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.