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Microvascular Decompression for Geniculate Neuralgia through a Retrosigmoid Approach.
J Neurol Surg B Skull Base 2019; 80(Suppl 3):S322JN

Abstract

Objectives To describe a retrosigmoid approach for the microvascular sectioning of the nervus intermedius and decompression of the 5th and 9th cranial nerves, with emphasis on microsurgical anatomy and technique. Design A retrosigmoid craniectomy is performed in the lateral decubitus position. The dura is opened and cerebrospinal fluid (CSF) is released from the cisterna magna and cerebellopontine cistern. Dynamic retraction without rigid retractors is performed. Subarachnoid dissection of the cerebellopontine angle exposes the 7th to 8th nerve complex. A neuromonitoring probe is used with careful inspection of the microsurgical anatomy to identify the facial nerve and the nervus intermedius as they enter the internal auditory meatus. The nervus intermedius is severed. A large vein coursing superiorly across cranial 9th nerve was coagulated and cut. A Teflon pledget is inserted between a small vessel and the 5th nerve. Photographs of the region are borrowed from Dr. Rhoton's laboratory to illustrate the microsurgical anatomy. Participants The senior author performed the surgery. The video was edited by Drs. V.N. and J.B. Outcome Measures Outcome was assessed by postoperative neurological function. Results The nervus intermedius was successfully cut and the 5th and 9th nerves were decompressed. The patient's pain resolved after surgery and at later follow-up. Conclusions Understanding the microsurgical anatomy of the cerebellopontine angle is necessary to identify the cranial nerves involved in facial pain syndromes. Subarachnoid dissection and meticulous microsurgical techniques are key elements for a successful microvascular decompression. The link to the video can be found at: https://youtu.be/pV5Wip7WusE .

Authors+Show Affiliations

Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States.Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States.Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States.Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31143613

Citation

Nguyen, Vincent N., et al. "Microvascular Decompression for Geniculate Neuralgia Through a Retrosigmoid Approach." Journal of Neurological Surgery. Part B, Skull Base, vol. 80, no. Suppl 3, 2019, pp. S322.
Nguyen VN, Basma J, Sorenson J, et al. Microvascular Decompression for Geniculate Neuralgia through a Retrosigmoid Approach. J Neurol Surg B Skull Base. 2019;80(Suppl 3):S322.
Nguyen, V. N., Basma, J., Sorenson, J., & Michael, L. M. (2019). Microvascular Decompression for Geniculate Neuralgia through a Retrosigmoid Approach. Journal of Neurological Surgery. Part B, Skull Base, 80(Suppl 3), pp. S322. doi:10.1055/s-0038-1676837.
Nguyen VN, et al. Microvascular Decompression for Geniculate Neuralgia Through a Retrosigmoid Approach. J Neurol Surg B Skull Base. 2019;80(Suppl 3):S322. PubMed PMID: 31143613.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microvascular Decompression for Geniculate Neuralgia through a Retrosigmoid Approach. AU - Nguyen,Vincent N, AU - Basma,Jaafar, AU - Sorenson,Jeffrey, AU - Michael,L Madison,2nd Y1 - 2018/12/24/ PY - 2018/06/02/received PY - 2018/11/11/accepted PY - 2020/06/01/pmc-release PY - 2019/5/31/entrez KW - cerebellopontine angle KW - facial nerve KW - geniculate neuralgia KW - glossopharyngeal nerve KW - internal auditory meatus KW - microsurgery KW - microvascular decompression KW - nervus intermedius KW - retrosigmoid approach KW - vagus nerve SP - S322 EP - S322 JF - Journal of neurological surgery. Part B, Skull base JO - J Neurol Surg B Skull Base VL - 80 IS - Suppl 3 N2 - Objectives To describe a retrosigmoid approach for the microvascular sectioning of the nervus intermedius and decompression of the 5th and 9th cranial nerves, with emphasis on microsurgical anatomy and technique. Design A retrosigmoid craniectomy is performed in the lateral decubitus position. The dura is opened and cerebrospinal fluid (CSF) is released from the cisterna magna and cerebellopontine cistern. Dynamic retraction without rigid retractors is performed. Subarachnoid dissection of the cerebellopontine angle exposes the 7th to 8th nerve complex. A neuromonitoring probe is used with careful inspection of the microsurgical anatomy to identify the facial nerve and the nervus intermedius as they enter the internal auditory meatus. The nervus intermedius is severed. A large vein coursing superiorly across cranial 9th nerve was coagulated and cut. A Teflon pledget is inserted between a small vessel and the 5th nerve. Photographs of the region are borrowed from Dr. Rhoton's laboratory to illustrate the microsurgical anatomy. Participants The senior author performed the surgery. The video was edited by Drs. V.N. and J.B. Outcome Measures Outcome was assessed by postoperative neurological function. Results The nervus intermedius was successfully cut and the 5th and 9th nerves were decompressed. The patient's pain resolved after surgery and at later follow-up. Conclusions Understanding the microsurgical anatomy of the cerebellopontine angle is necessary to identify the cranial nerves involved in facial pain syndromes. Subarachnoid dissection and meticulous microsurgical techniques are key elements for a successful microvascular decompression. The link to the video can be found at: https://youtu.be/pV5Wip7WusE . SN - 2193-6331 UR - https://www.unboundmedicine.com/medline/citation/31143613/Microvascular_Decompression_for_Geniculate_Neuralgia_through_a_Retrosigmoid_Approach L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0038-1676837 DB - PRIME DP - Unbound Medicine ER -