In Reply: Absence of Ischemic Injury After Sacrificing the Superior Petrosal Vein During Microvascular Decompression

2021 ◽  
Vol 20 (3) ◽  
pp. E260-E260
Author(s):  
Yuanxuan Xia ◽  
Michael Lim
Keyword(s):  
Microvascular Decompression ◽  
Ischemic Injury ◽  
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

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.

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.

scholarly journals Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

2018 ◽  
Vol 45 (1) ◽  
pp. E2 ◽  
Author(s):  
Hiroki Toda ◽  
Koichi Iwasaki ◽  
Naoya Yoshimoto ◽  
Yoshihito Miki ◽  
Hirokuni Hashikata ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Decompression Surgery ◽  
Vascular Compression ◽  
Petrosal Vein ◽  
Venous Compression ◽  
Bridging Veins ◽  
Superior Petrosal Vein ◽  
Microvascular Decompression Surgery

OBJECTIVEIn microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm, the bridging veins are dissected to provide the surgical corridors, and the veins of the brainstem may be mobilized in cases of venous compression. Strategy and technique in dissecting these veins may affect the surgical outcome. The authors investigated solutions for minimizing venous complications and reviewed the outcome for venous decompression.METHODSThe authors retrospectively reviewed their surgical series of microvascular decompression for trigeminal neuralgia and hemifacial spasm in patients treated between 2005 and 2017. Surgical strategies included preservation of the superior petrosal vein and its tributaries, thorough dissection of the arachnoid sleeve that enveloped these veins, cutting of the inferior petrosal vein over the lower cranial nerves, and mobilization or cutting of the veins of the brainstem that compressed the nerve roots. The authors summarized the patient characteristics, operative findings, and postoperative outcomes according to the vascular compression types as follows: artery alone, artery and vein, and vein alone. They analyzed the data using chi-square and 1-way ANOVA tests.RESULTSThe cohort was composed of 121 patients with trigeminal neuralgia and 205 patients with hemifacial spasm. The superior petrosal vein and its tributaries were preserved with no serious complications in all patients with trigeminal neuralgia. Venous compression alone and arterial and venous compressions were observed in 4% and 22%, respectively, of the patients with trigeminal neuralgia, and in 1% and 2%, respectively, of those with hemifacial spasm (p < 0.0001). In patients with trigeminal neuralgia, 35% of those with artery and venous compressions and 80% of those with venous compression alone had atypical neuralgia (p = 0.015). The surgical cure and recurrence rates of trigeminal neuralgias with venous compression were 60% and 20%, respectively, and with arterial and venous compressions the rates were 92% and 12%, respectively (p < 0.0001, p = 0.04). In patients with hemifacial spasm who had arterial and venous compressions, their recurrence rate was 60%, and that was significantly higher compared to other compression types (p = 0.0008).CONCLUSIONSDissection of the arachnoid sleeve that envelops the superior petrosal vein may help to reduce venous complications in surgery for trigeminal neuralgia. Venous compression may correlate with worse prognosis even with thorough decompression, in both trigeminal neuralgia and hemifacial spasm.

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