title: Is There a Safe and Effective Way to Treat Trigeminal Neuralgia Associated with Vertebrobasilar Dolichoectasia? Presentation of 8 Cases and Literature Review.
abstract: OBJECTIVE
  Surgical treatment of trigeminal neuralgia (TN) associated with vertebrobasilar dolichoectasia is challenging. We analyze the treatments for this disease, discussing the advantages and drawbacks, and present our own technique and series.
  
  
  METHODS
  This retrospective study covered the period January 2006 through January 2016. Vertebrobasilar dolichoectasia deviation from midline, basilar artery (BA) and vertebral artery diameter, and BA apex distance above the posterior clinoid process were measured on preoperative and postoperative magnetic resonance imaging. The BA was repositioned and kept in place with coagulation of the clival dura, Teflon pledgets, and fibrin glue. We also performed a thorough literature review using PubMed.
  
  
  RESULTS
  Our cases included 5 men and 3 women with mean age 64.88 years ± 10.32 (range, 48-81 years); 7 cases were TN, and 1 case was painful tic convulsif. Pain was on the left side in 6 cases and on the right in 2 cases. All cases affected cranial nerve V2and/or V3divisions. Both V2and V3were affected in 4 cases, V3was affected in 3 cases, and V2was affected in 1 case. Hypertension was present in 5 cases. TN disappeared postoperatively in all cases. One patient took clonazepam 2 mg/24 hours for 3 months because of facial dysesthesia. Postoperative complications included hearing loss in 1 patient; facial paresis plus diplopia in 1 patient, which resolved in 3 months; and arterial hypertension. Postoperative arterial hypertension improved in all affected patients, although only 2 patients discontinued antihypertensive medications. Mean follow-up time was 56.50 months ± 40.08 (range, 14 months to 9 years 9 months). No patient showed pain recurrence.
  
  
  CONCLUSIONS
  TN associated with vertebrobasilar dolichoectasia can be treated surgically with minimal morbidity. BA repositioning has the highest success rate. Our technique of inducing a dural scar to fix the BA in its new position away from the trigeminal nerve is simple, not technically demanding, and highly effective.
authors: Department of Neurosurgery, Hospital General Universitario de Valencia, Valencia, Spain. Electronic address: vvanaclo@hotmail.com.
authors: Vicente
authors: V
authors: Vanaclocha
authors: Department of Neurosurgery, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Juan Manuel
authors: JM
authors: Herrera
authors: Department of Neurosurgery, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Deborah
authors: D
authors: Martínez-Gómez
authors: Department of Neurosurgery, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Marlon
authors: M
authors: Rivera-Paz
authors: Department of Radiology, Hospital General Universitario de Valencia, Valencia, Spain.
authors: Cristina
authors: C
authors: Calabuig-Bayo
authors: Medical School, University College London, London, United Kingdom.
authors: Leyre
authors: L
authors: Vanaclocha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D061145:Microvascular Decompression Surgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D014277:Trigeminal Neuralgia / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D014715:Vertebrobasilar Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Microvascular decompression; Open posterior trigeminal rhizotomy; Painful tic convulsif; Trigeminal nerve; Trigeminal neuralgia; Vertebrobasilar dolichoectasia