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microvascular_decompression

Microvascular decompression (MVD)

Microvascular decompression (MVD) for neurovascular compression syndromes, such as trigeminal neuralgia and hemifacial spasm, has been traditionally described as an interposing technique using Teflon. Some alternative interposing materials have been proposed. In addition, transposing techniques have been increasingly reported as an alternative with a potentially lower recurrence rate and fewer complications. 1).

Indications

see Microvascular decompression for hemifacial spasm

see Microvascular decompression for trigeminal neuralgia

see Microvascular decompression for glossopharyngeal neuralgia.

Bartek et al., conducted a retrospective review of 98 adult patients (≥16 years) treated with MVD between 1 January 1994 and 1 June 2013. Adverse events occurring within 30 days were classified according to the Landriel Ibañez classification for neurosurgical complications: grade I represents any non-life threatening complication treated without invasive procedures; grade II is complications requiring invasive management; grade III is life-threatening adverse events requiring treatment in an intensive care unit (ICU); grade IV is death as a result of complications. We sought to compare our results with reports from the literature.

Patients' median age was 61 years (range 26-83), and 64 (65 %) were females. Indications for MVD were trigeminal neuralgia (n = 77, 79 %), glossopharyngeal neuralgia (n = 4, 4 %), hemifacial spasm (n = 16, 16 %) and combined trigeminal neuralgia and hemifacial spasm (n = 1, 1 %). The overall 30-day complication rate was 20 %, with 14 % grade I complications, 5 % grade II complications and 1 % grade III complications. The comparison with the literature was hampered by the diverse and unsystematic way of reporting complications.

They provide a standardized report of postoperative complications in a consecutive patient series undergoing MVD. Due to the heterogeneous and non-standardized reporting of complications in the literature, it is difficult to know if the 20 % complication rate is low or high. Standardized reporting is a necessity for meaningful and more valid comparisons across studies. The safety of MVD, a fairly standardized neurosurgical procedure, is well suited for comparisons across centers provided that complications are reported in a standardized manner 2).

1)
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. Epub 2017 Jul 25. PubMed PMID: 28754638.
2)
Bartek J Jr, Gulati S, Unsgård G, Weber C, Förander P, Solheim O, Jakola AS. Standardized reporting of adverse events after microvascular decompression of cranial nerves; a population-based single-institution consecutive series. Acta Neurochir (Wien). 2016 Sep;158(9):1775-81. doi: 10.1007/s00701-016-2856-7. Epub 2016 Jun 4. PubMed PMID: 27260489.
microvascular_decompression.txt · Last modified: 2017/11/08 14:49 by administrador