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J Neurol Surg B Skull Base 2024; 85(S 02): e38-e45
DOI: 10.1055/a-2198-8279
Original Article

Surgical Nuances and Predictors of Requirement for Suprameatal Tubercle Removal in Microvascular Decompression for Trigeminal Neuralgia

Koichi Iwasaki 
1   Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
2   Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan
,
Minami Uezato
1   Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
3   Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
,
Namiko Nishida
1   Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
,
Naoya Yoshimoto
1   Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
,
Kazushi Kitamura
2   Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan
,
Masanori Gomi
2   Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan
,
Hirokuni Hashikata
1   Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
,
Isao Sasaki
2   Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan
,
Hiroki Toda
1   Department of Neurosurgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
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Abstract

Objective Suprameatal tubercle (SMT), a bony prominence located above the internal acoustic meatus, is reported to impede the microscopic view during microvascular decompression (MVD) for trigeminal neuralgia (TN). For an enlarged SMT, removal of the SMT may be required in addition to the routine MVD to precisely localize the offending vessels. The objective of this study is to investigate the predictive factors influencing the requirement of SMT removal during trigeminal MVD.

Methods We retrospectively reviewed 197 patients who underwent MVD for TN, and analyzed the correlation of the SMT height and other clinicosurgical data with the necessity to remove the SMT during MVD. The parameters evaluated in the statistical analyses included maximum SMT height, patient's clinical characteristics, surgical data including the type and number of offending vessels, and surgical outcomes.

Results SMT removal was required for 20 patients among a total of enrolled 197 patients. In the univariate analysis, maximum SMT height, patient's age, and number (≥ 2) of offending vessels were associated with the requirement for SMT removal. Multivariate analysis with binary logistic regression revealed that the maximum SMT height and number (≥ 2) of offending vessels were significant factors influencing the necessity for SMT removal. A receiver operating characteristic curve analysis revealed that an SMT height ≥ 4.8 mm was the optimal cutoff value for predicting the need for SMT removal.

Conclusion Large SMTs and the presence of multiple offending vessels are helpful in predicting the technical difficulty of trigeminal MVD associated with the necessity of SMT removal.

Keywords

suprameatal tubercle - trigeminal neuralgia - microvascular decompression - petrous bone - offending vessels


Publication History

Received: 21 July 2023

Accepted: 18 October 2023

Accepted Manuscript online:
25 October 2023

Article published online:
28 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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