| OBJECTIVE:Purpose1:1) Our aim was to determine whether the anatomical configuration ofthe posterior fossa and pontomesencephalic cistern might represent a predispositionfactor for the occurrence of clinical neurovascular conflict in trigeminal neuralgia (TN).2)Discuss the contributing factors of prognosis of idiopathic trigeminal neuralgia (ITN)treat with microvascular decompression.Purpose2:1) Our aim was to determine whether a smaller posterior fossa andposterior fossa (PF) CSF space may be a risk factor for the occurrence of clinicalneurovascular conflict in hemifacial spasm (HFS).2) To investigate the value ofintraoperative facial muscles lateral spread response (LSR) and brainstem auditoryevoked potential (BAEP) in the microvascular decompression (MVD) for hemifacialspasm (HFS).Purpose3: To observed effects of MVD for tinnitus and vertigo induced bymicrovascular comprssion (MVC) syndrome.Purpose4: To observed effects of glossopharyngeal neuralgia treated with MVD.METHODS:Methods1:1) We used3-dimensional magnetic resonance (MR) volumetric studyin26patients with TN and20controls. The volume of the posterior fossa was comparedbetween the patients and controls, The volume of pontomesencephalic cistern, and thetrigeminal nerve on the clinical and non-affected sides was compared. The reliability hasbeen assessed in all measurements.2) Review of67patients with ITN for clinical datafrom January2009to January2011in the first affiliated hospital of Xinjiang MedicalUniversity.Follow up12to34months,21.5months in average. The statistics include age,sex, pathogenesis, clinical presentation, the degree of compression, the effection ofdecompression and other follow-up results.Methods2:1) We used3-dimensional MR volumetric study in40patients with HFS and20controls. The volume of the posterior fossa and (PF) CSF volume werecompared between the patients with HFS and controls. The reliability has been assessedin all measurements.2) From January2011to December2011,33patients affected withHFS treated down side by MVD, during which LSR and BAEP were monitoringsynchronously. Analysised the relationship between the monitoring results and theoutcomes.Methods3: MVD of the eighth cranial nerve through the retrosigmoid approachcarried on12cases of ipsilateral tinnitus, including8cases with vertigo. All patients werefollowed-up6～48months for the evaluation of treatment outcome.Methods4：16patients with glosssopharyngeal neuralgia were treatedmicrosurgically from March2002to September2011. of them,14patients were treatedby MVD,2by MVD combined with rhizotomy of glossopharyngeal nerve root and upper1st rootlets of vagus nerve root. From February2010to December2011, the anatomicalrelationship between glosssopharyngeal nerve root and rootlets of vagal nerve werestudied during exploration in microneurosurgical operations for89cases of HFS.RESULTS:Results1:1) In all patients, the posterior fossa volume was different in the clinicaland control groups (P＜0.05); A significantly smaller volume of the pontomesencephaliccistern was found on the affected side (P＜0.05). Healthy controls was not significant (P＞0.05). The volume of the clinically affected trigeminal nerve was significantly reduced(P＜0.05).2) All67patients divided into typical trigeminal neuralgia group (59cases)and atypical trigeminal neuralgia group (8cases) depended on their clinicalpresentation.The pathogenesis of ITN included Arterial compression (43cases), Veneouscompression (2cases), Arterial and Veneous compression (12cases), multipule arterialcompression (4cases), and5cases without specific compression.The degree ofcompression included contact (36cases), contact and displacement (14cases), adhesion(9cases), adhesion and displacemen (3cases).The effection of decompression includedfully decompression (59cases), partly decompression (3cases), and5cases withoutspecific compression, so we can not judge the decompression effective..After the surgery,50patients were cured,8patients recovered in3days to6months,7patients’ symptomhappened occasionally, but didn’t need drugs,1patient had symptom reappeared,1patient without any change. After Statistical analysis, the effection between trigeminalneuralgia groupand atypical trigeminal neuralgia group had significant difference (P＜ 0.05). Age, sex, affected side had no correlately effection to surgery (P＞0.05), whilepathogenesis, clinical presentation, the degree of compression, the effection ofdecompression had significant correlately effection to prognosis (P＜0.05).Results2:1) In all patients, The posterior fossa volume and (PF) CSF volumevolume were not different in the clinical and control groups (P＞0.05).2) LSR waveformcan be recorded in all of the33patients intraoperatively. LSR disappeared during28patients, and sustained in5patients. All of the28patients in the group of LSRdisappearing were cured, and only4patients cured in the group of LSR sustained.Statistical analysis were made between two groups, there were difference between them(P＜0.05). It suggests that the disappearing of LSR response indicate the facial spasmsymptom will disappear after operation.The outcome of the group that LSR responsepersisted after MVD were much more than the contrast group. It suggests that thedisappearing of LSR response can prognosticate the effect of MVD. Intraoperative BAEPwaveform in V wave reduced by50%or more or disappear in4patients, of which3patients were found hearing loss with obvious symptom after operation.Results3: During the early postoperative period, the tinnitus were resolved ormarkedly improved in5patients,2cases ineffectiveness;8cases who suffered with bothtinnitus and vertigo,6of them vertigo were markedly improved,2cases ineffectiveness.After operated for one week,3of them were cured,3improved and2ineffectiveness.After6month followed up,5cases of tinnitus had cure,2cases of tinnitus alleviatepatients felt cured,3cases of tinnitus alleviate patients felt improvement and2cases didnot change;4cases of vertigo had cured,2cases of vertigo alleviate felt no significantimprovement. After6months,1case felt improvement,1case ineffectiveness.Results4: The disappearance of pain was found in14patients right after theoperation, cases felt significantly reduced, and disappeared after2to3days.Thefollow-up curative rate was100%. There was no recurrence of pain during the follow-upperiod. Four different types of anatomical relationship between glosssopharyngeal nerveroot and rootlets of vagal nerve were found during exploration in microneurosurgicaloperations.CONCLUSIONS:Conclusions1:1) We found some association between the clinical NVC and thesize of the posterior fossa and pontomesencephalic cistern. MRI volumetry may show theatrophy of the affected trigeminal nerve in clinical NVC.2) The effection of MVD had been conform, and MVD was the only treatment for pathogenesis, mean whilepathogenesis, clinical presentation, the degree of compression, the effection ofdecompression have significant correlately effection to prognosis. In order to make surethe treatment effectively, the surgery should be done as early as we can after the dignosis.In addition, throughout explortion and fully decompression can improve the effection ofsurgery.Conclusions2:1) We did not found some association between the clinical NVC andthe size of the posterior fossa and (PF) CSF.2) Intraoperative monitoring of LSR andBAEP during MVD benefits to enhance the effective rate, forecast the outcome duringthe operation, and protect the audio function.Conclusions3: The evidence indicating that MVC of the eighth cranial nerve wasone of the causes of tinnitus. MVD of the vestibulocochlear nerve was a safe andeffective operation for these carefully selected tinnitus patients.Conclusions4: MVD can efficiently treat glossopharyngeal neuralgia. MVD andcombination rhizotomy of glossopharyngeal nerve root and upper1st to2nd rootlets ofvagus nerve were effective for the treatment of glossophryngeal neuralgia. Operativemethods should be chosen according to the followingtwo points: compression of nerveroots by affected vessels or not, and the con-dition of compression. |
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