Dataset Information

Isolated hypoglossal nerve neuropathy in vertebral dolichoectasia: Microvascular decompression by vessel transposition with Teflon cuff.

ABSTRACT:

Background

A clinical case of isolated unilateral hypoglossal nerve (HN) neuropathy, which spontaneously occurred from vertebral artery dolichoectasia and was cured by a new method of microvascular decompression by transposition of the vertebral artery using the Teflon cuff.

Case description

A young patient with an anamnesis of the disease for more than 4 years and complaints of a deviation of the tongue to the right and dysarthria was examined. MRI of the brain revealed compression of the medulla oblongata by an elongated, dilated, and deformed right vertebral artery. Compression of the medulla oblongata and HN was confirmed during surgery. A transposition of the vertebral artery was performed using a Teflon cuff in the ventral direction to the clivus. Three months after surgery, positive dynamics was noted in the form of regression of dysarthria and improvement of mobility and trophic language.

Conclusion

Thus, isolated HN neuropathy as a result of compression by an elongated, dilated, and deformed vertebral artery is a rare neurological disease that can be successfully treated by transposition using a Teflon cuff.

SUBMITTER: Rafaelyan A

PROVIDER: S-EPMC9479612 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Isolated hypoglossal nerve neuropathy in vertebral dolichoectasia: Microvascular decompression by vessel transposition with Teflon cuff.

Rafaelyan Artem A Svistov Dmitry V DV

Surgical neurology international 20220805

<h4>Background</h4>A clinical case of isolated unilateral hypoglossal nerve (HN) neuropathy, which spontaneously occurred from vertebral artery dolichoectasia and was cured by a new method of microvascular decompression by transposition of the vertebral artery using the Teflon cuff.<h4>Case description</h4>A young patient with an anamnesis of the disease for more than 4 years and complaints of a deviation of the tongue to the right and dysarthria was examined. MRI of the brain revealed compressi ...[more]

PMID: 36128154

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Project description:ObjectiveMicroscopic microvascular decompression (MVD) has been considered to be a useful treatment modality for medically refractory hemifacial spasm (HFS) and trigeminal neuralgia. But, the advent of the endoscopic era has presented new possibilities to MVD surgery. While the microscope remains a valuable tool, the endoscope offers several advantages with comparable clinical outcomes. Thus, fully endoscopic MVD (E-MVD) could be a reasonable alternative to microscopic MVD. This paper explores the safety and efficacy of the fully E-MVD technique.MethodsA single-center retrospective study was conducted in 25 patients diagnosed with HFS between September 2019 and July 2023. All surgeries were performed by a single neurosurgeon using the fully E-MVD technique without any assistance of a microscope. The study reviewed intraoperative brainstem auditory evoked potentials and disappearance of the lateral spread response. Outcomes were assessed based on the patients' clinical status immediately after surgery and at their last follow-up. Complications, including facial palsy, hearing loss, ataxia, dysphagia, palsy of other cranial nerves, and cerebrospinal fluid leakage, were also examined.ResultsThe most common offending artery was the anterior inferior cerebellar artery (AICA) in 15 cases (60.0%), followed by the posterior inferior cerebellar artery in eight cases (32.0%), vertebral artery (VA) in one case (4.0%), tandem lesions involving the AICA and VA in one case (4.0%). Ten patients (40.0%) had pre-operative facial palsy on the ipsilateral side, and eight patients (32.0%) experienced delayed facial palsy on the ipsilateral side, from which they fully recovered by the last follow-up. The median operation time was 105 minutes. All patients were symptom free immediately after surgery and at the last follow-up. One patient experienced a permanent complication, such as high-frequency hearing loss, from which he partially recovered over time.ConclusionFully E-MVD demonstrated similar clinical outcomes to microscopic MVD. It offered a similar complication rate, shorter operation time, and a panoramic view with a smaller craniectomy size. Although there is a learning curve associated with fully E-MVD, it presents a viable alternative in the endoscopic era.

Project description:IntroductionNeurogenic hypertension (HTN) is a type of HTN characterized by increased activity of the sympathetic nervous system. Vascular compression is one of the pathogenic mechanisms of neurogenic HTN. Despite Jannetta's solid anatomical and physiological arguments in favor of neurogenic HTN in the 1970's, the treatment for essential HTN by microvascular decompression (MVD) still lacks established selection criteria. Therefore, the subjects selected for our center were limited to patients with primary trigeminal neuralgia (TN) and primary hemifacial spasm (HFS) of the vertebral/basilar artery (VA/BA) responsible vessel type coexisting with neurogenic HTN who underwent MVD of the brainstem to further explore possible indications for MVD in the treatment of neurogenic HTN.MethodsA retrospective analysis of 63 patients who were diagnosed with neurogenic HTN had symptoms of HFS and TN cranial nerve disease. Patients were treated at our neurosurgery department from January 2018 to January 2023. A preoperative magnetic resonance examination of the patients revealed the presence of abnormally located vascular compression in the rostral ventrolateral medulla (RVLM) and the root entry zone (REZ) of the IX and X cranial nerves (CN IX- X).ResultsThere was no significant difference between the two groups in terms of gender, age, course of HFS, course of TN, course of HTN, degree of HTN, or preoperative blood pressure. Based on the postoperative blood pressure levels, nine out of 63 patients were cured (14.28%), eight cases (12.70%) showed a marked effect, 16 cases (25.40%) were effective, and 30 cases were invalid (47.62%). The overall efficacy was 52.38%. However, 39 cases of combined cranial nerve disease were on the left side of the efficacy rate (66.67%) and 24 cases of combined cranial nerve disease were on the right side of the efficacy rate (29.16%).DiscussionOver the last few decades, many scholars have made pioneering progress in the clinical retrospective study of MVD for neurogenic hypertension, and our study confirms the efficacy of MVD in treating vertebral/basilar artery-type neurogenic hypertension by relieving the vascular pressure of RVLM. In the future, with the development and deepening of pathological mechanisms and clinical observational studies, MVD may become an important treatment for neurogenic hypertension by strictly grasping the surgical indications.ConclusionMVD is an effective treatment for neurogenic HTN. Indications may include the following: left-sided TN or HFS combined with neurogenic HTN; VA/BA compression in the left RVLM and REZ areas on MRI; and blood pressure in these patients cannot be effectively controlled by drugs.

Dataset Information

Isolated hypoglossal nerve neuropathy in vertebral dolichoectasia: Microvascular decompression by vessel transposition with Teflon cuff.

Background

Case description

Conclusion

Publications

Isolated hypoglossal nerve neuropathy in vertebral dolichoectasia: Microvascular decompression by vessel transposition with Teflon cuff.

Similar Datasets

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