SciELO - Scientific Electronic Library Online

 
vol.41 issue4Contraceptive methods and epilepsy author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.41 no.4 São Paulo Dec. 1983

https://doi.org/10.1590/S0004-282X1983000400001 

Descompressão neurovascular na nevralgia do trigêmeo: análise de 70 casos

 

Neurovascular decompression in trigeminal neuralgia. Analysis of 70 cases

 

 

Paulo Niemeyer Filho

Chefe de Clínica. Escola Paulista de Medicina

 

 


RESUMO

Analisamos os achados cirúrgicos e os resultados obtidos com a técnica da descompressão neurovascular microcirúrgica, no tratamento de 70 pacientes com nevralgia essencial do trigêmeo. Com exceção de 3 casos, encontramos vasos em contato ou comprimindo a raiz do trigêmeo em todos os demais pacientes, sendo as artérias responsáveis pela dor em 73% dos casos. Observamos que os resultados melhoram com a experiência cirúrgica adquirida, sendo de 73,91% os resultados excelentes obtidos no primeiro grupo de 23 pacientes, e de 95,74% nos dois últimos grupos. Apenas 3 pacientes foram perdidos no follow-up que variou de 2 meses a 4 anos, ocorrendo a recidiva da dor em 4 pacientes. Não houve complicações importantes, com exceção de um óbito por hemorragia digestiva. Ressaltamos a importância deste método cirúrgico, quando comparado aos demais, pela possibilidade de preservação da sensibilidade da face, e concluimos que, por se tratar de um procedimento seguro em mãos experientes, deve ser o tratamento de eleição dos pacientes com nevralgia do trigêmeo que se encontrem em bom estado clínico geral.


SUMMARY

This paper analyses the surgical findings and results obtained with the neurovascular decompression tecnique in the treatment of 70 patients with essential trigeminal neuralgia. Except for 3 patients in whom nothing was found, vessels were seen touching or compressing the nerve root in all the other patients, being the arteries responsable for the pain in 73% of the cases. The surgical results improved with the increased familiarity of the tecnique, being of 73% the excellent results obtained in the first group of 23 patients, and 95% in the remaining two groups. Only 3 patients were lost in the follow-up which ranged from 2 months to 4 years. Recurrences occurred in 4 patients. There were no important complications except for a death from a post-operative gastrointestinal hemorrhage. Our results and those published in the literature confirm that neurovascular decompression is a safe procedure in experienced hands, and that it should be the chosen method in the treatment of trigeminal neuralgia in order to preserve the sensibility of the face.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

REFERÊNCIAS

1. ALKSNE, J. F. - Microsurgical vascular decompression of cranial nerves. Am. J. Surg. 140:156, 1980.         [ Links ]

2. ALMEIDA, G. M.; TEIXEIRA, M. J. & SALLES, A. F. Y. - Espasmo hemifacial. Tratamento microcirúrgico. Arq. bras. Neurocirurg. 1:89, 1982.         [ Links ]

3. APFELBAUM, R. I. - A comparison of percutaneous radiofrequency trigeminal neurolysis and microvascular decompression of the trigeminal nerve for the treatment of tic douloureaux. Neurosurgery 1:16, 1977.         [ Links ]

4. BREEZE, R. & IGNELZI, R. J. - Microvascular decompression for trigeminal neuralgia. J. Neurosurg. 57:487, 1982.         [ Links ]

5. BURCHIEL, K. J.; STEEGE, T. D.; HOWE, J. F. & LOESER, J. D. - Comparison of percutaneous radiofrequency gangliolysis and microvascular decompression for the surgical management of tic douloureaux. Neurosurgery 9:111, 1981.         [ Links ]

6. CONCHA, S. G.; LEMP, M. & YAÑES, A. - Experiência con la técnica de descompresion vascular en la neuralgia «esencial» del trigêmeo. In: Congresso Latino-americano de Neurocirurgia, 18º, Buenos Aires. Actas. Buenos Aires, 1979, pg. 195.         [ Links ]

7. DANDY, W. E. - Concerning the cause of trigeminal neuralgia. Am. J. Surg. 24:447, 1934.         [ Links ]

8. DANDY, W. E. - Operation for cure of tic douloureaux; partial section of the sensory root at the pons. Arch. Surg. 18:687, 1929.         [ Links ]

9. DANDY, W. E. - Section of the sensory root of the trigeminal nerve at the poons. Bull. Johns Hopkins Hosp. 36:105, 1925.         [ Links ]

10. DANDY, W. E. - Treatment of trigeminal neuralgia by the cerebellar route. Ann. Surg. 96:787, 1932.         [ Links ]

11. DENGLER, R. & STRUPPLER, A. - Neurophysiological diagnosis of trigeminal nerve function. In: Samii, M. & Jannetta, P. J. (eds.): The Cranial Nerves. Springer-Verlag, Berlin, 1981, pg. 302.         [ Links ]

12. FEGURSON, G. G.; BRETT, D. C; PEERLESS, S. J.; BARR, H. W. K. & GIRVIN, J. P. - Trigeminal neuralgia: comparison of the results of percutaneous rhizotomy and microvascular decompression. Can. J. neurol. Sci. 8:207, 1981.         [ Links ]

13. GARDNER, W. J. - Concerning the mechanism of trigeminal neuralgia and hemifacial spasm. J. Neurosurg. 19:947, 1962.         [ Links ]

14. GARDNER, W. J. - Trigeminal neuralgia. Clin. Neurosurg. 15:1, 1968.         [ Links ]

15. HAINES, S. J.; JANNETTA, P. J. & ZORUB, D. S. - Microvascular relations of the trigeminal nerve. An anatomical study with clinical correlation. J. Neurosurg. 52:381, 1980.         [ Links ]

16. HANKINSON, H. L. & WILSON, C. B. - Microsurgical treatment of hemifacial spasm. West J. Med. 124:191, 1976.         [ Links ]

17. HARDY, D. G. & RHOTON Jr, A. L. - Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve. J. Neurosurg. 49:669, 1978.         [ Links ]

18. JANNETTA, P. J. - Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J. Neurosurg. 26:159, 1967.         [ Links ]

19. JANNETTA, P. J. - Complications from microsurgical treatment of tic doulou-reaux. J. Neurosurg. 40:675, 1974.         [ Links ]

20. JANNETTA, P. J. - Cranial nerve vascular compression syndromes (other than tic douloureaux and hemifacial spasm). Clin. Neurosurg. 28:445, 1981.         [ Links ]

21. JANNETTA, P. J. - Microsurgery of cranial nerve cross - compression. Clin. Neurosurg. 26:607, 1979.         [ Links ]

22. JANNETTA, P. J. - Microsurgical approach to the trigeminal nerve for tic doulouleaux. Progr. Neurol. Surg. 8:180, 1976.         [ Links ]

23. JANNETTA, P. J. - Microsurgical exploration and decompression of the facial nerve in hemifacial spasm. Curr. Top Surg. Res. 2:217, 1970.         [ Links ]

24. JANNETTA, P. J. - Neurovascular cross-compression of the eighth cranial nerve in patient with vertigo and tinnitus. In: Samii, M. & Jannetta, P. J. (eds.): The Cranial Nerves. Springer-Verlag, Berlin, 1981, pg. 552.         [ Links ]

25. JANNETTA, P. J. - Vascular decompression in trigeminal neuralgia. In: Samii, M. & Jannetta, P. J. (eds.): The Cranial Nerves. Springer-Verlag, Berlin, 1981, pg. 331.         [ Links ]

26. KELLER, J. T. & TEW, J. - The treatment of trigeminal neuralgia by percutaneous radiofrequency technique. Clin. Neurosurg. 24:557, 1977.         [ Links ]

27. KIMURA, J.; RODNITZKY, R. L. & VAN ALLEN, M. L. - Electrophysiological study of trigeminal nerve. Neurology (Minneapolis) 20:574, 1970.         [ Links ]

28. LAHA, R. K. & JANNETTA, P. J. - Glossopharyngeal neuralgia. J. Neurosurg. 47:316, 1977.         [ Links ]

29. MAROON, J. C. - Hemifacial spasm: a vascular cause. Arch. Neurol. 35:481, 1978.         [ Links ]

30. MOTTA, P.; SOUZA, M. T. K. & SEUGUOTA, R. P. - Radiofrequência - Termocoagulação no tratamento da nevralgia do trigêmeo. Análise de 100 casos. Arq. Neuro-Psiquiat. (São Paulo) 38:33, 1980.         [ Links ]

31. NIEMEYER FILHO, P. - Microcirurgia do trigêmeo. Medicina de Hoje 6:478, 1980.         [ Links ]

32. NIEMEYER FILHO, P. - Tratamento cirúrgico da nevralgia do trigêmeo, com preservação da sensibilidade. Arq. Neuro-Psiquiat. (São Paulo) 38:1, 1980.         [ Links ]

33. OLIVECRONA, H. - Cholesteatomas of the cerebellopontine angle. Acta Psychiat. (Kbh.) 24:639, 1949.         [ Links ]

34. PETTY, P. G. & SOUTHBY, R. - Vascular compression of lower cranial nerves: observations using microsurgery, with particular reference to trigeminal neuralgia. Aust. N.Z. J. Surg. 47:314, 1977.         [ Links ]

35. POST, K. D.; GITTINGLER, J. W. & STEIN, B. M. - Visual improvement after surgical manipulation of dolicoectatic anterior cerebral arteries. Surg. Neurol. 15:321, 1981.         [ Links ]

36. RAND, R. W. - Gardner neurovascular decompression of the trigeminal and facial nerves for tic douloureaux and hemifacial spasm. Surg. Neurol. 16:329, 1981.         [ Links ]

37. RAND, R. W. - Microneurosurgical treatment of trigeminal neuralgia. In: Congresso Latinoamericano de Neurocirurgia, 18º, Buenos Aires, Actas. Buenos Aires, 1979, pg. 223.         [ Links ]

38. RAND, R. W. - Microsurgical operations in trigeminal and glossopharyngeal neuralgia. Microneurosurgery (2ª ed.). Mosby, St. Louis, 1978, pg. 239.         [ Links ]

39. REVILLA, G. A. - Neurinomas of cerebellopontine recess: clinical study of one hundred and sixty cases including operative mortality and end results. Bull. Hopk. Hosp. 80:254, 1947.         [ Links ]

40. REVILLA, G. A. - Tic douloureaux and its relationship to tumors of the posterior fossa: analysis of twenty-four cases. J. Neurosurg. 4:233, 1947.         [ Links ]

41. RHOTON, A. L. Jr. - Microsurgical anatomy of sellar region and cavernous sinus. Clin. Neurosurg. 24:54, 1978.         [ Links ]

42. RHOTON, A. L. Jr. - Microsurgical neurovascular decompression for trigeminal neuralgia and hemifacial spasm. J. Fla. med. Ass., 65:425, 1978.         [ Links ]

43. RHOTON, A. L. Jr.; MANISCALCO, J. E.; HOAGLAND, H. V. & CHOVART, B. D. - Percutaneous stereotaxic radiofrequency lesions for trigeminal neuralgia. J. Fla. med. Ass. 64:488, 1977.         [ Links ]

44. SAMII, M. & OHLEMUTZ, A. - Early experiences in vascular decompression for vestibulo-cochlear malfunction. In: Samii, M. & Jannetta, P. J. (eds.): The Cranial Nerves. Springer-Verlag, Berlin, 1981, pg. 556.         [ Links ]

45. STENDER, A. - Gangliolysis for the surgical treatment of trigeminal neuralgia. J. Neurosurg. 11:333, 1954.         [ Links ]

46. STENDER, A. - The mecanism of action of the so-colled decompressive operations in tic douloureaux. Trigeminal neuralgia. In: Hassler, R. & Walker, E. (eds.): Trigeminal neurologic. Georg Thieme Verlag, Stuttgart, 1970, pg. 26.         [ Links ]

47. STOWSAND, D.; MARKAKIS, E. & LAUBNER, P. - Zur electrocoagulation des Ganglion Gasseri bei idiopathischen Trigeminus-neuralgie. Nervenarzt. 44:44, 1973.         [ Links ]

48. SWEET, W. H. - Treatment of facial pain by percutaneous differential thermal trigeminal rhizotomy. Prog. Neurol. Surg. 7:153, 1976.         [ Links ]

49. SWEET, W. H. & WEPSIC, J. G. - Controlled thermocoagulation of trigeminal ganglion and rootles for differencial destruction of pain fibers. J. Neurosurg. 39:143, 1974.         [ Links ]

50. TAARNHOJ, P. - Descompression of the posterior trigeminal root in trigeminal neuralgia. A 30 year follow-up review. J. Neurosurg. 57:14, 1982.         [ Links ]

51. TARLOV, I. M. - Structure of the nerve root: 1-nature of the junction between the central and peripheral nervous system. Arch. Neurol. Psychiat. (Chicago) 37:555, 1937.         [ Links ]

52. TARLOV, I. M. - Structure of the nerve root: 2-differentiation of sensory from motor roots; observations on identification of function in roots of mixed cranial nerves. Arch. Neurol. Psychiat. (Chicago) 37:1338, 1937.         [ Links ]

53. VELASCO-SILES, J. M.; OVAXNINE, G. E.; MOHR, G.; NEGRO, P. M. & HARDY, J. - Bilateral trigeminal neuralgia. Surg. Neurol. 16:106, 1981.         [ Links ]

54. WAGA, S.; MORIKAWA, A. & KOJIMA, T. - Trigeminal neuralgia, compression of the trigeminal nerve by an elongated and dilated basilar artery. Surg. Neurol. 11:13, 1979.         [ Links ]

55. WEIDMANN, M. J. - Trigeminal neuralgia. Surgical treatment by microvascular decompression of the trigeminal root. Med. J. Aust. 2:628, 1979.         [ Links ]

56. WILSON, C. B.; YORKE, C. & PRIOLEAU, G. - Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm. West. J. Med. 132:481, 1980.         [ Links ]

 

 

Parte da Tese de Doutorado em Neurocirurgia apresentada à Escola Paulista de Medicina. Orientador: Prof. Aloysio de Mattos Pimenta. Trabalho do Instituto de Neurocirurgia da Santa Casa da Misericórdia do Rio de Janeiro (Diretor: Dr. Paulo Niemeyer).
Instituto de Neurocirurgia - Santa Casa da Misericórdia - Rua Santa Luzia, 206 - 20.020 Rio de Janeiro, R.J. - Brasil.

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License