Microdescompresión vascular en la neuralgia esencial del trigémino

Tania Margarita Cruz Hernández, Orestes López Piloto, Carlos Pérez Rodríguez, Pedro Domínguez Jiménez, Julio César Selva Infante

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Resumen

OBJETIVO: Determinar los resultados de la microdescompresión vascular (MDV) en los pacientes con diagnóstico de neuralgia esencial del trigémino no controlados con el tratamiento médico.

MÉTODOS: Se realizó un estudio retrospectivo de una serie con neuralgia esencial del trigémino operados por MDV en los Hospitales Clínico Quirúrgicos “Lucía Iñiguez Landín” y “Hermanos Ameijeiras” en el período comprendido de enero del 2001 a marzo del 2016. Se analizaron las variables edad, sexo, ramas neurales afectadas, tipo de compresión vascular más frecuentemente encontrada, complicaciones y recidivas.

RESULTADOS: La muestra quedó conformada por 61 pacientes. El sexo femenino fue el más afectado. Mayormente los casos tenían entre 50 y 60 años de edad. Las ramas más afectadas fueron la tercera y la asociación de la segunda y tercera rama para un 43,1 % (22) y 21,5 % (11) respectivamente. La sepsis de la herida y la fístula de LCR fueron las principales complicaciones con 13,7 % (7) y 9,8 % (5). En el transoperatorio se encontró la compresión vascular en el 60,3 % (31), siempre relacionado con arteria cerebelosa superior. El 88 % (45) de los pacientes operados no presentaron recidiva.

CONCLUSIONES: La MDV es efectiva, tanto, para aliviar el dolor, como para preservar las estructuras y funciones neurales, con una mínima aparición de recidivas.

Palabras clave

Descompresión Microvascular; Enfoque retrosigmoideo; Neuralgia del trigémino; Pronóstico

Referencias

Wen KZ, Ting ZS, Gong YZ, Li P. Microvascular decompression by retrosigmoid approach for trigeminal neuralgia: experience in 200 patients. Ann Otol Rhinol Laryngol. 1990;99:129-30.

Alberione F, Arena A, Matera R. Descompresiva microvascular en la neuralgia del trigémino: factores pronósticos. Neurocirugía. 2008;19:242-7.

Al-Quliti KW. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options. Neurosciences (Riyadh, Saudi Arabia). 2015;20(2):107-14.

Spina A, Mortini P, Alemanno F, Houdayer E, Iannaccone S. Trigeminal Neuralgia: Toward a Multimodal Approach. World Neurosurg. 2017;103:220-30.

Hitchon PW, Holland M, Noeller J, Smith MC, Moritani T, Jerath N, et al. Clin Neurol Neurosurg. 2016 Oct;149:166-70. doi: 10.1016/j.clineuro.2016.08.016.

Komatsu F, Imai M, Hirayama A, Hotta K, Hayashi N, Oda S, et al. Endoscopic Microvascular Decompression with Transposition for Trigeminal Neuralgia and Hemifacial Spasm: Technical Note. J Neurol Surg A Cent Eur Neurosurg. 2017 May;78(3):291-295. doi: 10.1055/s-0036-1592077.

Piazza M, Lee JY. Endoscopic and Microscopic Microvascular Decompression. Neurosurg Clin N Am. 2016 Jul;27(3):305-13. doi: 10.1016/j.nec.2016.02.008.

Khan SA, Khan B, Khan AA, Afridi EA, Mehmood S, Muhammad G, et al. Microvascular decompression for trigeminal neuralgia. J Ayub Med Coll Abbottabad. 2015 Jul-Sep;27(3):539-42.

Sandoval-Balanzario M, Alvarez-Vazquez L, Santos-Franco JA. Manejo invasivo de la neuralgia del trigémino. Experiencia de 8 años. Revista médica del Instituto Mexicano del Seguro Social. 2015;53 Suppl 1:S80-7. http://www.redalyc.org/articulo.oa?id=457744941013

Bohman LE, Pierce J, Stephen JH, Sandhu S, Lee JY. Fully endoscopic microvascular decompression for trigeminal neuralgia: technique review and early outcomes. Neurosurg Focus. 2014;37(4):E18. doi: 10.3171/2014.7.FOCUS14318.

Masuoka J, Matsushima T, Kawashima M, Nakahara Y, Funaki T, Mineta T. Stitched sling retraction technique for microvascular decompression: procedures and techniques based on anatomical viewpoint. Neurosurg Rev. 2011;34:373-80.

Mistry AM, Niesner KJ, Lake WB, Forbes JA, Shannon CN, Kasl RA, et al. Neurovascular Compression at the Root Entry Zone Correlates with Trigeminal Neuralgia and Early Microvascular Decompression Outcome. World Neurosurg. 2016;95:208-13.

Zhong J, Zhu J, Sun H, Dou NN, Wang YN, Ying TT, et al. Microvascular decompression surgery: surgical principles and technical nuances based on 4000 cases. Neurol Res. 2014 Oct;36(10):882-93. doi: 10.1179/1743132814Y.0000000344.

Sade B, Lee JH. Microvascular decompression for trigeminal neuralgia. Neurosurg Clin N Am. 2014 Oct;25(4):743-9. doi: 10.1016/j.nec.2014.06.007.

Barba D, Alksne JF. Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia. J Neurosurg. 1984;60:104.

Sweet WH. The history of the development of treatment for trigeminal neuralgia. Clin Neurosurg. 1985; 32: 293.

Gardner WJ, Dava GA. Hemifacial Spasm. A reversible pathophysiologic state. J. Neurosurg. 1962;19:240-7.

Hodaie M, Coello AF. Advances in the management of trigeminal neuralgia. J Neurosurg Sci. 2013 Mar;57(1):13-21.

Lundsford LD, Apfelbaum RI. Choice of surgical therapeutic modalities for treatment of trigeminal neuralgia. Clin Neurosurg. 1985; 32: 319.

Jannetta PJ. Trigeminal disorders: supralateral exposure of the trigeminal nerve in the cerebellopontine angle for microvascular decompression. In Apuzzo MLJ, ed. Brain surgery: complication avoidance and management. New York: Churchill Livingstone; 1993. p. 2085.

Jannetta PJ. Microvascular decompression for trigeminal neuralgia. Surg Rounds. 1983;6:24.

Jannetta PJ. Treatment of trigeminal neuralgia by suboccipital and transtentorial cranial operations. Clin Neurosurg. 1977;24:538.

Jannetta PJ. Structural mechanisms of trigeminal neuralgia. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg. 1967;26:158.

Martínez JE, Camblor L, Salva S. Termocoagulación gasseriana por radiofrecuencia en 825 pacientes con neuralgia trigeminal. Rev Soc Esp Dolor. 2006; 1: 24-8.

Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders. Cephalalgia. 2004; 24(suppl1):1-150.

de Coo I, van Dijk JM, Metzemaekers JD, Haan J. A Case Report About Cluster-Tic Syndrome Due to Venous Compression of the Trigeminal Nerve. Headache. 2017;57(4):654-7.

Dandy WE. Concerning the cause of trigeminal neuralgia. Am J Surg. 1934;24:447.

Dandy WE. Section of the sensory root of the trigeminal nerve at the pons: preliminary report of the operative procedure. John Hopkins Med J. 1925;36:105.

Wepsic JG. Tic douloureux: etiology, refined treatment. N Engl J Med. 1973;288:680.

Katusic S, Beard CM, Bergstralh E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnessota, 1945-1984. Ann Neurol. 1990 Jan;27(1):89-95.

Molina-Foncea E, Garcia-Navarrete LC, Calvo RGS. La descompresión microvascular en el tratamiento de la neuralgia esencial del trigémino. Rev Neurol. 1998; 27(155):65-70.

Bullit E, Tew JM, Boyd J. Intracranial tumors in patients with facial pain. J Neurosurg. 1986;64:865.

Sweet WH, Poletti CE, Macon JB. Treatment of trigeminal neuralgia and other facial pains by the retrogasserian injection of glycerol. Neurosurgery. 1981;9:647.

Apfelbaum RI. Microvascular decompression for tic douloureux: results. In Blackmann DE, ed. Neurological surgery of the ear and skull base. New York: Raven Press; 1982. p. 175.

Thomas KL, Vilensky JA. The anatomy of vascular compression in trigeminal neuralgia. Clin Anat. 2014 Jan;27(1):89-93. doi: 10.1002/ca.22157.

Shibahashi K, Morita A, Kimura T. Surgical results of microvascular decompression procedures and patient's postoperative quality of life: review of 139 cases. Neurologia medico-chirurgica. 2013;53(6):360-4.

Tanrikulu L, Hastreiter P, Bassemir T, Bischoff B, Buchfelder M, Dorfler A, et al. New Clinical and Morphologic Aspects in Trigeminal Neuralgia. World Neurosurg. 2016;92:189-96.

Apfelbaum RI. Surgery for tic douloureux. Clin Neurosurg. 1983;31:351.

Sweet WH. The treatment of trigeminal neuralgia (Tic Doloureux). N Engl J Med. 1986;315:174.

Barba D, Alksne JF. Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia. J Neurosurg. 1984;60:104-7.

Carballal CF, Salazar GF, Calvo JP, Leal RG, Gutiérrez FA, Carrillo R. Management of recurrent trigeminal neuralgia after failed microvascular decompression. Neurocirugía. 2004; 15: 345-52.

Boto GR. Neuralgia del trigémino. Neurocirugía. 2010;21:361-72.

Dumot C, Brinzeu A, Berthiller J, Sindou M. Trigeminal neuralgia due to venous neurovascular conflicts: outcome after microvascular decompression in a series of 55 consecutive patients. Acta neurochirurgica. 2017;159(2):237-49.

Jannetta PJ, Mclaughlin MR, Casey KF. Technique of microvascular decompression. Neurosurg Focus. 2005 May 15;18(5):E5.

Tyler-Kabara EC, Kassam AB, Horowitz MH, et al. Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J Neurosurg. 2002;96:527-53.

Miller J. Burchiel KJ. Microvascular Decompression for Trigeminal Neuralgia. In Winn HR, ed. Youmans Neurological Surgery. 6 e. Philadelphia, WB. Saunders; 2011. p. 1795-801.

Obata Y, Kawano Y, Tanaka Y, Maehara T. Prognostic Impact and Post-operative Evaluation of Volumetric Measurement of the Cerebellopontine Cistern in Trigeminal Neuralgia Using 3 Tesla Magnetic Resonance Imaging. Neurol Med Chir (Tokyo). 2017 Nov 14. doi: 10.2176/nmc.oa.2017-0157.

Yadav YR, Nishtha Y, Sonjjay P, Vijay P, Shailendra R, Yatin K. Trigeminal Neuralgia. Asian J Neurosurg. 2017 Oct-Dec;12(4):585-597. doi: 10.4103/ajns.AJNS_67_14.

Xu W, Jiang C, Yu C, Liang W. Percutaneous balloon compression for persistent or recurrent trigeminal neuralgia after microvascular decompression: personal experience of 28 patients. Acta Neurol Belg. 2017 Nov 6. doi: 10.1007/s13760-017-0858-8.

Mizobuchi Y, Ohtani M, Satomi J, Fushimi K, Matsuda S, Nagahiro S. The Current Status of Microvascular Decompression for the Treatment of Trigeminal Neuralgia in Japan: An Analysis of 1619 Patients Using the Japanese Diagnosis Procedure Combination Database. Neurol Med Chir (Tokyo). 2017 Nov 2. doi: 10.2176/nmc.oa.2017-0100.

Jiao Y, Yan Z, Che S, Wang C, Wang J, Wang X, et al. Improved Microvascular Decompression in Treating Trigeminal Neuralgia: Application of Nest-Shaped Teflon Fibers. World Neurosurg. 2017 Sep 28. pii: S1878-8750(17)31654-6. doi: 10.1016/j.wneu.2017.09.138.

Kato K, Ujiie H, Nakano H, Nomura S, Nakagawa M, Higa T, et al. Application of Ion-beam Implanted Expanded Polytetrafluoroethylene to Microvascular Decompression and the Surgical Outcome. Neurol Med Chir (Tokyo). 2017 Nov 15;57(11):601-606. doi: 10.2176/nmc.oa.2017-0007.

Kemeny AA. Long-term outcomes of microvascular decompression and Gamma Knife surgery for trigeminal neuralgia: a retrospective comparison study. Acta Neurochir (Wien). 2017 Nov;159(11):2137. doi: 10.1007/s00701-017-3326-6.

Cheng J, Long J, Hui X, Lei D, Zhang H. Effects of microvascular decompression on depression and anxiety in trigeminal neuralgia: A prospective cohort study focused on risk factors and prognosis. Clin Neurol Neurosurg. 2017 Oct;161:59-64. doi: 10.1016/j.clineuro.2017.08.011.

Gonzalez-Quarante LH, Ruiz-Juretschke F, Agarwal V, Garcia-Leal R. Microvascular Decompression for Trigeminal Neuralgia Using a Novel Fenestrated Clip and Tentorial Flap Technique. World Neurosurg. 2017 Oct;106:775-784. doi: 10.1016/j.wneu.2017.07.110.

Zhu J, Zhang X, Zhao H, Tang YD, Ying TT, Li ST. Utility of Brainstem Trigeminal Evoked Potentials in Patients with Primary Trigeminal Neuralgia Treated by Microvascular Decompression. J Craniofac Surg. 2017 Sep;28(6):e571-e577. doi: 10.1097/SCS.0000000000003882.



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