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"Birdlime" technique using TachoSil tissue sealing sheet soaked with fibrin glue for sutureless vessel transposition in microvascular decompression: operative technique and nuances.
J Neurosurg. 2018 05; 128(5):1522-1529.JN

Abstract

OBJECTIVE

Microvascular decompression (MVD) is effective for the treatment of trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia. The transposition technique is the standard procedure to avoid adhesions and granuloma around the decompression site but is more complex and difficult to perform than the interposition technique. The authors describe a simple and safe MVD transposition procedure they call the "birdlime" technique, which uses a tissue glue-coated collagen sponge soaked with fibrin glue, and the results of this technique.

METHODS

The authors retrospectively reviewed the medical charts and radiographic findings of 27 consecutive patients with TN (8 patients) and HFS (19 patients) who, between January 2012 and December 2015, had undergone an MVD transposition procedure utilizing a tissue glue-coated collagen sponge (TachoSil tissue sealing sheet) soaked with fibrin glue (Tisseel 2-component fibrin sealant, vapor heated). Offending arteries among the patients with TN were the superior cerebellar artery (SCA) in 5 patients, the SCA and anterior inferior cerebellar artery (AICA) in 2, and the AICA in 1. Those among the patients with HFS were the vertebral artery (VA) in 3 patients, the VA and AICA in 4, the VA and posterior inferior cerebellar artery (PICA) in 3, the PICA in 4, the AICA in 1, the AICA-PICA in 3, and the PICA and AICA in 1. Operations were performed according to the Jannetta procedure. The offending artery was transposed and fixed to the dura mater of the petrous bone using TachoSil pieces soaked with fibrin glue. Postoperative constructive interference in steady-state MRI was performed to evaluate the change in the position of the offending artery.

RESULTS

Transposition of the offending artery was easily and safely performed in all patients. All patients had total remission of symptoms directly after the procedure. No severe complications occurred. The postoperative course was uneventful. No recurrences, adhesions, or dysfunction of the cranial nerves was observed in any of the patients. Postoperative MRI showed that the offending vessels were displaced and fixed in the appropriate position.

CONCLUSIONS

The described transposition technique provides an easy and adjustable way to perform MVD safely and effectively. In addition, this transposition and fixation technique is simple and avoids the risk of needle injury close to the cranial nerves and vessels. This simple sutureless technique is recommended for MVD to reduce the risk of intraoperative neurovascular injury.

Authors+Show Affiliations

1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama; and.1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama; and.1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama; and.1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama; and.1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama; and.1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama; and.2Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.2Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama; and.1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama; and.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28799873

Citation

Otani, Naoki, et al. ""Birdlime" Technique Using TachoSil Tissue Sealing Sheet Soaked With Fibrin Glue for Sutureless Vessel Transposition in Microvascular Decompression: Operative Technique and Nuances." Journal of Neurosurgery, vol. 128, no. 5, 2018, pp. 1522-1529.
Otani N, Toyooka T, Fujii K, et al. "Birdlime" technique using TachoSil tissue sealing sheet soaked with fibrin glue for sutureless vessel transposition in microvascular decompression: operative technique and nuances. J Neurosurg. 2018;128(5):1522-1529.
Otani, N., Toyooka, T., Fujii, K., Kumagai, K., Takeuchi, S., Tomiyama, A., Nakao, Y., Yamamoto, T., Wada, K., & Mori, K. (2018). "Birdlime" technique using TachoSil tissue sealing sheet soaked with fibrin glue for sutureless vessel transposition in microvascular decompression: operative technique and nuances. Journal of Neurosurgery, 128(5), 1522-1529. https://doi.org/10.3171/2017.1.JNS161243
Otani N, et al. "Birdlime" Technique Using TachoSil Tissue Sealing Sheet Soaked With Fibrin Glue for Sutureless Vessel Transposition in Microvascular Decompression: Operative Technique and Nuances. J Neurosurg. 2018;128(5):1522-1529. PubMed PMID: 28799873.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "Birdlime" technique using TachoSil tissue sealing sheet soaked with fibrin glue for sutureless vessel transposition in microvascular decompression: operative technique and nuances. AU - Otani,Naoki, AU - Toyooka,Terushige, AU - Fujii,Kazuya, AU - Kumagai,Kosuke, AU - Takeuchi,Satoru, AU - Tomiyama,Arata, AU - Nakao,Yasuaki, AU - Yamamoto,Takuji, AU - Wada,Kojiro, AU - Mori,Kentaro, Y1 - 2017/08/11/ PY - 2017/8/12/pubmed PY - 2019/9/13/medline PY - 2017/8/12/entrez KW - AICA = anterior inferior cerebellar artery KW - HFS = hemifacial spasm KW - ICG = indocyanine green KW - MVD = microvascular decompression KW - PICA = posterior inferior cerebellar artery KW - REZ = root exit zone KW - SCA = superior cerebellar artery KW - TN = trigeminal neuralgia KW - TachoSil KW - VA = vertebral artery KW - fibrin glue KW - functional neurosurgery KW - microvascular decompression KW - surgical technique KW - vessel transposition SP - 1522 EP - 1529 JF - Journal of neurosurgery JO - J Neurosurg VL - 128 IS - 5 N2 - OBJECTIVE Microvascular decompression (MVD) is effective for the treatment of trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia. The transposition technique is the standard procedure to avoid adhesions and granuloma around the decompression site but is more complex and difficult to perform than the interposition technique. The authors describe a simple and safe MVD transposition procedure they call the "birdlime" technique, which uses a tissue glue-coated collagen sponge soaked with fibrin glue, and the results of this technique. METHODS The authors retrospectively reviewed the medical charts and radiographic findings of 27 consecutive patients with TN (8 patients) and HFS (19 patients) who, between January 2012 and December 2015, had undergone an MVD transposition procedure utilizing a tissue glue-coated collagen sponge (TachoSil tissue sealing sheet) soaked with fibrin glue (Tisseel 2-component fibrin sealant, vapor heated). Offending arteries among the patients with TN were the superior cerebellar artery (SCA) in 5 patients, the SCA and anterior inferior cerebellar artery (AICA) in 2, and the AICA in 1. Those among the patients with HFS were the vertebral artery (VA) in 3 patients, the VA and AICA in 4, the VA and posterior inferior cerebellar artery (PICA) in 3, the PICA in 4, the AICA in 1, the AICA-PICA in 3, and the PICA and AICA in 1. Operations were performed according to the Jannetta procedure. The offending artery was transposed and fixed to the dura mater of the petrous bone using TachoSil pieces soaked with fibrin glue. Postoperative constructive interference in steady-state MRI was performed to evaluate the change in the position of the offending artery. RESULTS Transposition of the offending artery was easily and safely performed in all patients. All patients had total remission of symptoms directly after the procedure. No severe complications occurred. The postoperative course was uneventful. No recurrences, adhesions, or dysfunction of the cranial nerves was observed in any of the patients. Postoperative MRI showed that the offending vessels were displaced and fixed in the appropriate position. CONCLUSIONS The described transposition technique provides an easy and adjustable way to perform MVD safely and effectively. In addition, this transposition and fixation technique is simple and avoids the risk of needle injury close to the cranial nerves and vessels. This simple sutureless technique is recommended for MVD to reduce the risk of intraoperative neurovascular injury. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/28799873/"Birdlime"_technique_using_TachoSil_tissue_sealing_sheet_soaked_with_fibrin_glue_for_sutureless_vessel_transposition_in_microvascular_decompression:_operative_technique_and_nuances_ L2 - https://thejns.org/doi/10.3171/2017.1.JNS161243 DB - PRIME DP - Unbound Medicine ER -