Modified Techniques of Microvascular Decompression in Patients with Trigeminal Neuralgia: Recent Encounters With 80 Consecutive patients.

Hidetoshi Kasuya, MD1, Shigeru Tani, MD, PhD1

1Tokyo, Japan

Keywords: trigeminal neuralgia, technique, microvascular decompression, outcome, pain

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     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 ()