Commentary: Surgical Relevance of the Suprameatal Tubercle During Superior Petrosal Vein Sparing Trigeminal Nerve Microvascular Decompression

2021 ◽  
Author(s):  
Kim J Burchiel
Keyword(s):  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Petrosal Vein ◽  
Superior Petrosal Vein

Surgical Relevance of the Suprameatal Tubercle During Superior Petrosal Vein-Sparing Trigeminal Nerve Microvascular Decompression

2021 ◽  
Author(s):  
Robert C Rennert ◽  
Michael G Brandel ◽  
Marcus L Stephens ◽  
Analiz Rodriguez ◽  
Thomas W Morris ◽  
...  
Keyword(s):  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Area Under The Curve ◽  
Magnetic Resonance Images ◽  
Petrosal Vein ◽  
Endoscopic Assistance ◽  
Recorded Data ◽  
Superior Petrosal Vein ◽  
Roc Area ◽  
First Time

Abstract BACKGROUND An enlarged suprameatal tubercle (SMT) can obscure visualization of the trigeminal nerve and require removal during microvascular decompression (MVD) surgery, especially when the superior petrosal vein (SPV) complex is preserved. OBJECTIVE To define the incidence and important variables affecting the need for SMT removal with an SPV-sparing trigeminal nerve MVD. METHODS Retrospective single-institution review identified patients who underwent a first-time, SPV-sparing MVD for trigeminal neuralgia (TGN) over a 26-mo period. SMT length (SMT-L), SMT width (SMT-W), and peri-trigeminal cerebellopontine cisternal thickness (CT) were measured from axial high-resolution magnetic resonance images. Need for SMT removal and use of endoscopic assistance was recorded. Data were analyzed using unpaired t-tests, and receiver operating characteristic (ROC)/area under the curve testing. RESULTS A total of 43 MVD surgeries for TGN on 42 patients (mean age 52.7 ± 14.4 yr) were analyzed. Mean SMT-L, SMT-W, and CT were 9.8 ± 1.6, 2.0 ± 0.8, and 4.2 ± 1.5 mm, respectively. SMT removal via drilling was required in 4/43 cases (9.3%). Endoscopic assistance was used in 3 cases (2 SMT removed and 1 SMT preserved). SMT-W was the biggest predictor of the need for SMT removal on ROC analysis (area under the curve 0.97, 0.92-1.0 95% CI). The combined thresholds of SMT-W ≥ 3.2 mm and CT ≤ 3.5 mm demonstrated 100% sensitive and 100% specificity for the need to remove the SMT on optimal cutoff analysis. CONCLUSION SMT drilling is necessary in nearly 10% of SPV-sparing MVDs for TGN. The combination of SMT width and cerebellopontine cistern thickness is predictive of the need for SMT removal.

Safety of Superior Petrosal Vein Sacrifice During Microvascular Decompression of the Trigeminal Nerve

2017 ◽  
Vol 103 ◽  
pp. 84-87 ◽  
Author(s):  
Omar. N. Pathmanaban ◽  
Frazer O'Brien ◽  
Yahia Z. Al-Tamimi ◽  
Charlotte L. Hammerbeck-Ward ◽  
Scott A. Rutherford ◽  
...  
Keyword(s):  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Petrosal Vein ◽  
Superior Petrosal Vein

Absence of Ischemic Injury after Sacrificing the Superior Petrosal Vein during Microvascular Decompression

2019 ◽  
Author(s):  
Yuanxuan Xia ◽  
Timothy Y Kim ◽  
Leila A Mashouf ◽  
Kisha K Patel ◽  
Risheng Xu ◽  
...  
Keyword(s):  
Microvascular Decompression ◽  
Ischemic Injury ◽  
Petrosal Vein ◽  
Superior Petrosal Vein

scholarly journals 106 Sacrificing the Superior Petrosal Vein During Microvascular Decompression Does Not Increase Vascular Complications: Experience From One Institution

Neurosurgery ◽  
2018 ◽  
Vol 65 (CN_suppl_1) ◽  
pp. 82-82
Author(s):  
Yuanxuan Xia ◽  
Timothy Y Kim ◽  
Leila A Mashouf ◽  
Kisha K Patel ◽  
Risheng Xu ◽  
...  
Keyword(s):  
Microvascular Decompression ◽  
Vascular Complications ◽  
Petrosal Vein ◽  
Superior Petrosal Vein

scholarly journals Suprafloccular approach via the petrosal fissure and venous corridors for microvascular decompression of the trigeminal nerve: technique notes and clinical outcomes

2018 ◽  
Vol 129 (2) ◽  
pp. 324-333 ◽  
Author(s):  
Hao Wang ◽  
Xiang Ying ◽  
Wen H. Yu ◽  
Qiang Zhu ◽  
Xiao Q. Dong ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Trigeminal Nerve ◽  
Morbidity Rate ◽  
Consecutive Series ◽  
Vestibulocochlear Nerve ◽  
Petrosal Vein ◽  
Working Space ◽  
Large Patient ◽  
Patient Series ◽  
Superior Petrosal Vein

OBJECTIVESurgical exposure and decompression of the entire trigeminal nerve in a conventional lateral supracerebellar approach can be challenging because of blockages from the superior petrosal vein complex, cerebellum, and vestibulocochlear nerve. The authors demonstrate a novel suprafloccular approach via the petrosal fissure and venous corridors that can be used as a substitute for the conventional route used to treat trigeminal neuralgia and present a consecutive series of patients and their clinical outcomes.METHODSPreoperative and postoperative clinical data from 420 patients who underwent this modified approach at Hangzhou First People’s Hospital between March 2012 and May 2014 were reviewed. The technique expands the working space by opening the petrosal fissure and dissecting adhesions between the vein of the cerebellopontine fissure and the simple lobule as needed. Via 3 surgical corridors, the entire trigeminal nerve is exposed and decompressed thoroughly with minimal retraction of the surrounding vital structures.RESULTSThe medial one-third of the trigeminal nerve accounted for the majority (275 [65.5%] cases) of neurovascular conflict sites. The lateral corridor was used in 219 (52.1%) cases, the medial corridor was used in 175 (41.7%) cases, and the intermediate corridor was used in 26 (6.2%) cases. The entire trigeminal nerve in each patient was accessed directly and decompressed properly. At the end of the 24-month follow-up period, the rate of excellent results (Kondo score of T0 or T1) was stable at approximately 90.5%. No complications were related directly to petrosal vein or vestibulocochlear nerve injury.CONCLUSIONSBased on data from the large patient series, the authors found this suprafloccular approach via the petrosal fissure and venous corridors provides full exposure and decompression of the entire trigeminal nerve, a high cure rate, and a low neurovascular morbidity rate.

Prevention of Superior Petrosal Vein Injury during Microvascular Decompression for Trigeminal Neuralgia: Operative Nuances

2021 ◽  
Author(s):  
Minsoo Kim ◽  
Sang-Ku Park ◽  
Seunghoon Lee ◽  
Jeong-A Lee ◽  
Kwan Park
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Patient Positioning ◽  
Vestibulocochlear Nerve ◽  
Neurophysiologic Monitoring ◽  
Petrosal Vein ◽  
Cerebrospinal Fluid Leaks ◽  
Superior Petrosal Vein ◽  
Surgical Corridor ◽  
Vein Injury

Abstract Background The superior petrosal vein (SPV) often obscures the surgical field or bleeds during microvascular decompression (MVD) for the treatment of trigeminal neuralgia. Although SPV sacrifice has been proposed, it is associated with multiple complications. We have performed more than 4,500 MVDs, including approximately 400 cases involving trigeminal neuralgia. We aimed to describe our operative technique and nuances to avoid SPV injury. Methods We have provided a detailed description of our institutional protocol, including the anesthesia technique, neurophysiologic monitoring, patient positioning, surgical approach, and SPV management. The surgical outcomes and treatment-related complications were retrospectively analyzed. Results No SPVs were sacrificed intentionally or accidentally during our MVD protocol for trigeminal neuralgia. In the 344 operations performed during 2006 to 2020, 269 (78.2%) patients did not require medication postoperatively, 58 (16.9%) tolerated the procedure with adequate medication, and 17 (4.9%) did not respond to MVD. Postoperatively, 35 (10.2%), 1 (0.3%), and 0 patients showed permanent trigeminal, facial, or vestibulocochlear nerve dysfunction, respectively. Wound infection occurred in five (1.5%) patients, while cerebrospinal fluid leaks occurred in three (0.9%) patients. Hemorrhagic complications appeared in four (1.2%) patients but these were unrelated to SPV injury. No surgery-related mortalities were reported. Conclusion MVD for the treatment of trigeminal neuralgia can be achieved safely without sacrificing the SPV. A key step is positioning the patient's vertex at a 10-degree elevation from the floor, which can ease venous return and loosen the SPV, making it less fragile to manipulation and providing a wider surgical corridor.

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