Modified Techniques of Microvascular Decompression in Patients with Trigeminal Neuralgia: Recent Encounters With 80 Consecutive patients.Hidetoshi Kasuya, MD1, Shigeru Tani, MD, PhD11Tokyo, Japan Keywords: trigeminal neuralgia, technique, microvascular decompression, outcome, painInteractive Manuscript
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What is the background behind your study?
Recurrence and unsuccessful rates of microvascular decompression for trigeminal neuralgia established by Jannetta have been reported to be about 20-25%.
What is the purpose of your study?
We examined whether modified techniques improve surgical results.
Describe your patient group.
Twenty-three patients were <70 in age (26-93); 50 were female; 46 involved the right side.
Describe what you did.
Based on surgery for recurrent trigeminal neuralgia and complications caused by the conventional approach, we have applied the following modified techniques for improving success rate: not use a prosthesis but move the compressed artery distally and attach to the dura using Teflon sheet with fibrin glue; dissect at least the medial part of the horizontal fissure to visualize REZ of the trigeminal nerve; coagulate or move compressed veins even if arterial compression is clear. For a reduction in complications related to cerebellar and cranial nerve injury, preserve the petrosal vein and do not use a retractor. Since April 2007, we have encountered 80 consecutive patients with trigeminal neuralgia.
Describe your main findings.
A prosthesis was not used in all 80; the horizontal fissure could be totally dissected in 43; the vein was moved or coagulated together with transposition of the artery in 19. The main trunk of the petrosal vein could be preserved in all 80. A retractor was not used in 50. Complete cure without medication was achieved in 78 patients at an average follow-up of 26 months. Facial numbness was found in 5; hearing disturbance in 1. No hematoma nor cerebellar swelling was observed.
Describe the main limitation of this study.
This is a retrospective study.
Describe your main conclusion.
Our modified techniques may improve surgical results.
Describe the importance of your findings and how they can be used by others.
This question was not answered by the author
Recurrence and unsuccessful rates of microvascular decompression for trigeminal neuralgia established by Jannetta have been reported to be about 20-25%.
We examined whether modified techniques improve surgical results.
Twenty-three patients were <70 in age (26-93); 50 were female; 46 involved the right side.
Based on surgery for recurrent trigeminal neuralgia and complications caused by the conventional approach, we have applied the following modified techniques for improving success rate: not use a prosthesis but move the compressed artery distally and attach to the dura using Teflon sheet with fibrin glue; dissect at least the medial part of the horizontal fissure to visualize REZ of the trigeminal nerve; coagulate or move compressed veins even if arterial compression is clear. For a reduction in complications related to cerebellar and cranial nerve injury, preserve the petrosal vein and do not use a retractor. Since April 2007, we have encountered 80 consecutive patients with trigeminal neuralgia.
A prosthesis was not used in all 80; the horizontal fissure could be totally dissected in 43; the vein was moved or coagulated together with transposition of the artery in 19. The main trunk of the petrosal vein could be preserved in all 80. A retractor was not used in 50. Complete cure without medication was achieved in 78 patients at an average follow-up of 26 months. Facial numbness was found in 5; hearing disturbance in 1. No hematoma nor cerebellar swelling was observed.
This is a retrospective study.
Our modified techniques may improve surgical results.
Project Roles:
H. Kasuya (), S. Tani ()
