Microvascular Decompression Surgery

194 Pages·2016·11.32 MB·English

by  Shi-Ting Li, Jun Zhong, Raymond F. Sekula, Jr. (eds.)

Microvascular
Decompression
Surgery
Shi-Ting Li
Jun Zhong
Raymond F. Sekula, Jr.
Editors
123
Microvascular Decompression Surgery

Shi-Ting Li (cid:129) J un Zhong
Raymond F. Sekula, Jr.
Editors
Microvascular
Decompression Surgery
Editors
Shi-Ting Li Raymond F. Sekula, Jr.
Shanghai Pittsburgh, PA
China USA
Jun Zhong
Shanghai
China
ISBN 978-94-017-7365-2 ISBN 978-94-017-7366-9 (eBook)
DOI 10.1007/978-94-017-7366-9
Library of Congress Control Number: 2015958559
Springer Dordrecht Heidelberg New York London
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Pref ace
Microvascular decompression (MVD) has been used to cure tens of thousands
of patients since it was introduced in the 1960s. Now it is still the most effec-
tive treatment for cranial nerve syndrome caused by vascular compression,
including primary trigeminal neuralgia, hemifacial spasm, glossopharyngeal
neuralgia, refractory tinnitus, and dizziness. The cure rate for trigeminal neu-
ralgia, hemifacial spasm, and glossopharyngeal neuralgia varies among differ-
ent centers, but it is over 90 % in most centers and can be as high as 98 %, even
though some patients do not have good results, and some patients have recur-
rence. What’s more, MVD has risks such as facial numbness, hearing loss or
deafness, peripheral facial paralysis, dysphagia, and hoarseness. This is mostly
because the mechanism by which vascular compression causes cranial nerve
syndrome is still unknown. In addition, the real cause of ineffectiveness and
recurrence is unknown. Therefore, study on the mechanism and refi nement of
our surgical techniques may help to improve the overall outcome.
As we reviewed the papers in the last 10 years, we found that many experts
had been devoted to the study of mechanism, diagnostic criterion, surgical
indications, operative techniques, electrophysiological monitoring, outcome
evaluation, as well as treatment principles for ineffectiveness and recurrence.
The results of these basic and clinical studies have further improved the theo-
retical bases for MVD, increased the reliability and safety, improved the cure
rate, and lowered the incidence of surgery-related complications. The pur-
pose of this book is to summarize these new theories, viewpoints, techniques,
and principles, to help clinical practice and improve cure rate. It is exciting
that we have invited some of the most famous experts on MVD, including
Peter Jannetta, MD, PhD; Albert L. Rhoton, Jr., MD; Raymond F. Sekula, Jr,
MD; Aage R. Moller, PhD; Marc P. Sindou, MD; Kwan Park, MD; Anthony
M. Kaufmann, MD; and Akinori Kondo, MD. We hope that this book can
show the frontiers of MVD and help professionals in this area.
In this book, we used literature review, description, classic case reports,
fi gures, and expert comments to make it illustrated and easy to understand.
However, due to the limitations of personal experience, omissions are inevi-
table. We look forward to your feedbacks and suggestions.
Shanghai, China Shi-Ting Li
v

Contents
1 The History of Microvascular Decompression Surgery . . . . . . . . 1
Petter Jannatta
2 Microsurgical Anatomy for Microvascular
Decompression Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Ken Matsushima , Xiaochun Jiang , and Albert L. Rhoton Jr.
3 Pathogenesis and Treatment of Hemifacial Spasm . . . . . . . . . . . 35
Aage R. Møller
4 A Novel Hypothesis on the Mechanism
of Hemifacial Spasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Jun Zhong and Ning-Ning Dou
5 Pathogenesis of Trigeminal Neuralgia . . . . . . . . . . . . . . . . . . . . . . 59
Andrew M. Frederickson , Michael S. Gold ,
and Raymond F. Sekula, Jr.
6 Surgical Technique of Microvascular Decompression
Surgery for Trigeminal Neuralgia . . . . . . . . . . . . . . . . . . . . . . . . . 67
Jun Zhong and Hui Sun
7 Surgical Techniques of Microvascular Decompression
for Hemifacial Spasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Shi-Ting Li and Hui Sun
8 Microvascular Decompression Surgery for Disabling
Positional Vertigo and Tinnitus . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Aage R. Møller
9 Microvascular Decompression Surgery
for Glossopharyngeal Neuralgia . . . . . . . . . . . . . . . . . . . . . . . . . 103
Anthony M. Kaufmann and Behzad Sabit
10 MVD for Neurogenic Hypertension: A Review . . . . . . . . . . . . . 123
Marc Sindou and Andrei Brînzeu
11 Treatment of Vagoglossopharyngeal Neuralgia
with MVD and Other Neurosurgical Procedures . . . . . . . . . . . 137
Marc Sindou and Jianqing Chen
vii
viii Contents
12 Intraoperative Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Shi-Ting Li and Ting-Ting Ying
13 Outcome Evaluation and Postoperative Management . . . . . . . 171
Akinori Kondo
14 Reoperation for Hemifacial Spasm . . . . . . . . . . . . . . . . . . . . . . . 177
Shi-Ting Li and Xue-Sheng Zheng
15 Perioperative Adverse Events of Microvascular
Decompression: Review and a Personal
Experience of 2263 Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Doo-Sik Kong and Kwan Park
1
The History of Microvascular
Decompression Surgery
Petter Jannatta
Neurosurgery is a very different surgical specialty caudally in the posterior fossa with aging
from the days when this investigator was a contributing to arterial and venous pulsatile
research fellow and resident in the years 1957 c ompression (Jannetta 1 967 , 1968 , 1975 , 1997 ;
through 1967. Technological advances have Rand and Jannetta 1 968 )
enabled most of these changes from an almost The best known of the cranial nerve vascular
brutal surgical specialty with many poor results to compression problems are trigeminal neuralgia,
a fi eld wherein a normally sensitive human being hemifacial spasm, and glossopharyngeal neuralgia
can work happily and effectively. These advances, (Rand and Jannetta 1968 ). Other entities include
“the four factors,” include application of the Meniere’s disease, vertigo, tinnitus (Jannetta 1 975 ),
binocular dissection microscope to surgery, clini- and spasmodic torticollis (Jho and Jannetta 1 995 ).
cal neurophysiology, neuroradiology imaging, and More recently, beginning in 1973 and fi rst pub-
neuroanesthesia. These advances were all neces- lished in 1979, brain stem vascular compression
sary for the work to be described below. Two other was found to be associated with essential hyper-
important applications of technology but not used tension (Jannetta and Gendell 1 979 ; Segal et al.
here include advances in stereotactic surgery (i.e., 1 979 ), type 2 diabetes (Jannetta and Hollihan
focused irradiation) and endovascular techniques. 2 004 ; Jannetta et al. 2 010 ), and most recently
Utilization of these four factors has enabled us to Parkinson’s disease (Jannetta et al. 2 011 ). Other
see and do things hitherto thought impossible or at entities not yet published include cardiac arrhyth-
least highly dangerous. mias (left and right heart), hypercholesterolemia
O ver the years, starting in 1965, neurosur- and hyperlipidemias, and cerebellomedullary
geons were able to defi ne a number of cranial auto-compression syndrome (“hypoplastic poste-
nerve diseases caused by pulsatile vascular com- rior fossa” as described by Rosner). The latter is
pression of the centrally myelinated (one or two frequently but not always associated with medul-
exceptions) cranial nerves (Jannetta 1 977 ). These lary vascular compression.
entities occur as the arteries of the base of the We will not consider some of these entities in
brain elongate and loop about with aging, so that order:
they impact the nerves. The brain also moves
1.1 Trigeminal Neuralgia
P. Jannatta , MD, PhD
Department of Neurosurgery, Allegheny General
Early work by Dandy (1 934 ) and Gardner (1 962 ),
Hospital, 420 East North Ave,
concerning vascular compression and other
Suite 302, Pittsburgh, PA 15212, USA
e-mail: [email protected] abnormalities of the root entry zone of the
© Springer Science+Business Media Dordrecht 2016 1
S.-T. Li et al. (eds.), Microvascular Decompression Surgery, DOI 10.1007/978-94-017-7366-9_1