Surgical treatment of patients with symptomatic Kimmerle's anomaly using video endoscopy

Background: Clinical manifestations of Kimmerle’s anomaly are detected in 5.5 to 20% of patients. The main reason for the development of symptoms is prolonged compression of the V3 (atlantic) segment of the vertebral artery in the bone ring as a result of the atlantooccipital membrane’s exostosis. To date, the final tactics for treating patients with Kimmerle’s anomaly has not been determined. The effectiveness of conservative methods of therapy does not exceed 40%. The aim Of this study was to evaluate the results of a minimally invasive surgical treatment of patients with symptomatic Kimmerle’s anomaly using video endoscopic assistance. Methods: In the period from 2020 to 2022, 15 patients were operated on. The indication for the surgical treatment was the lack of the conservative therapy’s effect for 1 year from the onset of the disease, aggravation of the disease symptoms, a decrease in the blood flow through the vertebral artery at the Kimmerle’s anomaly side when turning the head. The vertebral artery decompression was performed using video endoscopy through a posterior median approach in two (13%) patients and through a paravertebral intermuscular approach (4 cm incision in the occipitocervical region in the projection of the Kimmerle’s anomaly) in thirteen (87%) patients. Results: The outcome of the disease was assessed at the time of discharge from the hospital, as well as in 6 and in 12 months after the operation. Following the surgical treatment, all the patients showed the complete regression of symptoms and restoration of the blood flow velocities in the vertebral artery. There were no complications after the operation. The use of video endoscopy made it possible to reduce the size of the surgical wound from 12 cm to 4 cm, which contributed to a decrease in the intensity of pain in the postoperative period, early activation and a decrease in the duration of the inpatient treatment. Conclusion: With the proper selection of patients with Kimmerle’s anomaly, decompression of the V3 segment of the VA using video endoscopy is a safe and effective method of treatment

Long-term results of microvascular decompression with video endoscopy in the treatment of patients with atypical trigeminal neuralgia

Background: The incidence of atypical trigeminal neuralgia (aNTN) varies from 1 to 7 per 100,000 population per year. The main cause of its development is compression of the trigeminal nerve (TN) root by a vein and/or artery in the cerebellar cistern. To date, the final tactics of treatment for patients with aNTN has not been specified. The effectiveness of conservative methods of therapy does not exceed 50%. The aim of this study was to evaluate the results of microvascular decompression using video endoscopy in the treatment of patients with atypical trigeminal neuralgia. Methods: In the period from 2014 to 2021, 34 patients with aNTN were operated on, of which 18 (53%) patients had neuropathic pain (more than 4 points on the DN4 scale), and 15 (44%) patients had transformation of classical trigeminal neuralgia into atypical neuralgia. The conservative therapy (carbamazepine, gabapentin, pregabalin), administered to all the patients in the preoperative period, was not accompanied by a significant relief of pain syndrome. The maximum intensity of pain upon admission to the hospital was, according to the visual analog scale (VAS), 10 points, according to the BNI (Barrow Neurological Institute) Pain Intensity Scale V (severe, persistent pain). All the patients underwent microvascular decompression of the trigeminal nerve root with the use of Teflon; in 12 (35%) patients, in addition to microscopy, video endoscopy was used. The average follow-up period after the surgery was 3.41.7 years (from 1 to 5 years). Results: In all (100%) patients, the pain was completely eliminated (BNI I) after the surgery. A total five-year excellent and good outcome of the disease on the J. Miller and BNI scale (I -II) was noted in 80% (n=27) of patients with aNTN. The risk of pain recurrence after microvascular decompression was 14% (n=3) in the first three years, and 34% (n=4) after 5 years. The use of video endoscopy made it possible to identify the blood vessels compressing the root of the trigeminal nerve with a minimal displacement of the cerebellum and cranial nerves when visualizing the neurovascular conflict. Conclusion: The microvascular decompression method with video endoscopy is effective in the treatment of patients with aNTN