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J Neurol Surg B Skull Base
DOI: 10.1055/a-2587-6267
Original Article

Mini-invasive Anterior Petrosal Intertentorial Approach for Trigeminal Neuralgia: Rationale and Limits of the Technique

L. Giammattei
1   Departement of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
,
J.W. Squair
1   Departement of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
,
D. Peters 
2   Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
,
A. Fava
3   Department of Neurosurgery, Neuromed, Pozzilli, Italy
,
A. Mellal
1   Departement of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
,
V. Aureli
1   Departement of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
,
S. Pistocchi
4   Department of Medical Radiology, Service of Diagnostic and Interventional Radiology, Neuroradiology Unit, Lausanne University Hospital, Lausanne, Switzerland
,
D. Starnoni
1   Departement of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
,
R.T. Daniel
1   Departement of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
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Abstract

Background and Objectives

The retrosigmoid approach (RSA) is considered the standard surgical choice to address a neurovascular conflict involving the trigeminal nerve. The subtemporal transtentorial approach (STA) represents the main alternative. We describe here the mini-invasive anterior petrosal intertentorial approach with a view to reduce complications associated with the standard STA.

Methods

Mini-invasive anterior petrosal intertentorial approach (M-APIA) was described for a case of refractory trigeminal neuralgia. This approach includes a very limited amount of drilling of the petrous ridge to expose the posterior fossa dura and the superior petrosal sinus to facilitate the subsequent tentorial peeling. Tentorial peeling enables to develop an intertentorial plane between the temporal tentorial leaf (TTL) and the posterior fossa tentorial leaf (PFTL). A linear incision over the posterior fossa dura and the PFTL offers a wide exposure of the neurovascular conflict.

Results

M-APIA enables to expose the root entry zone (REZ) of the trigeminal nerve without exposing the temporal lobe or the cerebellum.

Conclusion

M-APIA can be considered as a safe alternative to the RSA or STA for trigeminal microvascular decompression (MVD), especially for select cases. Additional studies are needed for a better understanding of its advantages and disadvantages.

Keywords

anterior petrosal intertentorial approach - trigeminal neuralgia - microvascular decompression - tentorial peeling

Consent

Informed consent to participate and for publication was obtained from all individual participants included in the study.




Publikationsverlauf

Eingereicht: 16. November 2024

Angenommen: 11. April 2025

Accepted Manuscript online:
15. April 2025

Artikel online veröffentlicht:
02. Mai 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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