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J Neurol Surg B Skull Base 2022; 83(S 02): e284-e290
DOI: 10.1055/s-0041-1725036
Original Article

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

Minsoo Kim 
1   Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
2   Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, The Republic of Korea
,
Sang-Ku Park
3   Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, The Republic of Korea
,
Seunghoon Lee
1   Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
,
Jeong-A Lee
1   Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
,
Kwan Park
1   Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
3   Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, The Republic of Korea
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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.

Keywords

microvascular decompression - superior petrosal vein - trigeminal neuralgia - complications


Publication History

Received: 06 November 2020

Accepted: 17 January 2021

Article published online:
01 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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