Trans-cerebellar-fissure approach and via-venous corridor in microvascular decompression for trigeminal neuralgia

Abstract

Objective To summarize the efficacy and experience of trans-cerebellar-fissure approach and via-venous corridor in microvascular decompression (MVD) of trigeminal neuralgia (TN). Methods The clinical data, operation videos and outcomes of 420 patients with TN treated between March 2014 and September 2015 at Department of Neurosurgery, Hangzhou First People's Hospital were retrospectively analyzed. Results Among all patients, 219 cases (52.1%) had a sufficient exposure of trigeminal nerve after dissection through cerebellar petrosal fissure and lateral venous corridor. An extra opening of medial or intermediate venous corridor was needed for the other 201 cases (47.9%) to fully expose and decompress the fifth cranial nerve. No severe complications including death, disability, petrosal vein injures, hearing disturbance or facial paralysis directly caused by cerebellar retraction occurred. There were 3 (0.7%) patients developing severe facial numbness, 1 patient (0.2%) undergoing reoperation to evacuate cerebellar hematoma and 1 patient (0.2%) reporting permanent hearing loss post surgery by erroneous coagulation of a labyrinth artery. All patients were followed up for 9-30 months with an average of 24.0±8.5 months. At 1 month post operation, the rate of excellent outcomes (T0+ T1) was 94.0% (395 cases) and increased to 96.0% (403 cases) after 3 months with the remission of some non-specific symptoms. Pain recurrence was reported in 5.5% (23 cases) of all patients (23 case), and the overall rate of excellent outcomes was 91.0% (382 cases) at the end of follow-up. Conclusions Trans-cerebellar-fissure approach and via-venous corridor could be beneficial supplements for conventional approach of MVD in helping provide sufficient exposure of decompression of trigeminal nerve and reduce injuries of the petrous vein, facial and trigeminal nerves. Key words: Trigeminal neuralgia; Microvascular decompression; Vein; Petrosal fissure