Clinical Features And Surgical Treatment Of Trigeminal Neuralgia Caused By Vertebrobasilar Dolichoectasia

Objective:To explore the pathogenesis, clinical manifestations, imaging features, diagnosis, differential diagnosis and therapy of trigeminal neuralgia(TN) caused by vertebrobasilar dolichoectasia(VBD).Methods:11patients with TN caused by VBD which were hospitalized and treated in the Department of Neurosurgery, Qilu Hospital of Shandong Uniwersity between September2008to September2011were retrospectively analyzed and relevant literatures were reviewed. The clinical presentation, imaging data, intraoperative findings and postoperative follow-up data are discussed.458cases with idiopathic trigeminal neuralgia(ITN) were treated during the time above-mentioned, and11cases were selected according to the standard, accounting for2.40%of the total number. All patients underwent brain CT(computed tomography), MRI(magnetic resonance imaging) and3D-TOF-MRA(magnetic resonance angiography) examination and two cases were inspected by DSA(digital subtraction angiography) after the operation..Results:Of these11patients,8cases were male and the other3were female; Their ages ranged from52years to73years (mean,62.5years). The average duration from presenting symptoms to diagnosis was about3.87years (ranging between1month and10years).10cases had a history of hypertension, and8cases greater than or equal to10years;2cases with a history of diabetes;3cases had a transient ischemic attack (TIA);1case with a long-term smoking history; The location of the facial pain:the left2and3branch distribution area in5, the left2branch distribution area in3and the right2and3branch distribution area in the last3cases; The nature of pain were sharp pain; the pain score were from8to10according to the12depicts verbal rating scales;7cases with the ipsilateral facial hypoesthesia and1case hyperesthesia;2cases were associated with ipsilateral hemifacial spasm and1case with ipsilateral hearing loss;10cases used to oral drugs before admission(carbamazepine in8, wild papaya tablets in1, phenytoin in1);4cases had once percutaneous radiofrequency coagulation (hereinafter referred to as RF) and1patient had twice; Imaging findings of all the patients revealed that the vertebrobasilar arteries pathologically enlarged and tortuous;11patients’ facial pain was disappeared or relieved after the microvascular decompression(MVD), postoperative complications were disappeared, improvement or no progress after active treatment; With an average of22-month follow-up, there was no recrudesce, but1patient died of aneurysm.Conclusions:①TN caused by VBD is a rare clinical disease, mainly occurred in older men with a history of hypertension;②This disease has a certain degree of specificity of clinical manifestations:the pain were mainly located on the left face, and often accompanied by other symptoms of cranial nerve compression or brain stem compression;③CT, MRI and3D-TOF-MRA have great significance in the diagnosis and treatment of this disease,especially the3D-TOF-MRA has guiding significance for MVD;④Before the operation we should exclude the possibility of VBA dissection and fusiform aneurysm in order to avoid the serious postoperative complications like hemorrhage, infarction and so on;⑤MVD is the preferred treatment method with fewer complications and lower recurrence rate. It is difficult to isolate the VBA because it is too enlarged and tortuous and there may be more than one pressure points between the VBA and trigeminal nerve, we should do the operation carefully. If the trigeminal nerve can not be completely decompression, besides the MVD, we can do the elective part amputation of the trigeminal nerve sensory root.