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Vol. 29. Num. 3.May - June 2018
Pages 109-160
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Vol. 29. Num. 3.May - June 2018
Pages 109-160
Review article
DOI: 10.1016/j.neucie.2018.02.001
Absence of neurovascular conflict during microvascular decompression while treating essential trigeminal neuralgia. How to proceed? Systematic review of literature
Ausencia de conflicto neurovascular durante la microdescompresión vascular en el manejo de la neuralgia trigeminal esencial: ¿qué hacer? Revisión sistemática de la literatura
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Andreas Leidinger
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andreas_leidinger@hotmail.com

Corresponding author.
, Fernando Muñoz-Hernandez, Joan Molet-Teixidó
Servicio de Neurocirugía, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Table 1. Systemic review of techniques recommended in patients without neurovascular conflict during an MDV. Outcomes and complications.
Abstract
Introduction

Neurovascular conflict is the most accepted hypothesis for the cause for trigeminal neuralgia. Microvascular decompression of the trigeminal nerve is the most common surgical treatment for these patients. However, despite advances in diagnostic techniques, neurovascular conflict is sometimes not detected during surgery. The aim of this paper is to systematically review all the options available to best manage this scenario.

Results

Several techniques that could be used during microvascular decompression for trigeminal neuralgia in the absence of neurovascular conflict have been described. The success rates of these techniques, pain recurrence rates and rates of complications are also reported. Finally, we provide suggestions based on our experience.

Conclusions

There is no gold standard, but several techniques could be successfully used in the absence of neurovascular conflict. The use of destructive techniques, such as PSR, should be held as treatments of last resort.

Keywords:
Failed microvascular decompression
Trigeminal neuralgia
Neurovascular conflict
Partial sensory rhizotomy
Internal neurolysis
Resumen
Introducción

La presencia de conflicto neurovascular es la hipótesis aceptada en el desarrollo de la neuralgia trigeminal y la microdescompresión vascular, la técnica quirúrgica más empleada en su tratamiento. Sin embargo, pese a los avances diagnósticos, en ocasiones dicho conflicto es indetectable intraoperatoriamente. El objetivo de este trabajo es revisar sistemáticamente las opciones de manejo ante dicha situación.

Resultados

Existen diversas técnicas descritas que se pueden emplear ante la ausencia de conflicto neurovascular durante una microdescompresión vascular. Describimos dichas técnicas, sus tasas de éxito, la recurrencia del dolor y de complicaciones, y damos nuestras recomendaciones sobre la materia.

Conclusiones

No existe un consenso terapéutico, pero se dispone de diversas opciones quirúrgicas ante la ausencia de conflicto neurovascular. Creemos que las técnicas destructivas como la RPS deben relegarse a última línea terapéutica.

Palabras clave:
Microdescompresión vascular fallida
Neuralgia trigeminal
Conflicto neurovascular
Rizotomía parcial sensitiva
Neurólisis interna

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