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CASE REPORTS
THE USE OF PROTEC OF REPEREN iN MICROVAS DECOMPRESSION OF TRIGEMil
UDC 616.833-002-009.7-089.843:576.8 Received 17.10.2013
A.Y. Sheludyakov, PhD, Senior Research Worker1;
S.E. Tikhomirov, PhD, Neurosurgeon2;
Y.A. Stupak, Head of the Neurosurgery Department2
1Nizhny Novgorod Research Institute of Traumatology and Orthopedics, Ministry of Health of the I Verkhne-Volzhskaya naberezhnaya St., 18, Nizhny Novgorod, Russian Federation, 603155;
2City Clinical Hospital No.13, Patriotov St., 51, Nizhny Novgorod, 603018
For the first time there was used an isolating protector made of Reperen aiming to resolve a neurovascular conflict cerebellar artery and trigeminal nerve root — a leading cause of trigeminal neuralgia.
Key words: trigeminal neuralgia; microvascular decompression; Reperen.
Trigeminal neuralgia is a chronic disease, characterized by the strongest, sudden, usually unilateral pain paroxisms, localized more often in the zones of innervation of the 2nd and 3rd branches, affecting both of them or separately. Multiple investigations and every day practice proved that the main cause of trigeminal neuralgia is neurovascular conflict between superior cerebella artery and the root of trigeminal nerve, resulting in focal demyelinization in the zone of the root and artery contact, due to which arterial pulsing, transmitted to the root, induces strong pain attacks in the zones of trigeminal nerve innervation [1, 2]. Incidence rate of neuralgia of trigeminal nerve according to the literature amounts to 4-5 cases per 10,000 population a year [3-5].
Pathogenetically grounded operation — microvascular decompression of the trigeminal root with wrapping the nerve in a synthetic protector — gives good positive results in more than 90% cases. A high efficacy of microvascular decompression in neuralgia of trigeminal nerve determines the increase in the number of the operations performed in a given pathology, which, in its turn, inspires the development of optimal implant to protect the trigeminal root.
To isolate the root of the trigeminal nerve in microvascular decompression we used the material Reperen for the first time.
Patient D., 67 years of age, was admitted to the Neurosurgical Department of City Clinical Hospital No.13, Nizhny Novgorod, complaining of constant intensive darting pains in the right frontal, malar, buccal and parirhinal areas, increasing in mastication and speaking. Pains had been
bothering the patient for more than 2 months. Administration of Finlepsin failed to relieve the condition.
Neurological examination revealed a clear consciousness, good orientation. Hyperestesia was determined in the zone of innervations of the 1st and 2nd branches of the trigeminal nerve. Triggering zones in the site of the outcome of the 1st and 2nd branches; tendon reflexes from the limbs D=S, and normal motor function were also noted. MRT of the brain revealed cystic atrophic dyscirculatory changes (Fig. 1).
On 26 September 2013 an operation was performed: posterior cranial fossa trepanation on the right (right retrosigmoidal approach), microvascular decompression of the trigeminal nerve. Intraoperative photograph (Fig. 2)
The root of the trigeminal nerve The superior cerebellar artery
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Fig. 1. MRT of the posterior crania fossa structure of patient D.
For contacts: Tikhomirov Sergey Evgenievich, phone +7-951-919-11-13, e-mail: [email protected]
The Use of Protector Made of Reperen in Microvascular Decompression of Trigeminal Nerve СТМ J 2014 — vol. 6, No.1 121
CASE REPORTS
The superior cerebellar artery
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The trigeminal nerve
Fig. 2. Interoperative photograph. A close contact of the superior cerebellar artery with the trigeminal nerve is visualized, x12
The superior cerebellar artery The protector of “Reperen”
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The trigeminal nerve
Fig. 3. Intraoperative photograph. The root of the trigeminal nerve is separated from adhesions and wrapped in the isolating protector, made of “Reperen” material; x2
.contact of the trigeminal nerve root with the artery and some flattening of the root in
.aside and separated circularly.
The root of the trigeminal nerve was wrapped in the implant, formed from the artificial dura mater Reperen (Fig. 3).
Immediately after recovering from anesthesia, the patient noted complete pain regression in the face. Postoperative period was uneventful. The patient did not experience the demand in taking analgetics and Finlepsin.
References
1. Afanas’eva E.V. Nevralgiya troynichnogo nerva [Trigeminal neuralgia]. Rostov-on-Don: GOUVPO RostGMU Roszdrava; 2008; 180 p.
2. Gordienko K.S. Mikrovaskulyarnaya dekompressiya troynichnogo nerva v lechenii trigeminal’noy nevralgii. V kn.: Materialy VII Vserossiyskoy nauchno-prakticheskoy konferentsii «Polenovskie chteniya»; Sankt-Peterburg, 27-30 apr, 2008 [Microvascular decompression of trigeminal nerve in the treatment of trigeminal neuralgia. In: Proceedings of VII All-Russia Research and Practice Conference “Polenov’s Readings”; Saint Petersburg, April, 27-30, 2008]. Saint Petersburg; 2008; p. 126.
3. Otarashvili I.A., et al. Khirurgicheskoe lechenie nevralgii troynichnogo nerva. V kn.: Materialy V s”ezda neyrokhirurgov Rossii; Ufa, 22-25 iyunya, 2009 [Surgical management of trigeminal neuralgia. In: Proceedings of V Russian Congress of Neurosurgeons; Ufa, June, 22-25, 2009]. Ufa; 2009; p. 367.
4. Poshataev K.E., et al. Mikrovaskulyarnaya dekompressiya v lechenii nevralgii troynichnogo nerva. V kn.: Materialy IX Vserossiyskoy nauchno-prakticheskoy konferentsii «<Polenovskie chteniya»; Sankt-Peterburg, 6-10 apr., 2010 [Microvascular decompression in the treatment of trigeminal neuralgia. In: Proceedings of IX All-Russia Research and Practice Conference “Polenov’s Readings”; Saint Petersburg, April, 6-10, 2010]. Saint Petersburg; 2010; p. 364.
5. Likhachev S.A., et al. Khirurgicheskoe lechenie bol’nykh s nevralgiey troynichnogo nerva. V kn.: Materialy IX Vserossiyskoy nauchno-prakticheskoy konferentsii «<Polenovskie chteniya»; Sankt-Peterburg, 6-10 apr., 2010 [Surgical management of patients with trigeminal neuralgia. In: Proceedings of IX All-Russia Research and Practice Conference “Polenov’s Readings”; Saint Petersburg, April, 610, 2010]. Saint Petersburg; 2010; p. 357.
6. Tikhomirov S.E., Tsybusov S.N., Kravets L.Ya., Fraerman A.P., Balmasov A.A. Plastika defektov svoda cherepa i tverdoy mozgovoy obolochki novym polimernym materialom Reperen [Plasty of the base of the skull defects and dura mater with the Reperen’s new polymer material]. Sovrem Technol Med — Modern Technologies in Medicine 2010; 2: 6-11.
122 СТМ 1 2014 - vol. 6, No.1
A.Y. Sheludyakov, S.E. Tikhomirov, Y.A. Stupak
