Transposition of Superior Cerebellar Artery for Microvascular Decompression in Trigeminal Neuralgia Using an In Situ Superior Petrosal Vein Sling Technique.
Microvascular decompression
Sling
Superior cerebellar artery
Superior petrosal vein
Transposition
Trigeminal neuralgia
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
06
08
2019
revised:
04
11
2019
accepted:
05
11
2019
pubmed:
17
11
2019
medline:
7
3
2020
entrez:
17
11
2019
Statut:
ppublish
Résumé
Several microvascular decompression technical variations for the treatment of medically refractory trigeminal neuralgia have been proposed that can be categorized generally as interposition and transposition techniques. These latter approaches, so-called slinging techniques, have been increasing in popularity, because they can possibly reduce the long-term recurrence rates by preventing the formation of fibrosis and granulomas at the decompression site. We have reported a technique for transposition of the superior cerebellar artery for microvascular decompression in trigeminal neuralgia using the superior petrosal vein as an in situ sling to anchor and reroute the artery away from the nerve. We have presented a technical report with illustrative intraoperative images and video from 2 cases of trigeminal neuralgia in which the superior petrosal vein was used as a simple and straightforward in situ sling for transposition of the superior cerebellar artery. The technique was applied successfully in 2 patients with complete and immediate remission of trigeminal neuralgia, without surgical morbidity. The most frequent neurovascular conflict in trigeminal neuralgia involves the superior cerebellar artery, and the strategic location of the superior petrosal vein relative to this neurovascular complex allows for its use as a natural in situ sling that reroutes the artery and prevents its recoil against the nerve. This technique can be added to the increasing armamentarium of transposition techniques for microvascular decompression, with the advantage of simplicity and no requirement for a complex prosthesis to secure the transposition.
Sections du résumé
BACKGROUND
BACKGROUND
Several microvascular decompression technical variations for the treatment of medically refractory trigeminal neuralgia have been proposed that can be categorized generally as interposition and transposition techniques. These latter approaches, so-called slinging techniques, have been increasing in popularity, because they can possibly reduce the long-term recurrence rates by preventing the formation of fibrosis and granulomas at the decompression site. We have reported a technique for transposition of the superior cerebellar artery for microvascular decompression in trigeminal neuralgia using the superior petrosal vein as an in situ sling to anchor and reroute the artery away from the nerve.
METHODS
METHODS
We have presented a technical report with illustrative intraoperative images and video from 2 cases of trigeminal neuralgia in which the superior petrosal vein was used as a simple and straightforward in situ sling for transposition of the superior cerebellar artery.
RESULTS
RESULTS
The technique was applied successfully in 2 patients with complete and immediate remission of trigeminal neuralgia, without surgical morbidity.
CONCLUSION
CONCLUSIONS
The most frequent neurovascular conflict in trigeminal neuralgia involves the superior cerebellar artery, and the strategic location of the superior petrosal vein relative to this neurovascular complex allows for its use as a natural in situ sling that reroutes the artery and prevents its recoil against the nerve. This technique can be added to the increasing armamentarium of transposition techniques for microvascular decompression, with the advantage of simplicity and no requirement for a complex prosthesis to secure the transposition.
Identifiants
pubmed: 31733391
pii: S1878-8750(19)32865-7
doi: 10.1016/j.wneu.2019.11.029
pii:
doi:
Types de publication
Case Reports
Journal Article
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
402-407Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.