Flat posterior cranial fossa affects outcomes of microvascular decompression for trigeminal neuralgia.

Flat posterior cranial fossa affects outcomes of microvascular decompression for trigeminal neuralgia.

World Neurosurg. 2017 Dec 27;:

Authors: Fukuoka T, Nishimura Y, Hara M, Nomura K, Ryu H, Yoshikawa S, Wakabayashi T

Abstract
OBJECTIVE: The aim of this study was to investigate prognostic factors for microvascular decompression (MVD) in patients with primary trigeminal neuralgia (TN), with a particular focus on the morphology of the posterior cranial fossa (PCF).
METHODS: The present study investigated 126 surgically treated primary TN patients with more than 1-year follow-up who underwent high-resolution magnetic resonance imaging between April 2003 and September 2015. We retrospectively reviewed clinical information and operative findings. Outcomes of MVD were also evaluated and patients were classified into "success" and "failure" groups. Furthermore, length, width, and height of the PCF were measured by approximation to an ellipsoid with reference to the anterior commissure-posterior commissure line. These values were compared between groups.
RESULTS: Atypical type-2 TN (P<0.001) and weak neurovascular compression (NVC) (P<0.001) correlated significantly with poor outcomes of MVD for primary TN. In terms of PCF morphology, the failure group showed a flatter PCF than the success group, while sex, age, affected side, topography of facial pain, interval between onset and surgery, responsible vessel, location of compression along the nerve, and site of compression around the circumference of the nerve root did not significantly affect outcomes of MVD for primary TN.
CONCLUSIONS: The present study identified type-2 TN, weak NVC, and flatness of the PCF as predictors of poor prognosis after MVD for primary TN.

PMID: 29288851 [PubMed - as supplied by publisher]

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