Hellow guys, Welcome to Utubetrends, and you are watching Microvascular Decompression for Trigeminal Neuralgia in an elderly patient with "Tentorial Sling". and this vIdeo is uploaded by Vitaly Siomin at 2020-04-30T20:59:49-07:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | Microvascular Decompression for Trigeminal Neuralgia in an elderly patient with "Tentorial Sling" |
| Video Uploader | Video From Vitaly Siomin |
| Upload Date | This Video Uploaded At 01-05-2020 03:59:49 |
| Video Discription | Trigeminal neuralgia (TN) is a relatively common facial pain syndrome characterized by episodes of an "electric shock" - like or lancinating pain, that occurs in the distribution of the trigeminal nerve branches. It usually affects one side, but can be bilateral, especially in patients with multiple sclerosis. The pain can be triggered by various stimuli, including chewing, cold air, tooth brushing and others. The most common cause is compression of the trigeminal nerve by a loop of the superior cerebellar artery. Repeat pulsation of the artery against the nerve cal lead to the nerve damage and pain. Although the diagnosis of TN is clinical, it is important to obtain baseline neuroimaging studies to rule out less common causes, such as posterior fossa tumor, or multiple sclerosis. Medical treatment is very effective... initially. About 70% of the patients report acceptable pain relief. However, the majority eventually fail and will need a procedure. The main cause of failure is development of tolerance to medications, which requires increased doses. Side effects of medications can very significant, especially in older patients and may include sleepiness, low levels of energy, "mental slowness", cognitive decline balance problems, etc. Non-medical options include percutaneous techniques, such as glycerol injections, balloon compression, stereotactic radiosurgery SRS and motor cortex stimulation in refractory cases. Microvascular decompression (MVD) is a relatively minimally invasive procedure, performed through a "small craniotomy". It was introduced by Dr. Peter Jannetta in the late 1960's. MVD can help to achieve the highest levels of long-term patient satisfaction compared to other treatments. The immediate success rate is 80-90%, which decreases to about 70% over 5 years after surgery. It appears to be safe even in elderly patients, provided that they are fit to tolerate a small craniotomy. The risks include less than 1% mortality, about 5% chance of hearing loss, 2% risk of cerebrospinal-spinal fluid leak. The risk of facial sensory loss after MVD is smaller than after percutaneous procedures. This case illustrates a recently introduced "tentorial sling" technique. The offending artery is mobilized completely away from the nerve and suspended on the sling, which is anchored with a small aneurysm clip. This technique eliminates the need to place a foreign body (e.g. Teflon felt), between the artery and the nerve and may potentially decrease the risk of granuloma formation. This case is also interesting because in addition to the arterial compression, we discovered trigeminal vein compressing the nerve more distally. To achieve venous decompression we had to utilize the traditional Teflon felt placement between the vein and the nerve. An importance of meticulous inspection of the trigeminal nerve along its entire course is emphasized. |
| Category | Education |
| Tags | MVD | trigeminal neuralgia | microvascular | decompression | sling | tentorial | trigeminal nerve | facial pain | superior cerebellar artery | arterial | venous | compression | elderly | microsurgery | craniotomy |
.png){kind=logo}
