[Microsurgical treatment of XXXX . Results and prognostic factors of microsurgical vascular decompression].

@entity1 @entity2695 @entity5 @entity4254 @entity158 @entity531
The authors have reviewed 100 cases of @entity4254 operated upon at the cerebello-pontine angle using microsurgical techniques, i.e. 20% of their total series of 513 @entity1 with tic douloureux, 413 of them having been submitted to percutaneous R.F.--thermocoagulation. In 10 of the above 100 @entity1 , a @entity5 or an @entity2695 have been found and with its removal a total relief of @entity158 has been obtained. In all but three of the other 90 @entity1 , a @entity531 has been revealed. In 17 of them a selective section of the trigeminal root had to be performed, as its cross-compression could not be eliminated. A total cure was achieved in all but three cases in which the result was only partial. In 70 @entity1 a microvascular decompression (MVD) was performed and in 68 of them a follow-up of 1 to 5 years has been analyzed. In 82.4% the results were excellent. Further 7.3% thought to be benefited by the operation; although they still had some @entity158 , they were well controlled by medical treatment. In 10.3% an unsatisfactory improvement, failure or recurrence were noted. Then a critical study of the whole material has been made in search for the causes of unsatisfactory results and for the possibilities of making the efficacity of MVD ascertained in a higher percentage of @entity1 . The results of this study lead to definite conclusions, a part of which is quoted below: Some of clinical findings showed to be of paramount importance for the prognosis. The most evident has been a highly significant difference in the percentage of a total cure in @entity1 with attacks of tic douloureux only (94.5%) and in those with the same type of attacks, but associated with permanent @entity158 (58.3%). The analysis of the operative findings and of the details of the surgical procedure indicated to a necessity of restitution of the normal shape and course of the trigeminal root from the petrous ridge up to the entry-zone and of an adequate root protection (for instance with Dacron), after the Vth nerve had been detached from the conflicting vessel. A correlation of the above findings with the angiographic ones has been made. A measurable method has been used to make available data which could be informative as to the presence of a conflict, as well as to its anatomical cause. But this still needs a further critical elaboration.
