Trigeminal neuralgia or hemifacial spasm due to vertebrobasilar dolichoectasia: a single-center case series and systematic review.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.