Neurosurgical focus最新文献

{"title":"Is complete elimination of lateral spreading response essential in microvascular decompression for hemifacial spasm?","authors":"Szu-Yen Pan, Chih-Ming Lai, Chih-Wei Huang, Yi-Ching Chen, Lan-Yan Yang, Lanjun Guo","doi":"10.3171/2025.6.FOCUS25436","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25436","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to investigate whether complete intraoperative elimination of the lateral spread response (LSR) is essential during microvascular decompression (MVD) for hemifacial spasm (HFS) and to identify a quantitative intraoperative biomarker predictive of favorable outcomes.</p><p><strong>Methods: </strong>The authors retrospectively analyzed 208 adult patients who underwent MVD for primary HFS. Intraoperative neurophysiological monitoring (IONM) included LSR recordings from three facial muscles. Based on clinical outcomes at the 6-month postoperative follow-up, patients were independently categorized into two binary outcome groups-completely resolved (CR) versus non-CR, and clinically improved (CI) versus non-CI-for separate analyses. The final-to-baseline amplitude change ratio (FBCR) of LSR amplitude was calculated. Predictive thresholds were identified using machine learning models including random forest and decision trees.</p><p><strong>Results: </strong>LSR was most frequently observed in the mentalis (96.2%) and orbicularis oris (92.3%). Complete disappearance of LSR was not a prerequisite for achieving either CI or CR outcomes. FBCR ≥ 86.5% in the mentalis muscle predicted CR with 88% accuracy, 99% sensitivity, and 47% specificity. FBCR ≥ 48.5% predicted CI with 98% accuracy and 91% specificity. Multivariate models did not significantly improve prediction compared to mentalis FBCR alone.</p><p><strong>Conclusions: </strong>Complete elimination of LSR is not essential for clinical success in MVD for HFS. A quantitative reduction in LSR amplitude, especially in the mentalis muscle, provides a robust and practical intraoperative predictor of both objective and subjective outcomes. These findings advocate for a shift toward a muscle-specific, threshold-driven strategy for intraoperative neurophysiological monitoring in HFS surgery.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E5"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscle pad interposition technique in microvascular decompression for primary hemifacial spasm: a single-center case series and systematic review.","authors":"Riccardo Draghi, Francesco Tengattini, Francesco Travaglini, Francesco Salomi, Diego Sangiorgi, Ignazio Borghesi, Fabio Calbucci","doi":"10.3171/2025.6.FOCUS25432","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25432","url":null,"abstract":"<p><strong>Objective: </strong>Primary hemifacial spasm (HFS) is a rare neurological condition characterized by involuntary contractions of hemifacial mimic muscles. Microvascular decompression (MVD) with the interposition technique, in which a Teflon spacer is inserted between the nerve and the offending vessel, is the most commonly used treatment. However, the authors' institution has used autologous muscle pledgets for more than 15 years as an alternative spacer material, with satisfactory results. They report a single-center study of 75 consecutive patients treated with interposition MVD using autologous muscle pledgets between November 2012 and March 2023.</p><p><strong>Methods: </strong>All patients had a minimum follow-up of 1 year. Surgical outcomes were assessed using the Japanese grading system of Kondo and colleagues, which evaluates both the efficacy of surgery and complications. Furthermore, a systematic review of recent series on HFS treated by the interposition technique was done, to compare the present study results and outcomes.</p><p><strong>Results: </strong>Among the 75 patients, 31 (41.3%) were male, the median age was 52 years, and the median duration of the disease was 5 years. In 51 patients (68.0%), the neurovascular conflict (NVC) was due to single-vessel compression, while multiple vessels were found in 24 cases (32.0%). Complete resolution of HFS was achieved in 84% of patients, with an additional 6.7% reporting occasional mild spasms. Delayed resolution occurred in 18.7% of cases, typically within 30 days postsurgery. The overall complication rate was low, with 8.0% experiencing hearing deficits and 1.3% reporting persistent dysphonia. According to the Japanese grading system, excellent results (complete disappearance of HFS and no complications) were obtained in 62 patients (82.7%) and good results in 7 (9.3%). Involvement of the vertebral artery (VA) was associated with poorer outcomes, with a significant reduction in achieving complete resolution (OR 0.23, p = 0.031).</p><p><strong>Conclusions: </strong>Interposition MVD using autologous muscle pads represents an effective and durable treatment for HFS, particularly when the offending vessel is not a large-caliber artery, such as the VA or basilar artery (BA). The present study results are in line with those of the best series evaluating long-term resolution of the spasm and surgical complications. Despite a limited rate of recurrences, the described technique provides a high rate of spasm resolution, minimal complications, and high patient satisfaction. In the case of an NVC near the VA or BA, interposition with stiffer materials or the transposition technique may ensure a higher rate of HFS control.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E7"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A double burden: depression and early pain recurrence following surgical management of trigeminal neuralgia.","authors":"Omid Shoraka, David Botros, Philipp Taussky, Randy L Jensen, William T Couldwell, John D Rolston, Shervin Rahimpour","doi":"10.3171/2025.6.FOCUS25463","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25463","url":null,"abstract":"<p><strong>Objective: </strong>Trigeminal neuralgia (TN) is characterized by recurrent, unilateral episodes of electric shock-like facial pain, frequently triggered by routine activities, that can significantly impair quality of life. Although interventions such as microvascular decompression, stereotactic radiosurgery, and minimally invasive percutaneous procedures often provide rapid pain relief, recurrence remains a clinical challenge. Psychological comorbidities, particularly depressive disorder, may play a role in predicting outcomes after surgical intervention. This study aimed to determine whether a preexisting diagnosis of depressive disorder was independently associated with earlier recurrence of pain after surgical intervention.</p><p><strong>Methods: </strong>This single-center retrospective study included patients with TN who underwent surgical intervention between March 30, 2017, and March 30, 2024. Exposure variables consisted of demographic data, comorbidities, preprocedural characteristics of TN, procedure type, and total number of interventions. Primary outcomes were defined as > 50% pain relief at the last follow-up and recurrence of pain during the follow-up period.</p><p><strong>Results: </strong>A total of 150 patients with TN who underwent 193 procedures were included in this retrospective analysis. The mean follow-up duration was 11.4 months. Among these cases, 54 patients had a clinical diagnosis or were being treated for depressive disorder. Female sex (74.1%) and comorbid migraine (44.4%) were significantly more prevalent in the depressed cohort. Patients with depressive disorder also underwent balloon compression rhizotomy (52.1%) and radiosurgery (32.4%) at higher rates compared with those without depressive disorder. No other significant differences were observed between the two groups. Postoperatively, recurrence of any level of facial pain was significantly more common in patients with depressive disorder (70.4% vs 51.6%, p = 0.011). In a multivariable mixed-effects Cox regression model, depressive disorder emerged as an independent predictor of earlier pain recurrence during follow-up, alongside type of surgical intervention received.</p><p><strong>Conclusions: </strong>Depressive disorder is a common psychiatric comorbidity among patients with TN. This study demonstrated that depressive disorder also serves as an independent predictor of earlier pain recurrence after surgical intervention. Recognizing depressive disorder alongside other preexisting conditions may aid clinicians in setting realistic expectations of surgical outcomes and guiding clinical decision-making. Further studies are necessary to validate the observed associations and further clarify the impact of psychological comorbidities on pain outcomes after surgery.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E11"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with persistent abnormal muscle responses in microvascular decompression for hemifacial spasm and prognostic analysis.","authors":"Hao Zhou, Yiming Cao, Shiliang Liu, Xingrong Wei, Defeng Zeng, Shuguang Zhang, Yang Li, Xueqian Hu, Zhenqing Wei","doi":"10.3171/2025.6.FOCUS25327","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25327","url":null,"abstract":"<p><strong>Objective: </strong>An abnormal muscle response (AMR) is an important electrophysiological indicator for the diagnosis, treatment, and prognosis of hemifacial spasm (HFS). The purpose of this study was to analyze the factors associated with and to establish a predictive model for the persistence of AMRs during microvascular decompression (MVD), while also evaluating the relationship between the disappearance of AMRs and delayed recovery.</p><p><strong>Methods: </strong>In this retrospective study, authors collected clinical data from patients with HFS who underwent MVD at The First Affiliated Hospital of Dalian Medical University between August 2019 and August 2024. Factors associated with the persistence of AMRs were analyzed, and a predictive model for their persistence was developed.</p><p><strong>Results: </strong>The results showed the disappearance of AMRs at a rate of 78.3% among the 157 patients included in the study. Factors influencing the persistence of AMRs included disease duration, preoperative symptom severity, carbamazepine use, number of responsible vessels, preoperative AMR amplitude, cerebellar retraction depth, and degree of responsible vessel displacement. The predictive model achieved an area under the curve of 0.931, indicating high accuracy. Follow-up data revealed that the persistence of AMRs was associated with recovery rates at 3 months postoperatively (p < 0.01).</p><p><strong>Conclusions: </strong>Risk factors for the persistence of AMRs can be used to predict the probability of persistent intraoperative AMRs. An intraoperative AMR that persists despite having a low preoperative predicted probability may indicate inadequate facial nerve decompression or undetected offending vessels, requiring either additional surgical exploration or transposition of the offending vessels. Conversely, when an AMR persists in the context of a high preoperative predicted probability, the MVD procedure can be safely terminated after confirming adequate decompression to minimize surgical complications. Patients with persistent AMRs may experience delayed recovery, with symptom relief potentially taking 3 months. If symptoms persist without improvement for 6 months to a year, a second surgery can be considered.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E4"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcome of endoscope-assisted microvascular decompression in trigeminal neuralgia.","authors":"Jakob Wurzinger, Henry W S Schroeder, Marc Matthes, Jörg Baldauf","doi":"10.3171/2025.6.FOCUS25434","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25434","url":null,"abstract":"<p><strong>Objective: </strong>The therapy of choice for classical trigeminal neuralgia (TN) is usually microvascular decompression (MVD). Although in most surgical procedures the view with the operating microscope is sufficient to inspect the entire course of the trigeminal nerve from the brainstem to Meckel's cave, anatomical abnormalities may hinder the view. In these conditions, visualization with an endoscope with an angulated view provides additional exposure and may identify a compression that was hidden on microscopic view. The authors report their experience with this endoscope-assisted microvascular decompression (EA-MVD) technique and provide long-term results.</p><p><strong>Methods: </strong>Between 2000 and 2020, 182 patients with classic TN and radiologically and intraoperatively confirmed neurovascular conflict (NVC) underwent endoscope-assisted surgery. Follow-up was conducted via our outpatient clinic or by telephone interview. EA-MVD included endoscopic inspection and dissection, as well as bimanual dissection under the microscope. The influence of several factors on postoperative outcome was statistically analyzed.</p><p><strong>Results: </strong>In total, 168 (92%) of the authors' patients showed complete pain relief immediately postoperatively, 12 only partial relief, and 2 reported no improvement at all (1 with venous compression). Seventeen patients were unavailable for follow-up. The mean (range) follow-up duration was 62 (3-240) months. On last follow-up, 143 patients (78.6%) had a very good outcome (Barrow Neurological Institute [BNI] score I/II), 34 (18.7%) reported a moderate outcome (BNI score III), and 5 patients' outcomes (2.8%) were classified as failures (BNI score IV/V). Twenty-five patients (13.7%) had recurrence of pain. The average pain-free interval until recurrence was 25 months. The use of the endoscope was classified as very beneficial in 29 operations (15.9%). Major complications occurred in 4 patients (2.2%). Only the number of affected trigeminal branches showed a significant impact on outcome, with a single affected branch associated with better outcome. Duration of symptoms, sex, affected side, type of compression, and number of NVCs showed no correlation with outcome.</p><p><strong>Conclusions: </strong>The authors results confirmed that EA-MVD is a safe technique with a high success rate. The value of the endoscope is especially apparent in patients with a prominent suprameatal tubercle that obscures the straight view to Meckel's cave with the operating microscope.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E15"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive microvascular decompression for trigeminal neuralgia: results and complication avoidance in a consecutive series of patients.","authors":"Francesco Tomasello, Massimiliano Salvatore Cardali, Filippo Flavio Angileri, Alberto Romano, Domenico La Torre","doi":"10.3171/2025.6.FOCUS25475","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25475","url":null,"abstract":"<p><strong>Objective: </strong>Microvascular decompression (MVD) represents a milestone for the treatment of trigeminal neuralgia (TN). Nevertheless, several complications still occur and may negatively affect the outcome. The authors recently proposed a minimally invasive technique, including endoscopic assistance in instances of intraoperative hidden corners, with which they were able to achieve good results in terms of pain relief and minimize overall complication rates. The aim of this study was to verify the short- and long-term efficacy of the proposed refinement of the standard MVD technique in terms of pain relief and reduction of complication rates.</p><p><strong>Methods: </strong>The authors analyzed the surgical and outcome data of 154 consecutive patients with TN over a 10-year period. Outcome variables included pain relief, facial numbness, muscular atrophy, local cutaneous occipital and temporal pain or numbness, cerebellar injury, hearing loss, cranial nerve deficits, wound infection, CSF leakage, recurrences, and mortality rate. The overall complication rate was defined as the occurrence of any of the aforementioned items.</p><p><strong>Results: </strong>A total of 154 consecutive patients were included in the study. Pain relief was achieved in 97.4% immediately after surgery, while 92.9%, 85.7%, and 83.1% of patients were pain free at the 1-year, 5-year, and last follow-up, respectively. The mean follow-up was 71.18 months (range 11-120 months). The overall complication rate was 5.8%, but only 1.3% of patients experienced permanent neurological complications. The CSF leakage rate was 3.2%. Two patients (1.3%) developed complete hearing loss, and another patient developed mild temporary dysfunction of the eighth cranial nerve. One patient experienced postoperative ataxia but completely recovered in 1 month. No other complication or death was observed.</p><p><strong>Conclusions: </strong>The proposed minimally invasive refinement of the standard MVD technique has been shown to be effective in maintaining excellent results in terms of pain relief, in both the short and long term, while minimizing the overall complication rate associated with this surgical approach.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E14"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trigeminal neuralgia or hemifacial spasm due to vertebrobasilar dolichoectasia: a single-center case series and systematic review.","authors":"Ahmad Pour-Rashidi, Mohamad Shirani, Zahra Zali, Abbas Amirjamshidi","doi":"10.3171/2025.6.FOCUS25440","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25440","url":null,"abstract":"<p><strong>Objective: </strong>Dolichoectasia of the intracranial arteries is a rare vascular disorder. Patients with vertebrobasilar dolichoectasia (VBD) can present with cranial nerve deficits, such as cranial rhizopathies. The aim of this study was to systematically review existing literature and to share an institutional experience in treating VBD-associated trigeminal neuralgia (TN) and hemifacial spasm (HFS), as well as to provide an overview for optimal therapeutic decision-making in these patients.</p><p><strong>Methods: </strong>A systematic search was conducted across three major databases to identify publications on VBD in which patients presented with TN or HFS. Articles were screened based on predefined eligibility criteria. Relevant patient data were extracted from the included articles, and statistical analyses were performed to evaluate the effectiveness of different treatment modalities.</p><p><strong>Results: </strong>A total of 155 articles were identified comprising 801 patients, plus 7 patients from the authors' institution, resulting in 808 patients (mean age 60.1 years) with VBD-associated TN and/or HFS. Among patients receiving nonsurgical treatments such as medication, symptoms did not fully resolve. Of patients who underwent radiosurgery, 63.7% experienced symptom resolution, but 47.2% had recurrence after a mean of 14.1 months. Among patients treated with microvascular decompression (MVD), symptoms resolved in 87.3%, improved in 11.7%, and recurred in 6.5% (over a mean of 17.4 months after surgery). A significant statistical difference was seen between the recurrence rates of MVD and radiosurgery (p < 0.005). Interestingly, interposition and transposition surgical techniques showed similar efficacy, with symptom resolution in 89.2% and 87.4% of patients, respectively. Moreover, endoscopic approaches significantly reduced complication rates compared to microscope-assisted approaches (5.3% vs 23.8%), although their impact on complete symptom resolution was not statistically significant.</p><p><strong>Conclusions: </strong>Compared with the other therapeutic approaches, MVD had a higher rate of symptom resolution and a lower recurrence rate. Notably, endoscope-assisted decompression was linked to fewer complications. Additionally, the interposition and transposition surgical techniques showed similar efficacy.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E6"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of frailty with worse pain outcomes in older patients with trigeminal neuralgia treated using primary percutaneous glycerin rhizotomy.","authors":"Sai Chandan Reddy, Sumil K Nair, Deepti Tantry, Anita Kalluri, Emeka Ejimogu, Hussain Al-Khars, Mostafa Abdulrahim, Yuanxuan Xia, Vivek Yedavalli, Christopher M Jackson, Judy Huang, Michael Lim, Chetan Bettegowda, Risheng Xu","doi":"10.3171/2025.6.FOCUS25379","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25379","url":null,"abstract":"<p><strong>Objective: </strong>Trigeminal neuralgia (TN) is a neurological disorder that typically manifests as excruciating orofacial pain along the branches of the trigeminal nerve. Percutaneous treatments for TN have been shown to provide short-term pain relief, but they are often associated with the recurrence of pain. In this study, the authors assessed the role of frailty status in postoperative pain and numbness outcomes for patients treated with primary percutaneous glycerin rhizotomy.</p><p><strong>Methods: </strong>At the authors' institution, 231 older patients (age ≥ 60 years) who underwent primary glycerin rhizotomy between 2011 and 2022 were reviewed. These patients were dichotomized by the presence or absence of frailty using the modified 5-item Frailty Index. Demographic data, comorbidity information, clinical characteristics, intraoperative complications, and postoperative outcomes were collected. Kaplan-Meier analysis, multivariable ordinal regression, and Cox proportional hazards analysis were used to compare Barrow Neurological Institute (BNI) pain and numbness index outcomes between frail and nonfrail patients.</p><p><strong>Results: </strong>Frail patients (n = 87) had significantly higher rates of hypertension, diabetes, history of cerebrovascular accidents, chronic kidney disease, hyperlipidemia, chronic obstructive pulmonary disease, and congestive heart failure compared to nonfrail patients (n = 144, p < 0.05). Frail patients had significantly worse pain at final follow-up compared to nonfrail patients (p < 0.01). They also experienced significantly higher rates of pain recurrence (p < 0.01) and rhizotomy failure (p < 0.01), defined as a BNI pain index score > 3 within 3 months after surgery. Multivariable ordinal regression determined that frailty was significantly associated with higher BNI pain index scores at final follow-up (p < 0.01). Cox proportional hazards models indicated that while male sex was associated with greater pain recurrence (p < 0.01), frailty was associated with a higher likelihood of rhizotomy failure (p < 0.01).</p><p><strong>Conclusions: </strong>In this study, frail older patients who underwent primary glycerin rhizotomy experienced greater pain levels postoperatively and had a higher incidence of rhizotomy failure relative to their nonfrail counterparts. Therefore, frailty status should be considered during preoperative counseling prior to percutaneous glycerin rhizotomy to guide clinical decision-making and inform patient expectations following the procedure.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E9"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of perforating arterial branches on microvascular decompression for hemifacial spasm.","authors":"Ahmed Al Menabbawy, Mariam Al Mutawa, Viviann Tran, Sebastian Lehmann, Ehab El Refaee, Marc Matthes, Henry W S Schroeder","doi":"10.3171/2025.6.FOCUS25418","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25418","url":null,"abstract":"<p><strong>Objective: </strong>Microvascular decompression (MVD) is the definitive surgical procedure for hemifacial spasm (HFS), with reported success rates exceeding 90%. However, the complexity of neurovascular compression varies between patients, and the presence of perforating arteries at the root exit zone (REZ) may hinder optimal decompression. This study aimed to analyze anatomical patterns and characteristics of perforating arterial branches at the REZ, and to evaluate their potential impact on the MVD procedure and surgical outcomes.</p><p><strong>Methods: </strong>The authors conducted a retrospective review of high-quality intraoperative images and videos of patients who underwent MVD for HFS between January 2017 and October 2022. Inclusion criteria were pure arterial compression and a minimum postoperative follow-up of 6 months. Patient demographics; number of perforators within a 5-mm radius of the REZ and their length, direction, and involvement in facial nerve decompression; and postoperative outcomes were assessed.</p><p><strong>Results: </strong>One hundred five patients met the inclusion criteria. The mean patient age was 55.6 (SD 11.2) years, with a male-to-female ratio of 1:1.63 and a mean follow-up duration of 24.4 (SD 28.1) months. Favorable outcome reached 89.5% (94/105 patients), and persistent complications occurred in 3.81%. The compressing vessel was solely the anterior inferior cerebellar artery (AICA) in 28.6% of patients, the posterior inferior cerebellar artery (PICA) in 38.1%, and a combination in the remainder. The median number of perforators per patient was 2, with notable differences in length and vascular territory: AICA perforators were significantly shorter and more likely to supply the cranial nerve (CN) VII-VIII complex (p < 0.05). Furthermore, AICA perforators interfered more frequently with decompression than those from the PICA (53.3% vs 22.5%, p < 0.05). Postoperative outcomes did not differ significantly between groups.</p><p><strong>Conclusions: </strong>The anatomical characteristics of perforating branches vary depending on the parent vessel. AICA perforators are usually shorter and more often supply the CN VII-VIII complex, thereby posing a greater challenge during MVD compared to PICA branches. Nonetheless, with appropriate surgical expertise, neuroendoscopic visualization, and adjunctive intraoperative monitoring, favorable outcomes can still be reliably achieved.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E3"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of preoperative medical management on postoperative outcomes after index percutaneous rhizotomy for trigeminal neuralgia.","authors":"Megan Parker, Yuanxuan Xia, Melanie Alfonzo Horowitz, Divyaansh Raj, Saket Myneni, Sina Ahmadi, Praneethkumar Madhu, Anita Kalluri, Sumil K Nair, Sai Chandan Reddy, Michael Lim, Christopher Jackson, Judy Huang, Risheng Xu, Chetan Bettegowda","doi":"10.3171/2025.6.FOCUS25173","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25173","url":null,"abstract":"<p><strong>Objective: </strong>Initial medical management fails in nearly half of patients with trigeminal neuralgia (TN), and patients will seek surgical management with either rhizotomy or microvascular decompression. The impact of preoperative medical management on post-rhizotomy outcomes is unclear. The authors aimed to further evaluate this relationship.</p><p><strong>Methods: </strong>In this single-center, retrospective cohort study, the authors recorded clinical and demographic data for patients with TN who underwent first-time rhizotomy at their institution (1995-2023). Univariate logistic regression and Cox regression analyses were used to evaluate associations between the number and duration of preoperative pain medications with postoperative outcomes, including pain improvement, medication-free remission, and time to pain recurrence.</p><p><strong>Results: </strong>A total of 413 patients met inclusion criteria (mean age 62.6 ± 15.7 years, 63.0% female). The mean time on preoperative pain medications for TN was 57.0 ± 73.1 months. At the time of presentation, 85.5% of patients were taking ≥ 1 pain medication for TN, with anticonvulsants being the most commonly prescribed (78.7%). Postoperatively, 75.3% experienced pain improvement and 14.3% achieved remission. The median time to recurrence was 8.6 (95% CI 6.2-11.0) months among the entire cohort, 12.8 (95% CI 8.8-16.7) months for patients who had postoperative improvement in TN pain, and 36.0 (95% CI 12.7-59.3) months for patients who achieved pain remission not requiring medication. There were no significant associations between time on preoperative pain medications, number of pain medications tried, number of pain medications at presentation to neurosurgery, and postoperative outcomes.</p><p><strong>Conclusions: </strong>While early neurosurgical referral is valuable for discussing treatment options, the authors' findings suggest that prolonged medication use does not diminish the effectiveness of rhizotomy in relieving TN symptoms.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E8"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}