeit partially reversible. The comparatively high rate of complications of the microvascular decompression underlines the fact that the dolichoectatic arterial compression of the trigeminal root is also in the hands of experienced neurosurgeons, a challenging surgical endeavour.

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Ma, X., Sun, X., Yao, J. et al. Clinical analysis of trigeminal neuralgia caused by vertebrobasilar dolichoectasia. Neurosurg Rev 36, 573–578 (2013). https://doi.org/10.1007/s10143-013-0468-8

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  • DOI: https://doi.org/10.1007/s10143-013-0468-8

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