{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T22:59:14Z","timestamp":1774306754952,"version":"3.50.1"},"reference-count":25,"publisher":"Scientific Scholar","license":[{"start":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T00:00:00Z","timestamp":1648425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["ruralneuropractice.com"],"crossmark-restriction":true},"short-container-title":["JNRP"],"abstract":"<jats:title>Abstract<\/jats:title>\n<jats:p>\n<jats:bold>Objective<\/jats:bold>\u2003To describe and correlate the clinical, radiological, and intraoperative findings in patients with refractory neurovascular syndromes (NVS) not responding to conventional medical management and to determine the surgical outcome of the microvascular decompression (MVD) procedure.<\/jats:p>\n<jats:p>\n<jats:bold>Methods<\/jats:bold> Medical records of 17 patients with NVS (trigeminal neuralgia [TN]\u2009=\u200914 and hemifacial spasm\u2009=\u20093) who underwent surgery for symptom relief from January 2018 to July 2021 with follow-up data (1\u201336 months) were retrospectively analyzed. Patient demographics (age, sex), clinical features (site, duration of symptoms, distribution), magnetic resonance imaging (MRI) findings, micro-neurosurgical details (type of surgery, obstructive vessel), and postoperative outcome and complications were recorded.<\/jats:p>\n<jats:p>\n<jats:bold>Statistical Analysis<\/jats:bold>\u2003Descriptive analysis was performed. Variables were presented as either mean and standard deviation or frequency and percentages.<\/jats:p>\n<jats:p>\n<jats:bold>Results<\/jats:bold>\u2003The mean (standard deviation) age of patients in our study cohort was 52.6 (12.2) years. TN was common in females (64.3%). The mean duration of symptoms was longer in patients with hemifacial spasms than in patients with TN (3.3 vs. 2.7 years). While the right side was commonly affected in TN (64.3%), the left side was common in hemifacial spasm (66.7%). Most common neuralgia symptoms were distributed along the V2V3 (maxillary and mandibular division) branches (42.9%). MRI revealed neurovascular conflict in nine patients, epidermoid tumor in three patients, classical vestibular schwannoma in two patients, and short cisternal segments in three patients. Intraoperatively, superior cerebellar artery was the main offending vessel in TN followed by anterior inferior cerebellar artery (AICA) and venous compression, while tortuous vertebral artery and AICA along with thickened entangled arachnoid were seen in hemifacial spasms. Almost all patients (88.2%) reported immediate postoperative complete pain relief. One patient died secondary to chest infection after a month.<\/jats:p>\n<jats:p>\n<jats:bold>Conclusion<\/jats:bold>\u2003Arachnoid entanglement around the neurovascular bundle along with vascular compression over the cranial nerves is the main cause of NVS. Advanced micro-neurosurgical techniques used in MVD achieve excellent outcomes with improved quality of life. However, identifying the refractory NVS not responding to conventional medical management and early surgical management are paramount.<\/jats:p>","DOI":"10.1055\/s-0042-1744125","type":"journal-article","created":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T23:19:01Z","timestamp":1648509541000},"page":"283-289","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Complex Neurovascular Syndromes: Is the Compressing Vessel Alone the Culprit?"],"prefix":"10.25259","volume":"13","author":[{"given":"Aniruddh","family":"Kulkarni","sequence":"first","affiliation":[{"name":"Department of Neuro and Spine Surgery, Neuro World and Suchirayu Hospital, Hubli, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2022,3,28]]},"reference":[{"issue":"19","key":"10.1055\/s-0042-1744125\/ref-1","doi-asserted-by":"crossref","first-page":"7012","DOI":"10.3390\/ijerph17197012","article-title":"Chronic facial pain: trigeminal neuralgia, persistent idiopathic facial pain, and myofascial pain syndrome-an evidence-based narrative review and etiological hypothesis","volume":"17","author":"Gerwin","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"8","key":"10.1055\/s-0042-1744125\/ref-2","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.3174\/ajnr.A4683","article-title":"Imaging of neurovascular compression syndromes: trigeminal neuralgia, hemifacial spasm, vestibular paroxysmia, and glossopharyngeal neuralgia","volume":"37","author":"Haller","year":"2016","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.1055\/s-0042-1744125\/ref-3","doi-asserted-by":"crossref","first-page":"s65","DOI":"10.1007\/s10072-005-0410-0","article-title":"Epidemiology of typical and atypical craniofacial neuralgias","volume":"26","author":"Manzoni","year":"2005","journal-title":"Neurol Sci"},{"issue":"4","key":"10.1055\/s-0042-1744125\/ref-4","first-page":"54","article-title":"Nerve compression syndromes in the posterior cranial fossa","volume":"116","author":"Baldauf","year":"2019","journal-title":"Dtsch Arztebl Int"},{"key":"10.1055\/s-0042-1744125\/ref-5","doi-asserted-by":"crossref","first-page":"bcr2016218883","DOI":"10.1136\/bcr-2016-218883","article-title":"Hemifacial spasm and neurovascular compression syndrome","volume":"2017","author":"Dehgani Mobaraki","year":"2017","journal-title":"BMJ Case Rep"},{"issue":"41","key":"10.1055\/s-0042-1744125\/ref-6","first-page":"667","article-title":"Hemifacial spasm: conservative and surgical treatment options","volume":"109","author":"Rosenstengel","year":"2012","journal-title":"Dtsch Arztebl Int"},{"issue":"2","key":"10.1055\/s-0042-1744125\/ref-7","doi-asserted-by":"crossref","first-page":"377","DOI":"10.4103\/0028-3886.258002","article-title":"The neurovascular syndromes: a review of pathophysiology - lessons learnt from Prof. Chandy's paper published in 1989","volume":"67","author":"Bhatoe","year":"2019","journal-title":"Neurol India"},{"issue":"3","key":"10.1055\/s-0042-1744125\/ref-8","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/j.wneu.2015.04.063","article-title":"Trigeminal neuralgia caused by venous angioma: a case report and review of the literature","volume":"84","author":"Samadian","year":"2015","journal-title":"World Neurosurg"},{"issue":"2","key":"10.1055\/s-0042-1744125\/ref-9","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1227\/01.NEU.0000223501.27220.69","article-title":"Microanatomy of the central myelin-peripheral myelin transition zone of the trigeminal nerve","volume":"59","author":"Peker","year":"2006","journal-title":"Neurosurgery"},{"issue":"9","key":"10.1055\/s-0042-1744125\/ref-10","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1002\/mds.23692","article-title":"The many faces of hemifacial spasm: differential diagnosis of unilateral facial spasms","volume":"26","author":"Yaltho","year":"2011","journal-title":"Mov Disord"},{"key":"10.1055\/s-0042-1744125\/ref-11","doi-asserted-by":"crossref","first-page":"455","DOI":"10.25259\/SNI_729_2020","article-title":"Please spare my teeth! Dental procedures and trigeminal neuralgia","volume":"11","author":"Tripathi","year":"2020","journal-title":"Surg Neurol Int"},{"issue":"4","key":"10.1055\/s-0042-1744125\/ref-12","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1212\/WNL.34.4.418","article-title":"Pathophysiology of hemifacial spasm: I. Ephaptic transmission and ectopic excitation","volume":"34","author":"Nielsen","year":"1984","journal-title":"Neurology"},{"issue":"9","key":"10.1055\/s-0042-1744125\/ref-13","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1177\/0333102413485658","article-title":"The International Classification of Headache Disorders, 3rd edition (beta version)","volume":"33","author":"Headache Classification Committee of the International Headache Society (IHS)","year":"2013","journal-title":"Cephalalgia"},{"key":"10.1055\/s-0042-1744125\/ref-14","doi-asserted-by":"crossref","first-page":"1744806920901890","DOI":"10.1177\/1744806920901890","article-title":"Trigeminal neuralgia: an overview from pathophysiology to pharmacological treatments","volume":"16","author":"Gambeta","year":"2020","journal-title":"Mol Pain"},{"issue":"5","key":"10.1055\/s-0042-1744125\/ref-15","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1007\/s00701-011-0975-8","article-title":"Harvey Cushing's case series of trigeminal neuralgia at the Johns Hopkins Hospital: a surgeon's quest to advance the treatment of the \u2018suicide disease\u2019","volume":"153","author":"Adams","year":"2011","journal-title":"Acta Neurochir (Wien)"},{"issue":"2","key":"10.1055\/s-0042-1744125\/ref-16","doi-asserted-by":"crossref","first-page":"134","DOI":"10.4103\/0028-3886.51279","article-title":"Microvascular decompression as a surgical management for trigeminal neuralgia: a critical review of the literature","volume":"57","author":"Kabatas","year":"2009","journal-title":"Neurol India"},{"key":"10.1055\/s-0042-1744125\/ref-17","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/B978-0-444-52014-2.00048-3","article-title":"Hemifacial spasm","volume":"100","author":"Abbruzzese","year":"2011","journal-title":"Handb Clin Neurol"},{"issue":"2","key":"10.1055\/s-0042-1744125\/ref-18","doi-asserted-by":"crossref","first-page":"70","DOI":"10.5812\/aapm.2164","article-title":"Trigeminal neuralgia: frequency of occurrence in different nerve branches","volume":"1","author":"Bangash","year":"2011","journal-title":"Anesth Pain Med"},{"issue":"2","key":"10.1055\/s-0042-1744125\/ref-19","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1212\/WNL.0000000000002840","article-title":"Trigeminal neuralgia: new classification and diagnostic grading for practice and research","volume":"87","author":"Cruccu","year":"2016","journal-title":"Neurology"},{"issue":"1","key":"10.1055\/s-0042-1744125\/ref-20","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s10194-019-0969-0","article-title":"Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options","volume":"20","author":"Di Stefano","year":"2019","journal-title":"J Headache Pain"},{"key":"10.1055\/s-0042-1744125\/ref-21","doi-asserted-by":"crossref","first-page":"349319","DOI":"10.1155\/2014\/349319","article-title":"Hemifacial spasm and neurovascular compression","volume":"2014","author":"Lu","year":"2014","journal-title":"ScientificWorldJournal"},{"issue":"5","key":"10.1055\/s-0042-1744125\/ref-22","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s00701-012-1320-6","article-title":"Microvascular decompression on patients with trigeminal neuralgia caused by ectatic vertebrobasilar artery complex: technique notes","volume":"154","author":"Yang","year":"2012","journal-title":"Acta Neurochir (Wien)"},{"issue":"4","key":"10.1055\/s-0042-1744125\/ref-23","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.jocn.2010.08.015","article-title":"Correlation between idiopathic hemifacial spasm and the MRI characteristics of the vertebral artery","volume":"18","author":"Guan","year":"2011","journal-title":"J Clin Neurosci"},{"issue":"6","key":"10.1055\/s-0042-1744125\/ref-24","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.3171\/2014.11.JNS141741","article-title":"Trigeminal neuralgia without neurovascular compression presents earlier than trigeminal neuralgia with neurovascular compression","volume":"123","author":"Ko","year":"2015","journal-title":"J Neurosurg"},{"key":"10.1055\/s-0042-1744125\/ref-25","doi-asserted-by":"crossref","first-page":"e262","DOI":"10.1016\/j.wneu.2019.01.060","article-title":"Arachnoid membranes around the cisternal segment of the trigeminal nerve: a cadaveric anatomic study and intraoperative observations during minimally invasive microvascular decompression surgery","volume":"125","author":"Kurucz","year":"2019","journal-title":"World Neurosurg"}],"container-title":["Journal of Neurosciences in Rural Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ruralneuropractice.com\/complex-neurovascular-syndromes-is-the-compressing-vessel-alone-the-culprit\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ruralneuropractice.com\/complex-neurovascular-syndromes-is-the-compressing-vessel-alone-the-culprit\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,5]],"date-time":"2023-08-05T04:39:35Z","timestamp":1691210375000},"score":1,"resource":{"primary":{"URL":"https:\/\/ruralneuropractice.com\/complex-neurovascular-syndromes-is-the-compressing-vessel-alone-the-culprit\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,28]]},"references-count":25,"alternative-id":["10.1055\/s-0042-1744125"],"URL":"https:\/\/doi.org\/10.1055\/s-0042-1744125","relation":{},"ISSN":["0976-3155","0976-3147"],"issn-type":[{"value":"0976-3155","type":"electronic"},{"value":"0976-3147","type":"print"}],"subject":[],"published":{"date-parts":[[2022,3,28]]},"article-number":"283"}}