Journal article
Combined Macrovascular Sling Transposition of Dolichoectatic Vertebral Artery and Microvascular Decompression of Superior Cerebellar Artery for Treatment of Trigeminal Neuralgia Type 2: 2-Dimensional Operative Video
OPERATIVE NEUROSURGERY, v 25(2), pE96
Aug 2023
PMID: 37133277
Abstract
Patients with trigeminal neuralgia type 2 (TN2) suffer from the spontaneous onset of constant or near-constant pain in the trigeminal distribution, with or without concurrent lancinating pain.1 Rates of long-term pain freedom after surgery for TN2 may be lower than in patients with TN1.(2,3) As with TN1, macrovascular compression can infrequently result in TN2.(4) While a small number of publications detailing macrovascular transposition (MVT) exist in the literature,(5,6) there are a paucity of video publications detailing MVT in the complex clinical context of TN2. In this video publication, we report the unique case of a 76-year-old man who presented with TN2 secondary to severe compression of the trigeminal nerve from an ectatic left vertebral artery (VA) inferiorly and superior cerebellar artery (SCA) superiorly. The patient first elected to proceed with balloon rhizotomy, which failed to improve his near-constant burning pain. Ultimately, the patient was offered a retrosigmoid craniotomy for combined macrovascular and microvascular decompression. Intraoperatively, the ectatic left VA was mobilized from the inferior surface of the trigeminal nerve and MVT was accomplished using a Durepair sling.(5,6) Next, the SCA was sharply dissected from the superior dorsal root entry zone of the trigeminal nerve before decompression with Teflon interposition. The patient noted complete pain relief postoperatively and was discharged home without complication. The index operative video discusses technical nuances associated with the procedure, with special emphasis on the relationship of neighboring anatomic structures to the region of clip application.(7,8) The patient consented to the procedure and to the publication of his image. Infrequently, TN2 develops secondary to macrovascular compression from an ectatic vertebral artery.
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Details
- Title
- Combined Macrovascular Sling Transposition of Dolichoectatic Vertebral Artery and Microvascular Decompression of Superior Cerebellar Artery for Treatment of Trigeminal Neuralgia Type 2: 2-Dimensional Operative Video
- Publication Details
- OPERATIVE NEUROSURGERY, v 25(2), pE96
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:001031296900016
- Scopus ID
- 2-s2.0-85165221928
- Other Identifier
- 991021860716904721
InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Surgery