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Trigeminal neuralgia due to venous neurovascular conflicts: outcome after microvascular decompression in a series of 55 consecutive patients

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Abstract

Background

Implication of veins as neurovascular conflict (NVC) in the genesis of trigeminal neuralgia (TN) remains a matter of debate. Few reports dealing with venous NVC have been published. The objective of this study is to describe the outcome in a historical cohort of consecutive patients with classical TN due to venous compression.

Methods

All patients with TN treated by microvascular decompression (MVD) from 2005 to 2013 were included if a marked venous compression was found at the surgery either alone or accompanied by an artery. Patients were evaluated for clinical presentation, operative findings and the long-term outcome. Outcome was considered favourable if patients were classed as BNI I or II (i.e. not requiring any medication). Kaplan-Meier analysis was used to determine probability of a favourable outcome at 10 years of follow-up.

Results

Out of the overall series of 313 patients having been treated by MVD and considered for the study, in 55 (17.5 %) a vein was the main compressive vessel; in 26 (8.3 %) it was the only compressive vessel. Probability of relief with no need for medication at 10 years was 70.6 %. The patients with focal arachnoiditis had a poor long-term outcome, i.e. BNI III-V, in 85.7 % compared with 20.8 % without arachnoiditis (p = 0.0037 Fisher’s exact test). No differences in outcome were found between patients presenting with purely venous compression and patients with mixed compression. Outcome was similarly good for patients with atypical neuralgia when compared to patients with typical clinical presentation.

Conclusions

Venous NVC as a cause of TN is far from rare. MVD with complete liberation of the entire root in cases with clear-cut venous compression on imaging studies gives a good probability of long-term pain relief, thus encouraging to propose surgery for such patients.

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Author contributions

Chloe Dumot

Substantial contributions to conception and design, acquisition of data, analysis and interpretation of data. Drafting the article and critical revision for all intellectual content. Final approval of the version to be published.

Andrei Brinzeu

Substantial contributions to conception and design, acquisition of data, analysis and interpretation of data. Drafting the article and critical revision for all intellectual content. Final approval of the version to be published.

Julien Berthillier

Statistical analysis.

Marc Sindou

Principal surgeon—responsible for all surgical procedures. Substantial contributions to conception and design, acquisition of data, analysis and interpretation of data. Drafting the article and critical revision for all intellectual content. Final approval of the version to be published.

Author information

Authors and Affiliations

  1. Neurosurgical Department, Hospital Pierre Wertheimer, University Lyon 1, Lyon, France

    Chloe Dumot, Andrei Brinzeu, Julien Berthiller & Marc Sindou

  2. University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania

    Andrei Brinzeu

  3. Clinique medico-chirurgicale Bretéché, Nantes, France

    Marc Sindou

  4. Neurosurgical Department, Hopital Pierre Wertheimer, GHE, Service de Neurochirurgie A, 59 Bd. Pinel, 69500, Bron, France

    Andrei Brinzeu

Authors
  1. Chloe Dumot
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  4. Marc Sindou
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Corresponding author

Correspondence to Andrei Brinzeu.

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Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organisation 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.

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For this type of study formal consent is not required.

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Comments

The Lyon group has provided us with another careful analysis of their surgical experience for microvascular decompression in trigeminal neuralgia. This time they focus on the response of venous decompression in pain relief from trigeminal neuralgia.

In 17.5 % of their patients, venous compression played a significant role. Their results in performing venous decompression was similar to their arterial decompression series. This is an important observation as previous studies in the literature have downplayed the role of venous compression in the pathophysiology of trigeminal neuralgia. Some authors go as far as advocating a partial rhizotomy when encountering venous compression only.

The authors have correctly pointed out the dangers of sacrificing the offending vein which may lead to a cerebellar infarct. In this scenario, when the offending vein cannot be separated from the trigeminal root, a partial rhizolysis may be an alternative safer maneuver.

Another contribution in the manuscript is to point out the poor response rate of patients with arachnoiditis to the surgical procedure. When encountering this pathology, a surgical partial rhizolysis could be a useful addition to the procedure.

The authors are to be congratulated on this important contribution to the surgical treatment of trigeminal neuralgia.

Zvi Harry Rappaport

Petah Tiqva, Israel

Portions of this work have been delivered through oral presentations to the Annual Meeting of the French-Speaking Society of Neurosurgery, Paris, France, 2014

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Dumot, C., Brinzeu, A., Berthiller, J. et al. Trigeminal neuralgia due to venous neurovascular conflicts: outcome after microvascular decompression in a series of 55 consecutive patients. Acta Neurochir 159, 237–249 (2017). https://doi.org/10.1007/s00701-016-2994-y

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  • DOI: https://doi.org/10.1007/s00701-016-2994-y

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