PDF(Pubmed)
Abstract：
BACKGROUND: In microvascular decompression (MVD) for vein-related trigeminal neuralgia (TN), determining whether transection of the offending vein is safe can be challenging. Here, the authors present a case of vein-related TN successfully treated by sacrificing the offending vein on the basis of findings from indocyanine green (ICG) video angiography and a temporary venous occlusion test to assess the collateral flow of the offending vessel.
METHODS: A 43-year-old man presented with TN, which had failed to respond to previous medical therapy. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed that the transverse or superior petrosal vein was the offending vein. The patient underwent MVD. Because the transposition of the offending vein was anatomically challenging, a temporary vein occlusion test was performed using ICG video angiography. During and after temporary occlusion, bidirectional flow in the offending vein was observed, suggesting collateral flow even after vein occlusion. On the basis of these findings, the offending vein was transected, resulting in relief from pain without any complications. Postoperative MRI revealed no new lesions in the brainstem or the cerebellar hemisphere. The patient has been free from neuralgia for 6 months.
CONCLUSIONS: The temporary vein occlusion test under ICG video angiography was useful for evaluating collateral flow in the offending vein in TN.
METHODS: A 43-year-old man presented with TN, which had failed to respond to previous medical therapy. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed that the transverse or superior petrosal vein was the offending vein. The patient underwent MVD. Because the transposition of the offending vein was anatomically challenging, a temporary vein occlusion test was performed using ICG video angiography. During and after temporary occlusion, bidirectional flow in the offending vein was observed, suggesting collateral flow even after vein occlusion. On the basis of these findings, the offending vein was transected, resulting in relief from pain without any complications. Postoperative MRI revealed no new lesions in the brainstem or the cerebellar hemisphere. The patient has been free from neuralgia for 6 months.
CONCLUSIONS: The temporary vein occlusion test under ICG video angiography was useful for evaluating collateral flow in the offending vein in TN.
摘要：
背景：在静脉相关性三叉神经痛（TN）的微血管减压术（MVD）中，确定违规静脉的横切是否安全可能具有挑战性。这里,作者介绍了一例静脉相关的TN病例,根据吲哚菁绿(ICG)视频血管造影和评估违规血管侧支血流的临时静脉闭塞试验的结果,通过牺牲违规静脉成功治疗.
方法：一名43岁的男子出现TN，对以前的药物治疗没有反应。钆增强磁共振成像（MRI）显示，横静脉或岩上静脉是违规静脉。患者接受MVD。因为违规静脉的移位在解剖学上具有挑战性，使用ICG视频血管造影进行临时静脉闭塞试验.在暂时闭塞期间和之后，观察到违规静脉中的双向流动，即使在静脉阻塞后也提示侧支血流。根据这些发现,受伤的静脉被切断,导致疼痛缓解，没有任何并发症。术后MRI显示脑干或小脑半球无新病变。患者已无神经痛6个月。
结论：ICG视频血管造影术下的临时静脉闭塞试验可用于评估TN中违规静脉的侧支血流。
方法：一名43岁的男子出现TN，对以前的药物治疗没有反应。钆增强磁共振成像（MRI）显示，横静脉或岩上静脉是违规静脉。患者接受MVD。因为违规静脉的移位在解剖学上具有挑战性，使用ICG视频血管造影进行临时静脉闭塞试验.在暂时闭塞期间和之后，观察到违规静脉中的双向流动，即使在静脉阻塞后也提示侧支血流。根据这些发现,受伤的静脉被切断,导致疼痛缓解，没有任何并发症。术后MRI显示脑干或小脑半球无新病变。患者已无神经痛6个月。
结论：ICG视频血管造影术下的临时静脉闭塞试验可用于评估TN中违规静脉的侧支血流。
