Keisuke Onoda, Yoshinori Takaya, Yu Hirokawa, Ryohei Sashida, Ren Fujiwara, Tomihiro Wakamiya, Yuhei Michiwaki, Tatsuya Tanaka, Kazuaki Shimoji, Eiichi Suehiro, Fumitaka Yamane, Masatou Kawashima and Akira Matsuno

Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Japan

*Corresponding Author: Keisuke Onoda, Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan.

Received: September 25, 2022; Published: October 13, 2022

Abstract

Background: Trigeminal neuralgia (TN) caused solely by veins is relatively rare, and it is more difficult to visualize the responsible vein than the artery using MRI. There has been no comprehensive description of the condition and best practices for diagnosing and surgically treating it. Here, we aimed to visualize the vein causing TN and discuss intraoperative considerations in view of the reported relatively highly frequent recurrence of TN with vein compared to TN with arterial compression.

Methods: To study vein-caused TN, we reviewed 110 cases of microvascular decompression (MVD) from the past 3 years, including seven cases (6.4%) involving veins alone. All patients underwent preoperative three-dimensional magnetic resonance cisternogram/angiogram (3D-MRC/MRA) fusion imaging. Surgery was performed using conventional retrosigmoid approach, and pain level was evaluated using Barrow Neurological Institute (BNI) Pain Intensity Score.

Results: 3D-MRC/MRA helped detect vein involvement in all cases. Surgical findings confirmed compression caused by vein, consistent with preoperative imaging. In six (86%) cases, trigeminal nerve was adherent to arachnoid membrane, and nerve was deformed. After adhesions were dissected and vein was moved, improving nerve deformity, resulting in complete disappearance of pain (BNI grade I) in all six cases. In the single case with no adhesion (14%), transposition improved TN from BNI grade IV to II.

Conclusions: 3DMRC/MRA helped diagnose TN caused by vein compression and aided surgical simulation and decision-making. We recommend to dissect adhesions around trigeminal nerve to improve deformity. Long-term follow-up is necessary because vein-caused TN has a high recurrence risk.

Keywords: Microvascular Decompression; Trigeminal Neuralgia; Vein; Magnetic Resonance Imaging

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Citation

Citation: Keisuke Onoda., et al. “A Retrospective Study of Trigeminal Neuralgia Cases Caused Solely by Veins". Acta Scientific Neurology 5.11 (2022): 43-49.

Copyright

Copyright: © 2022 Keisuke Onoda., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.