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Vol. 27. Num. 6.November - December 2016Pages 263-316
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Vol. 27. Num. 6.November - December 2016Pages 263-316
Case report
DOI: 10.1016/j.neucir.2016.05.003
Microvascular decompression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia. Case report, literature review, and pooled case analysis
Descompresión microvascular para la neuralgia del trigémino secundaria a dolicoectasia vertebrobasilar. Caso clínico, revisión de la literatura, de casos y análisis de casos agrupados
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Ignacio Arrese
Corresponding author
iarrese14@yahoo.es

Corresponding author.
, Rosario Sarabia
Unit of Vascular Neurosurgery, Hospital Universitario Río Hortega, Valladolid, Spain
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Table 1. F/M, female/male ratio. BA/VA, basilar artery/vertebral artery ratio of offending vessel.
Abstract
Introduction

Vertebrobasilar dolichoectasia is a condition in which there is elongation and dilatation of the vertebral and basilar arteries. Few studies have been reported that focus on cases of trigeminal neuralgia (TN) secondary to vertebrobasilar dolichoectasia (VD) and treated by microvascular decompression (MD).

Patients and methods

A case is presented of trigeminal neuralgia caused by vertebral artery compression. An analysis of the microsurgical technique, as well as a systematic review of the literature about this uncommon nerve compression is performed, in order to investigate, by pooled case analysis, if MD is a good option for this type of patient.

Results

A total of 7 studies were included for analysis, to which the present case was added, making a total of 56 patents. There were excellent results in 53 cases, and partial recovery in 3, with a mean follow up of 54 months. No major complications were found.

Discussion

The good clinical results and absence of postoperative mortality or severe morbidity in our pooled case series lead us to recommend MD as the preferred treatment for TN caused by VD in patients in whom major surgery is not contraindicated.

Keywords:
Microvascular decompression
Trigeminal neuralgia
Vertebrobasilar dolichoectasia
Resumen
Introducción

La dolicoectasia vertebrobasilar se caracteriza por la elongación y dilatación de las arterias vertebral y basilar. Muy pocos estudios se han enfocado a casos de neuralgia del trigémino secundaria a dolicoectasia vertebrobasilar tratada mediante descompresión microvascular.

Pacientes y métodos

Presentamos un caso de neuralgia del trigémino causada por compresión de la arteria vertebral. Se realiza un análisis de la técnica quirúrgica así como una revisión sistemática de la literatura sobre este tipo de compresión poco común, con el fin de hacer un análisis de los casos para evaluar si la descompresión microvascular es una buena opción terapéutica.

Resultados

Seleccionamos 7 estudios que fueron incluidos en el análisis a los que añadimos nuestro caso, contando con un total de 56 pacientes. Se obtuvieron excelentes resultados en 53 casos y mejoría parcial en 3 con una media de seguimiento de 54 meses. No se encontraron complicaciones severas.

Discusión

Los buenos resultados clínicos y la ausencia de morbimortalidad severa postoperatoria encontrados en nuestro estudio nos conducen a recomendar la descompresión microvascular como tratamiento de elección para pacientes con neuralgia del trigémino secundaria a compresión por dolicoectasia vertebrobasilar en pacientes en los que la cirugía mayor no esté contraindicada.

Palabras clave:
Descompresión microvascular
Neuralgia del trigémino
Dolicoectasia vertebrobasilar

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