Surgical neurology international · 2024
Microvascular decompression for primary trigeminal neuralgia with the 3/4 circumferential expanded polytetrafluoroethylene (ePTFE) sleeve technique.
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Burgos-Sosa Erik, Mendizabal-Guerra Rafael, Nieto-Velazquez Nayeli Goreti, Ayala-Arcipreste Arturo
Аннотация
BACKGROUND: Microvascular decompression (MVD) using Teflon or Ivalon is the surgeon's preference for treating trigeminal neuralgia (Tn). Still, sometimes the prosthetic material is unavailable, or there is some recurrence of pain during the follow-up. In this case series, we report the outcome analysis for MVD using the expanded polytetrafluoroethylene (ePTFE) sleeve technique in classic Tn.
METHODS: We conducted a retrospective analysis of patients with Tn from January 2017 to March 2022. Classic or primary Tn was considered a direct compression by a cerebrovascular structure in the posterior fossa, detected by magnetic resonance imaging or direct surgical visualization. Pre- and postoperative Barrow Neurological Institute Pain Intensity Scale (BNI-SI) and Barrow Neurological Institute Hypoesthesia Scale (BNI-HS) were used for the clinical results assessment of the ePTFE sleeve circumferential technique.
RESULTS: There were nine patients approached with the 3/4 circumferential ePTFE sleeve technique with BNISI IV (n: 11, 58%) and BNI-SI V (n: 8, 42%). In all patients, there was a clinical improvement after the surgical treatment (P < 0.001). All patients obtained BNI-SI ≤ IIIa in an average follow-up of 11.89 (±14.137), with a slight improvement in BNI-HS (P: 0.157). In our revision, this technique has not previously been described for Tn.
CONCLUSION: The circumferential ePTFE sleeve technique is a good option for MVD in Tn. For classic Tn, MVD could remain the first option, and this technique could be applied for multi-vessel compression.
METHODS: We conducted a retrospective analysis of patients with Tn from January 2017 to March 2022. Classic or primary Tn was considered a direct compression by a cerebrovascular structure in the posterior fossa, detected by magnetic resonance imaging or direct surgical visualization. Pre- and postoperative Barrow Neurological Institute Pain Intensity Scale (BNI-SI) and Barrow Neurological Institute Hypoesthesia Scale (BNI-HS) were used for the clinical results assessment of the ePTFE sleeve circumferential technique.
RESULTS: There were nine patients approached with the 3/4 circumferential ePTFE sleeve technique with BNISI IV (n: 11, 58%) and BNI-SI V (n: 8, 42%). In all patients, there was a clinical improvement after the surgical treatment (P < 0.001). All patients obtained BNI-SI ≤ IIIa in an average follow-up of 11.89 (±14.137), with a slight improvement in BNI-HS (P: 0.157). In our revision, this technique has not previously been described for Tn.
CONCLUSION: The circumferential ePTFE sleeve technique is a good option for MVD in Tn. For classic Tn, MVD could remain the first option, and this technique could be applied for multi-vessel compression.