Clinical long-term observation of the keyhole microvascular decompression with local anesthesia on diagnosis and treatment of vestibular paroxysmia

Abstract

Background: The pathophysiology and etiology of vestibular paroxysmia (VP) remains unclear, moreover, due to the lack of reliable diagnostic features for VP, the clinical diagnosis will be made mainly by exclusion.

Aims/objectives: To evaluate the diagnostic value and curative effect of keyhole microvascular decompression with local anesthesia for VP.

Material and methods: 54 patients with trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia underwent keyhole microvascular decompression with local anesthesia, twelve of whom were coexistent with VP. The evaluation of the vertigo after operation was performed with symptom report card for 12 patients with VP and the mean follow-up period was 116 months (range 114–118 months).

Results: The cochleovestibular neurovascular compression at the root zone of vestibular nerve was found in 12 patients with VP, of whom 11 patients had the neurovascular compressive vertigo induced intra-operatively and the vertigo disappeared postoperatively, moreover, one patient had no neurovascular compressive vertigo induced intra-operatively and the vertigo was not improved significantly after operation. Of 12 patients with VP during the mean 116-month follow-up, 11 patients had no recurrence of neurovascular compressive vertigo and the effective control rate of vertigo was 91.7%.

Conclusions and significance: Keyhole microvascular decompression with local anesthesia is not only an effective method for treating VP and controlling neurovascular compressive vertigo, but also has definite clinical significance in the diagnosis of VP.

Chinese abstract

背景：前庭阵发性神经性疾病（VP）的病理生理和病因尚不清楚, 而且由于缺乏可靠的VP诊断特征, 临床诊断将以排除法为主。

目的：评价局部麻醉下微创微血管减压术对VP的诊断意义和疗效。

材料与方法：对54例三叉神经痛、面肌痉挛和舌咽神经痛患者行局麻下微创微血管减压术, 其中十二例同时伴有VP。对12例VP患者采用症状自评量表进行术后眩晕评定, 平均随访116个月（114～118个月）。

结果：12例VP患者前庭神经根区有耳蜗前庭神经血管压迫, 其中11例术中出现神经血管压迫性眩晕, 术后眩晕消失, 1例术中无神经血管压迫性眩晕, 术后眩晕改善不明显。随访116个月, 12例VP患者中11例无神经血管压迫性眩晕复发；眩晕有效控制率为百分之91.7。

结论及意义：局部麻醉微创微血管减压术是治疗VP和控制神经血管压迫性眩晕的有效方法, 而且对VP的诊断具有一定的临床意义。

Keywords:

• Vertigo
• cochleovestibular nerve
• cranial nerve
• vestibular paroxysmia
• neurovascular compression
• microvascular decompression
• local anesthesia

Disclosure statement

No potential conflict of interest was reported by the author(s).