Teflon bridge technique for endoscopic-assisted microvascular decompression of ectatic basilar artery and anterior inferior cerebellar artery for trigeminal neuralgia: operative video and technical nuances.

James K Liu,Asif Shafiq

doi:10.3171/2020.7.focvid2032

Abstract

In this illustrative operative video, the authors demonstrate a Teflon bridge technique to achieve safe transposition of a large, tortuous ectatic basilar artery (BA) and anterior inferior cerebellar artery (AICA) complex to decompress the root entry zone (REZ) of the trigeminal nerve in a 61-year-old woman with refractory trigeminal neuralgia via an endoscopic-assisted retractorless microvascular decompression. Postoperatively, the patient experienced immediate facial pain relief without requiring further medications. The Teflon bridge technique can be a safe alternative to sling techniques when working in narrow surgical corridors between delicate nerves and vessels. The operative technique and surgical nuances are demonstrated.The video can be found here: https://youtu.be/hIHX7EvZc1c

Highlights

In this illustrative operative video, the authors demonstrate a Teflon bridge technique to achieve safe transposition of a large, tortuous ectatic basilar artery (BA) and anterior inferior cerebellar artery (AICA) complex to decompress the root entry zone (REZ) of the trigeminal nerve in a 61-year-old woman with refractory trigeminal neuralgia via an endoscopicassisted retractorless microvascular decompression
We used a larger skin incision to accommodate for a larger bone opening and dural opening, so that we would have more surgical degrees of freedom when working with a large ectatic basilar artery
As predicted on the FIESTA MRI, a tortuous ectatic basilar artery is identified displacing the trigeminal nerve toward the tentorium

Summary

Introduction

In this illustrative operative video, the authors demonstrate a Teflon bridge technique to achieve safe transposition of a large, tortuous ectatic basilar artery (BA) and anterior inferior cerebellar artery (AICA) complex to decompress the root entry zone (REZ) of the trigeminal nerve in a 61-year-old woman with refractory trigeminal neuralgia via an endoscopicassisted retractorless microvascular decompression. This is Dr James Liu, and I will be demonstrating the Teflon bridge technique for endoscopic-assisted microvascular decompression of an ectatic basilar artery and anterior inferior cerebellar artery for trigeminal neuralgia. Preoperative FIESTA MRI demonstrated an ectatic basilar artery compressing the left trigeminal nerve at the root entry zone.[1] The nerve appeared to be displaced superiorly toward the tentorium. The patient underwent a left retrosigmoid craniectomy for endoscopic-assisted microvascular decompression.[2,3,4] A lateral park-bench position is used and a left-sided C-shaped skin incision is marked roughly three fingerbreadths behind the pinna.

Results

Conclusion