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Objective: The most common cause for trigeminal neuralgia (TN) is vascular compression at the nerve root, and microvascular decompression (MVD) has been proven to be an effective surgical approach for this disease. For some patients, TN is secondary to the intracranial space-occupying lesion, and tumor resection is usually recommended. However, it is not easy to determine proper treatments when craniotomy is infeasible. In this study, we aim to explore the clinical outcomes of percutaneous balloon compression (PBC) for secondary TN caused by cerebellopontine angle (CPA) tumors., Methods: From June 2016 to December 2019, 15 patients with TN caused by CPA tumors underwent PBC in Nanjing Drum Tower Hospital. The clinical features, surgical outcomes, and complications of these patients were analyzed retrospectively., Results: Fourteen out of the 15 patients had immediate pain relief after successful PBC, while one showed occasional pain, without needing any medication. No patients had a relapse of facial pain within a mean follow-up of 32.5 months. As for surgical complications, 14 patients experienced facial numbness, and six had masseter muscle weakness. No patients experienced serious surgical morbidities., Conclusions: For the patients with TN caused by CPA tumors, PBC could be considered a useful technique, especially when craniotomy is infeasible., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Objective: Microvascular decompression (MVD) has become an accepted treatment modality for the vertebral artery (VA)-involved hemifacial spasm (HFS). The aim of this retrospective study was to evaluate clinical and surgical outcomes of HFS patients undergoing MVD and surgical and cranial nerve complications and investigate reasonable transposition procedures for two different anatomic variations of VA., Methods: Between January and December 2018, 109 patients underwent first MVD for HFS involving VA at Nanjing Drum Tower Hospital. Based on whether the VA could be moved ventrally at the lower cranial nerves (LCNs) level, patients were assigned to Group A (movable VA, n = 72) or B (unmovable VA, n = 37), and clinical and surgical outcomes and complications on the day of post-surgery and during follow-up were assessed. All patients were followed up ranging from 17 to 24 months with a mean follow-up period of 21 months., Results: After a mean follow-up of 21 months, the total cure rate significantly decreased in all patients compared to that achieved on the day of surgery, and Group A patients exhibited a higher cure rate versus Group B (93.1% vs. 75.7%, P = 0.015). Group B patients with unmovable VA revealed both higher incidence of surgical complications (45.9% vs. 15.3%, P = 0.001) and frequency of bilateral VA compression (27% vs. 8.3%, P = 0.009) versus Group A. No significant difference was observed in long-term cranial nerve complications., Conclusions: VA-involved HFS can benefit from MVD strategies after preoperative assessment of VA compression. HFS patients with movable VA may receive better long-term efficacy and fewer complications. A Teflon bridge wedged between the distal VA and medulla gives rise to adequate space for decompression surgery., (© 2021. The Author(s).)

The objective of this study is to investigate the long-term effects of percutaneous balloon compression (PBC) for treating persistent or recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD). The clinical features, surgical findings, outcomes, and complications of 28 patients underwent PBC for TN in Nanjing Drum Tower Hospital between April 2011 and March 2015 were analyzed retrospectively. All the patients had received MVD before but they did not get cured or the symptom relapsed during follow-up. Twenty-six patients (92.9%) experienced immediate pain relief; one patient (3.6%) improved but still had occasional pain. The other one (3.6%) had no pain relief and repeat PBC was performed with complete resolution of the symptom. With a mean follow-up of 39.9 months, ranging from 24 to 65 months after surgery, 24 (85.7%) patients remained pain-free; three patients (11.1%) had a relapse. Surgical complications included facial numbness in 27 patients (96.4%), masseter muscle weakness in 10 patients (35.7%), and diplopia secondary to abducens nerve palsy in one patient (3.6%). None of the patients had serious surgical morbidities. PBC is a minimally invasive, safe, and effective treatment for trigeminal neuralgia, especially suitable for patients with persistent or recurrent TN after MVD.

Background: To investigate the repeat microvascular decompression on hemifacial spasm patients who failed the first MVD., Methods: Twenty-six patients underwent late redo MVD in our institution from January 1, 2011 to December 31, 2015. The clinical features, surgical findings, outcomes, and complications of the repeat MVD were analyzed retrospectively., Results: Twenty-four (92.3 %) patients were cured immediately after the redo MVD. Delayed relief was found in two (7.7 %) patients; it took 6 days and 2 weeks for them to obtain complete relief. No recurrence was found during follow-up. Surgical complications including three (11.5 %) facial paralysis and one (3.8 %) hearing loss., Conclusions: We suggested that repeat MVD can be performed 2 years after the first MVD if the spasm was not resolved. Repeat MVD for HFS is effective.