UNASSIGNED: Neurogenic 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.
UNASSIGNED: A 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).
UNASSIGNED: There 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%).
UNASSIGNED: Over 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.
UNASSIGNED: MVD 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.

UNASSIGNED: Although there have been many researches on the etiology and risk factors with the onset of hemifacial spasm, researches on the risk factors related to progression rate are limited. This study aims to analyze the risk factors related to the progression rate of hemifacial spasm.
UNASSIGNED: The study enrolled 142 patients who underwent microvascular decompression for hemifacial spasm. Based on the duration and severity of symptoms, patients were classified into rapid progression group and slow progression group. To analyze risk factors, univariate and multivariate logistic regression analyses were conducted. Of 142 patients with hemifacial spasm, 90(63.3%) were classified as rapid progression group, 52(36.7%) were classified as slow progression group.
UNASSIGNED: In the univariate analysis, there were significant statistical differences between the two groups in terms of age of onset (P = 0.021), facial nerve angle (P < 0.01), hypertension (P = 0.01), presence of APOE ε4 expression (P < 0.01) and different degrees of brainstem compression in the Root Entry Zone (P < 0.01). In the multivariable analyses, there were significant statistical differences between the two groups in terms of age of symptom onset (P < 0.01 OR = 6.591), APOE ε4 (P < 0.01 OR = 5.691), brainstem compression (P = 0.006 OR = 5.620), and facial nerve angle (P < 0.01 OR = 5.758). Furthermore, we found no significant correlation between the severity of facial spasms and the progression rate of the disease (t = 2.47, P = 0.12>0.05).
UNASSIGNED: According to our study, patients with facial nerve angle ≤ 96.5°, severer compression of the brainstem by offending vessels, an onset age > 45 years and positive expression of APOE ε4, may experience faster progression of hemifacial spasm.

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Trigeminal neuralgia (TN) is a debilitating disorder causing severe, episodic, unilateral stabbing facial pain disturbing enough to disrupt the activities of daily life. Classic TN is caused due to compression injury of the trigeminal nerve at the cistern segment caused by either an artery or a vein, referred to as neurovascular contact or conflict (NVC). Magnetic resonance imaging (MRI) has been the standard tool for the diagnosis of NVC. This study aimed to determine the incidence of NVC in TN, as identified by MRI, assess the various MRI grading patterns among patients with TN, and identify the vessels primarily involved in NVC. A systematic search of studies that used MRI for the diagnosis of TN in reference to NVC was conducted on DOAJ and PubMed/PubMed Central. Data were extracted and entered into a Microsoft Excel spreadsheet. The outcomes measured were the incidence of NVC as shown in MRI, vessels involved in NVC, and MRI grading patterns. We identified and selected 20 studies that fulfilled inclusion/exclusion criteria. In total, 1,436 patients were enrolled in all included studies. The type of MRI used was 1.5 T or 3 T MRI. The mean age of the patients varied from 49 to 63 years, with an equivalent male-to-female ratio. NVC was seen in 1,276 cases out of 1,436 cases (88.85%) of TN on the ipsilateral side, as shown by MRI. The vessels involved were arteries in 80-90% of the cases, followed by veins. Among the arteries, the superior cerebellar artery was the most common artery (80-90% of cases). The grades of NVC as assessed by MRI included grades I, II, and III with varied proportions in different studies. NVC is a common problem in TN, wherein there is compression at the nerve root entry zone, and it shows a strong predilection for the elderly population. MRI seems to be a novel imaging diagnostic investigation to identify NVC associated with TN. Moreover, NVC grading must be done with MRI so that it may help the surgeon in stratifying the patient\'s treatment.

UNASSIGNED: Primary Trigeminal Neuralgia (PTN) is a common and refractory neurological disease. Conventional vascular compression theory could not completely explain the etiology and pathogenesis of PTN. This study used diffusion tensor imaging (DTI) to demonstrate the microstructural changes of root entry zone (REZ) region in PTN patients.
UNASSIGNED: DTI sequences was performed on PTN patients and healthy controls (HCs). Clinical data included affected side, disease course and visual analogue scale (VAS) were collected. Quantitative DTI variables such as FA, MD, AD and RD of the root entry/Exit zone (REZ) were measured and compared in PTN/HCs, affected/unaffected side, and pre/post operation groups. The PCoA was established to conduct overall differences between PTN group and the HCs.
UNASSIGNED: A total of 17 patients with PTN (mean age 59.29 ± 8.53; 5 men) and 34 HCs (mean age 57.70 ± 6.37; 10 men) were included. Lower FA value of the affected side of PTN group was observed compared to the unaffected side and the HCs (p = 0.001), whereas the values of MD, AD and RD were significantly increased (p < 0.001). Moreover, the decrease of FA value was recovered post operation. PCoA results of the comprehensive indexes can significantly distinguish PTN group from HCs (r = 0.500, p < 0.001).
UNASSIGNED: Quantitative variables derived from DTI in REZ had significantly different profiles between PTN patients and HCs, which were associated with VAS situation and the disease course of PTN. The comprehensive index established on DTI variables were of great potential to reveal the microstructure changes in PTN patients and predict the therapeutic effect.

Trigeminal neuralgia (TN) is a disabling painful condition along the course of the sensory distribution of the trigeminal nerve that most commonly occurs due to vascular compression or conflict at the root entry zone of the trigeminal nerve. We report a 27-year-old female patient who presented with pain and an electric shock-like sensation on the right side of her face that started three years ago. Magnetic resonance imaging of the brain was done and revealed no neurovascular conflict along the course of the trigeminal nerve. The absence of Meckel\'s cave with atrophy of the cisternal segment of the trigeminal nerve on the affected side was reported. The absence of Meckel\'s cave is an exceedingly rare cause of TN, and only a handful of reported cases in the literature suggest the association between them.

Endoscopic microvascular decompression (eMVD) provides excellent visualization and minimally invasive surgical treatment of trigeminal neuralgia (TN). The transposition technique is desirable for long-term outcomes of TN.
A two-step transposition technique is performed during eMVD for TN due to the arch-shaped superior cerebellar artery (SCA). First, the cerebellomesencephalic segment of the SCA is pulled out using oxycellulose balls. Second, the retracted lateral pontomesencephalic segment of the SCA is detached from the trigeminal nerve and is transposed for fixation at the tentorium cerebelli.
The two-step transposition technique offers simple, reliable decompression for TN due to the arch-shaped SCA.

A repair strategy for venous bleeding from the superior petrosal vein (SPV) is essential during endoscopic microvascular decompression.
Sliced oxycellulose seats are rounded off, making balls around 10 mm in diameter. When venous bleeding arises from the SPV, the first oxycellulose ball is placed just behind the SPV in the surgical view. A second ball is then applied in front of the SPV. The SPV is thus immediately and entirely covered by oxycellulose, and hemostasis is safely achieved with the preservation of the SPV.
This oxycellulose ball technique offers simple, reliable control of venous bleeding from the SPV.

The optimal technique of microvascular decompression (MVD) for trigeminal neuralgia (TN) caused by venous conflict remains unclear. The objectives of this study are to characterize the offending veins identified during MVD for TN and to evaluate intraoperative technique applied for their management. From 2007 till 2019, 308 MVD surgeries were performed in 288 consecutive patients with TN, and in 58 of them, pure venous conflict was identified. In 44 patients, the offending vein was interrupted, as was done for small veins arising from the cisternal trigeminal nerve (CN V) or its root entry zone (REZ) causing their stretching (19 cases), small veins on the surface of REZ (9 cases), transverse pontine vein (TPV) compressing REZ or distal CN V (12 cases), and superior petrosal vein (SPV) using flow conversion technique (4 cases). In 14 other cases, the offending vein was relocated, as was done for the SPV or the vein of cerebellopontine fissure (8 cases), TPV (3 cases), and the vein of middle cerebellar peduncle (3 cases). Complete pain relief after surgery was noted in 49 patients (84%). No one patient experienced major neurological deterioration. Postoperative facial numbness developed in 14 patients (24%), and in 8 of them, it was permanent. In 14 patients, MRI demonstrated venous infarction of the middle cerebellar peduncle, which was associated with the presence of any (P = 0.0180) and permanent (P = 0.0002) facial numbness. Ten patients experienced pain recurrence. Thus, 39 patients (67%) sustained complete pain relief at the last follow-up (median, 48 months), which was significantly associated with the presence of any (P = 0.0228) and permanent (P = 0.0427) postoperative facial numbness. In conclusion, in cases of TN, small offending veins arising from REZ and/or distal CN V and causing their stretching may be coagulated and cut. In many cases, TPV can be also interrupted safely or considered as collateral way for blood outflow. The main complication of such procedures is facial numbness, which is associated with the venous infarction of middle cerebellar peduncle and long-term complete pain relief.

Gamma Knife radiosurgery (GKRS) is a well-defined treatment for trigeminal neuralgia. The aim of this study was to determine how the GKRS planning might change on the basis of the patient\'s own anatomy and how to best choose the target location.
Trigeminal cisternal length, pontotrigeminal angle, and distance between middle of the shot and emergence were evaluated in 112 consecutive GKRS plans for trigeminal neuralgia. Correlations with pain outcomes and facial hypoesthesia were analyzed.
The mean angle was 29° ± 4.4° and 37° ± 0.9°, respectively, in patients developing and not developing severe hypoesthesia (P = 0.045), despite no significant difference on brainstem dose (11.9 ± 0.8 and 10.5 ± 0.3 Gy; P = 0.22). The length of the nerve was not relevant on clinical outcomes but the shot-emergence distance (mean 8.1 ± 0.2 mm) depended on both trigeminal length and angle (P = 0.01). At constant prescription dose, 6-month cumulative rates of pain relief and control without therapy were 52.9% when the shot-emergence distance was ≤8 mm, whereas 25% when this distance was >8 mm (P = 0.017). The maintenance of good pain control was more long lasting in the first group (49.5 ± 6.6 vs. 25.4 ± 5 months; P = 0.006) with a 5-year cumulative rate of 70% and 26%, respectively (P < 0.001).
The pontotrigeminal angle and the shot-emergence distance should be considered during GKRS planning: the first as a potential risk factor for hypoesthesia, and the second should not exceed 8 mm.