Explore the vast range of titles available.

Abstract BACKGROUND Microvascular decompression (MVD) is a potentially curative surgery for drug-resistant trigeminal neuralgia (TN). Predictors of pain freedom after MVD are not fully understood. OBJECTIVE To describe rates and predictors for pain freedom following MVD. METHODS Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, PubMed, Cochrane Library, and Scopus were queried for primary studies examining pain outcomes after MVD for TN published between 1988 and March 2018. Potential biases were assessed for included studies. Pain freedom (ie, Barrow Neurological Institute score of 1) at last follow-up was the primary outcome measure. Variables associated with pain freedom on preliminary analysis underwent formal meta-analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for possible predictors. RESULTS Outcome data were analyzed for 3897 patients from 46 studies (7 prospective, 39 retrospective). Overall, 76.0% of patients achieved pain freedom after MVD with a mean follow-up of 1.7 ± 1.3 (standard deviation) yr. Predictors of pain freedom on meta-analysis using random effects models included (1) disease duration ≤5 yr (OR = 2.06, 95% CI = 1.08-3.95); (2) arterial compression over venous or other (OR = 3.35, 95% CI = 1.91-5.88); (3) superior cerebellar artery involvement (OR = 2.02, 95% CI = 1.02-4.03), and (4) type 1 Burchiel classification (OR = 2.49, 95% CI = 1.32-4.67). CONCLUSION Approximately three-quarters of patients with drug-resistant TN achieve pain freedom after MVD. Shorter disease duration, arterial compression, and type 1 Burchiel classification may predict more favorable outcome. These results may improve patient selection and provider expectations. Graphical Abstract Graphical Abstract

ObjectivesThis study aimed to investigate the feasibility of segmentation-independent volume rendering (SI-VR) in visualising the root entry zone (REZ), and to explore the influence on the management of vascular compression syndromes (VCSs).MethodsTwo hundred and twenty patients with VCSs were recruited in this prospective study from July 2015 to May 2019. SI-VR was reconstructed based on inverted 3D fast spin echo T2WI. They were assigned to the experimental group and control group randomly. Patients in the experimental group would accept extra evaluation based on SI-VR before microvascular decompression. Image quality and diagnostic accuracy between SI-VR and 3D fast spin echo T2WI in the experimental group were compared by Mann–Whitney U test and chi-square test, separately. Interobserver agreement was performed with intraclass correlation coefficient. Postsurgical outcomes and complications between two groups were compared by chi-square test.ResultsSI-VR had a better interobserver agreement (0.82 vs 0.68) and diagnostic accuracy (95.5% vs 83.6%, p = 0.004) than that of 3D fast spin echo T2WI. Especially, significantly improved diagnostic accuracy was reached in detecting the multi-vascular branches compression (100% vs 15.4%, p < 0.001). There were fewer complications (7.1% vs 26.8%, p = 0.004) and less operation time (20.7 min vs 14.5 min, p = 0.007) but no significant difference of pain relief (p = 0.19) in the experimental group than in the control group.ConclusionsThe SI-VR method is feasible for the precise demonstration of the anatomy structure along the REZ, with high reliability and reproducibility. Unbiased pre-surgical visualisation could reduce redundant explorations and post-surgical complications in patients who undergo microvascular decompression.Key Points• Visualisation of the root entry zone by the segmentation-independent volume rendering is in accordance with the landscape by the neuro-endoscopy.• Segmentation-independent volume rendering has an advantage over 3D fast spin echo T2WI in the visualisation of multi-vascular branches compression.• Presurgical 3D visualisation of the neurovascular compression at the root entry zone leads to less postsurgical complications from the decrease of redundant exploration.

Abstract BACKGROUND Microvascular decompression (MVD) can be an effective intervention for trigeminal neuralgia (TN); however, an optimal system for patient selection and surgical outcome prediction has not been defined. OBJECTIVE To develop and validate a preoperative TN grading system for the prediction of long-term pain relief after MVD. METHODS This retrospective cohort study included consecutive patients suffering unilateral TN who underwent MVD with >18-mo follow-up. A grading system was formulated using 3 previously validated preoperative characteristics. The primary end-point was long-term, pain-free status without use of medication. Ability to predict pain-free status was analyzed by multiple regression and assessed by area under the receiver operating characteristic curve (AUC). Clinical utility to predict MVD success and reduce unnecessary surgeries was assessed by decision-curve analysis. RESULTS Of 208 patients analyzed, 73% were pain-free without medication at >18-mo follow-up. Pain-free status was predicted by classical TN type, positive response to carbamazepine and/or oxcarbazepine, and presence and nature of neurovascular compression demonstrated on MRI (all P < .01). The TN grading system demonstrated good discriminatory ability for prediction of pain-free status (AUC 0.85, 95% CI 0.80-0.91). Decision-curve analysis demonstrated a net reduction of 20 cases likely to be unsuccessful per 100 patients evaluated with this grading system above a decision threshold of 80%. CONCLUSION This TN grading system reliably predicts long-term pain-free status without medications following MVD. The use of the TN grading system as part of a comprehensive work-up may reduce the number of unsuccessful operations.

ObjectiveThe safety and efficacy of surgical microvascular decompression (MVD) in elderly patients with trigeminal neuralgia (TN) is controversially discussed in the literature. A widespread reluctance to expose this cohort to major intracranial surgery persists. Our aim was to compare the efficacy and safety between older and younger patients with TN.MethodsIn this cross-sectional study, 139 MVD procedures (103 patients < 70 and 36 patients ≥ 70) were included. Surgical fitness was assessed by the American Society of Anesthesiology (ASA) grade. The pain-free interval was evaluated using Kaplan–Meier analysis only in patients with a recent follow-up visit. Independent risk factors for recurrence in patients with a minimum 12-month follow-up were determined.ResultsPatients ≥ 70 showed a significantly higher number of comorbidities. Pain intensity, affection of trigeminal branches and symptom duration was similar between groups. No significant difference in treatment associated complications and permanent neurological deficits was shown. There was no treatment-related mortality. A tendency towards a lower recurrence rate in patients < 70 did not reach statistical significance (17.6% vs. 28.6%, P = 0.274). Pain-free interval was not different between both cohorts (78.7 vs. 73.5 months, P = 0.391).ConclusionDespite a higher prevalence of comorbidities in elderly patients, complication rates and neurological deficits after MVD were comparable to younger patients. Rates of immediate and long-term pain relief compared favorably to previous studies and were similar between elderly and younger patients. These data endorse MVD as a safe and effective first-line surgical procedure for elderly patients with TN and neurovascular conflict on MRI.

Background Microvascular decompression (MVD) represents the only definitive and non-ablative treatment for hemifacial spasm (HS). Teflon is the most used interposing material because considered inert; nevertheless, it is not free from complications. Method We discuss and illustrate our method to resolve the neurovascular conflict accounting for HS through a sling transposition technique using aneurysm clip and biopatch in carefully selected cases. Conclusion Several MVD procedures, including interposing and transposing techniques, have been proposed for HS, mainly selected according to surgeon’s preference. We consider the described technique a definitive treatment, safe, not associated to pain recurrence and without needing revision surgery.

Background Various instruments are used in microvascular decompression (MVD) to mobilize offending vessels. Most instruments have straight tips for safety but provide limited ability to retract vessels toward the surgeon. To address this limitation, we developed a double-faced microprobe, designated as the “SWAN probe,” to enhance maneuverability in confined operative spaces. Methods The instrument has a 2.5-mm upward-bending tip (1.0-mm width) with multiple curved surfaces for controlled vessel manipulation. The inner face (angled at 45° with a narrow hollow) allows secure vessel capture and retraction, whereas the outer face (angled at 60° with a broader hollow) is optimized for advancing the vessel away from the nerve. Flat lateral surfaces enable gentle lateral displacement. The sandblasted surface reduces slippage and minimizes light reflection. The microprobe was used in 51 MVD procedures for trigeminal neuralgia (TN) and hemifacial spasm (HFS). Its utility and safety were assessed based on intraoperative performance across key maneuvers. Results Usability scores were consistently higher than the theoretical baseline representing procedures achievable with conventional straight-tip instruments. Benefits were most apparent during proximal retraction (“pull-out”) maneuvers of the superior cerebellar artery. The probe also aided Teflon sling handling and controlled arachnoid incision. No procedure-related complications attributable to the instrument were observed. Conclusions The double-faced microprobe allows both retraction and displacement of offending vessels, improving intraoperative maneuverability in selected situations. Within the limits of this study, the SWAN probe appears to be a safe and useful adjunct for MVD and may have broader applicability in microsurgery.

Dizziness often occurs after microvascular decompression (MVD), and therapeutic options are limited. The aim of this trial was to determine the potential efficacy of transcutaneous electrical acupoint stimulation (TEAS), against dizziness and its safety in patients undergoing MVD. Adult patients scheduled to undergo MVD for hemifacial spasm under total intravenous anesthesia were randomized at a 1:1 ratio to receive, after extubation, 30-min TEAS in the mastoid region as well as Fengchi acupoints (GB20) and Neiguan acupoints (PC6) or 30-min sham stimulation. The primary outcome was the incidence of dizziness at 2 h after surgery. Secondary outcomes included dizziness, postoperative nausea and vomiting (PONV) or headache severity, rescue medication, changes in intraocular pressure before and after surgery, length of stay, dizziness symptoms 4 weeks after discharge, and surgical complications. A total of 86 patients (51.9 ± 9.4 years of age; 67 women) were enrolled. One patient (in the TEAS arm) was excluded from analysis due to conversion to sevoflurane anesthesia. The rate of dizziness at 2 h after surgery was 31.0 % (13/42) in the TEAS arm vs. 53.5 % (23/43) in the sham control arm (P = 0.036). TEAS was also associated with significantly lower severity of dizziness, based on a 10-point scale, during the first 24 h after surgery. None of the other secondary efficacy outcomes differed significantly between the two arms. All postoperative complications were Clavien-Dindo grade I or II. The rate of postoperative complications was 21.4 % (9/42) in the TEAS arm vs. 16.3 % (7/43) in the sham control arm (P = 0.544). Compared with sham control, TEAS was associated with a lower incidence of dizziness within 2 h and lower severity of dizziness within 24 h post-operatively, but no improvement in other outcomes, in adult patients undergoing MVD for hemifacial spasm. •The dizziness rate after microvascular decompression (MVD) surgery was high (57.6 % at 24 h after surgery).•Transcutaneous electrical acupoint stimulation (TEAS) reduced dizziness rate at 2 h after surgery (P = 0.036) and severity within 24 h after surgery.•TEAS maybe integrated into daily practice and enhance patient recovery.

BackgroundTransposition of the vertebral artery (VA) for microvascular decompression for hemifacial spasm (HFS) is often challenging. Various procedures have been proposed to transpose the immobile tortuous VA that cannot be decompressed satisfactorily in the usual manner.MethodsA Teflon piece that is cut into a wedge shape was used for transposition of the VA as an offending artery in HFS. One or more wedge-shaped Teflon pieces were simply inserted into a small space between the VA and the brainstem or cerebellar hemisphere without any contact with the entry into the root exit zone (REZ) of the facial nerve. A minimal space can be created by slight mobilization of the VA through rostral or caudal, or in between to the lower cranial nerves (LCNs). In cases of a hypertrophic VA that is hard to mobilize, two or more rigid wedge-shaped Teflon pieces that are coated by fibrin glue can be applied to obtain adequate mobilization of the VA. Moreover, a much harder Teflon bar, which is bent into a V shape, can be used in cases of an immobile VA. Once the VA is transposed to an appropriate position, the Teflon, VA, and contacted surface of the brainstem are fixed together by drops of fibrin glue.ResultsThe offending arteries were VA-posterior inferior cerebellar artery (PICA) in eight cases, VA in four cases, PICA in four cases, VA-anterior inferior cerebellar artery (AICA) in one case, and AICA in one case. Eighteen cases of HFS were successfully treated using the “Wedge technique.” Symptoms disappeared within 2 weeks in all patients. Transient facial nerve palsy developed in one case, and transient hoarseness developed in one case.ConclusionsThe wedge technique is a simple straight-line maneuver that facilitates sufficient transposition of the VA without any related complications. This technique is also useful for other large offending vessels, such as the anterior or posterior inferior cerebellar arteries, which are hard to mobilize due to the torque of the vessels.

Objective: This study aimed to investigate the clinical efficacy and early outcomes of endoscopic microvascular decompression (MVD) for primary trigeminal neuralgia (TN) and provide clinical experience for the application of full endoscopic techniques in MVD surgery. Methods: This study retrospectively collected medical records of patients who underwent microvascular decompression (MVD) surgery at our institution between January 2020 and January 2023. According to predefined inclusion and exclusion criteria, a total of 137 patients were ultimately included in the study. To evaluate the severity of facial pain in these patients, we utilized the Barrow Neurological Institute (BNI) pain intensity rating system. Additionally, this study analyzed and compared the clinical outcomes of MVD procedures performed endoscopically versus those performed under microscopy. Results: There were no statistically significant differences between endoscopic and microscopic microvascular decompression (MVD) in terms of postoperative hospital stay, recurrence rate, complication incidence, and surgical duration ( P  > 0.05). However, regarding the efficacy of treatment, the effectiveness rate after endoscopic MVD was superior to that of microscopic MVD, with a statistically significant difference observed between the two groups ( P  < 0.05). Conclusion: Endoscopic microvascular decompression (MVD) for primary trigeminal neuralgia is a safe and effective treatment, with the critical success factor being the accurate localization of the vessel compressing the nerve. Compared to traditional microscopic MVD, endoscopic MVD shows superior postoperative outcomes, offering wide-angle and multi-angle views along with close-up inspection capabilities. However, it requires attention to overcoming limitations such as a lack of stereoscopic vision and potential blind spots.

Background Microvascular decompression (MVD) is the gold-standard surgical treatment for cranial nerve compression disorders, including trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN). This review synthesizes historical milestones, recent advances, and evolving techniques in MVD, with a primary focus on these conditions. Methods A comprehensive literature review was conducted using databases such as PubMed, SpringerLink, Google Scholar, BioMed Central, Scopus, and ScienceDirect. Studies published between 1970 and 2024 were analyzed, emphasizing surgical techniques, clinical outcomes, and technological innovations in MVD. Articles addressing TN, HFS, GPN, and other cranial nerve disorders treated with MVD were selected for detailed evaluation. Results MVD demonstrates high efficacy, with 80–90% of patients achieving immediate symptom relief. Nevertheless, 15–25% of patients experience symptom recurrence, though long-term outcomes remain favorable. Fully endoscopic MVD has shown potential for enhanced intraoperative visualization, particularly in complex anatomical regions; however, its impact on surgical precision and clinical outcomes is still under investigation. Moreover, innovations in visualization technologies, including three-dimensional exoscopic systems and artificial intelligence-assisted surgery, continue to improve procedural safety and outcomes. Despite these advancements, complications such as hearing loss (1–2%) and cerebrospinal fluid leakage (2–4%) persist, highlighting the need for continuous refinement of techniques. Conclusions MVD is evolving with the integration of cutting-edge technologies, resulting in improved clinical outcomes and reduced complication rates. Emerging innovations such as robotic-assisted MVD and gene therapies for cranial nerve disorders, including TN and GPN, promise even greater efficacy and precision. However, further research is necessary to standardize surgical protocols and address disparities in healthcare systems globally. Graphical Abstract