Skip to main content
SpringerLink
Log in

Surgical Technique of Microvascular Decompression Surgery for Trigeminal Neuralgia

  • Chapter
  • First Online:
Microvascular Decompression Surgery

Abstract

As an etiological treatment of trigeminal neuralgia, the microvascular decompression (MVD) surgery has been popularized around the world for more than half a century. However, as a functional operation in the cerebellopontine angle, this process should be refined to enhance the cure rate and minimize the complication. After accomplishment of more than 6000 MVDs, we’ve learned something concerning the operative technique: (1) the principle of MVD is to separate the neurovascular confliction rather than isolation with prostheses; (2) identification of the conflict site is important, which relies upon a good exposure; (3) a satisfactory working space can be established by an appropriate positioning and a close-to-the-sigmoid craniectomy as well as a caudorostral approach; (4) a sharp dissection of arachnoids leads to a maximal visualization of the entire intracranial course of the nerve root; (5) all the vessels contacting the trigeminal nerve root should be treated; and (6) the dura should be closed with watertight stitches at the end. In this chapter, every single step of the procedure was detailed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Auger RG, Whisnant JP. Hemifacial spasm in rochester and olmsted county, minnesota, 1960 to 1984. Arch Neurol. 1990;47:1233–4.

    Article  CAS  PubMed  Google Scholar 

  • Barker 2nd FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334:1077–83.

    Article  Google Scholar 

  • Choudhari KA. Superior petrosal vein in trigeminal neuralgia. Br J Neurosurg. 2007;21:288–92.

    Article  CAS  PubMed  Google Scholar 

  • Cohen-Gadol AA. Microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm: naunces of the technique based on experiences with 100 patients and review of the literature. Clin Neurol Neurosurg. 2011;113:844–53.

    Article  PubMed  Google Scholar 

  • Cook BR, Jannetta PJ. Tic convulsif: results in 11 cases treated with microvascular decompression of the fifth and seventh cranial nerves. J Neurosurg. 1984;61:949–51.

    Article  CAS  PubMed  Google Scholar 

  • de Lange EE, Vielvoye GJ, Voormolen JH. Arterial compression of the fifth cranial nerve causing trigeminal neuralgia: angiographic findings. Radiology. 1986;158:721–7.

    Article  PubMed  Google Scholar 

  • De Ridder D, Moller A, Verlooy J, Cornelissen M, De Ridder L. Is the root entry/exit zone important in microvascular compression syndromes? Neurosurgery. 2002;51:427–33; discussion 433–4.

    Article  PubMed  Google Scholar 

  • Devor M, Amir R, Rappaport ZH. Pathophysiology of trigeminal neuralgia: the ignition hypothesis. Clin J Pain. 2002;18:4–13.

    Article  PubMed  Google Scholar 

  • El-Ghandour NM. Microvascular decompression in the treatment of trigeminal neuralgia caused by vertebrobasilar ectasia. Neurosurgery. 2010;67:330–7.

    Article  PubMed  Google Scholar 

  • Haines SJ, Martinez AJ, Jannetta PJ. Arterial cross compression of the trigeminal nerve at the pons in trigeminal neuralgia. Case report with autopsy findings. J Neurosurg. 1979;50:257–9.

    Article  CAS  PubMed  Google Scholar 

  • Helbig GM, Callahan JD, Cohen-Gadol AA. Variant intraneural vein-trigeminal nerve relationships: an observation during microvascular decompression surgery for trigeminal neuralgia. Neurosurgery. 2009;65:958–61; discussion 961.

    Article  PubMed  Google Scholar 

  • Hong W, Zheng X, Wu Z, Li X, Wang X, Li Y, Zhang W, Zhong J, Hua X, Li S. Clinical features and surgical treatment of trigeminal neuralgia caused solely by venous compression. Acta Neurochir (Wien). 2011;153:1037–42.

    Article  Google Scholar 

  • Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. 1967. J Neurosurg. 2007;107:216–9.

    Article  PubMed  Google Scholar 

  • Jiao W, Zhong J, Sun H, Zhu J, Zhou QM, Yang XS, Li ST. Microvascular decompression for the patient with painful tic convulsif after bell palsy. J Craniofac Surg. 2013;24:e286–9.

    Article  PubMed  Google Scholar 

  • Katusic S, Beard CM, Bergstralh E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, rochester, minnesota, 1945–1984. Ann Neurol. 1990;27:89–95.

    Article  CAS  PubMed  Google Scholar 

  • Kellogg R, Pendleton C, Quinones-Hinojosa A, Cohen-Gadol AA. Surgical treatment of trigeminal neuralgia: a history of early strides toward curing a “Cancerous acrimony”. Neurosurgery. 2010;67:1419–25; discussion 1425.

    Article  PubMed  Google Scholar 

  • Kimura T, Sako K, Tohyama Y, Yonemasu Y. Trigeminal neuralgia caused by compression from petrosal vein transfixing the nerve. Acta Neurochir (Wien). 1999;141:437–8.

    Article  CAS  Google Scholar 

  • Lee SH, Levy EI, Scarrow AM, Kassam A, Jannetta PJ. Recurrent trigeminal neuralgia attributable to veins after microvascular decompression. Neurosurgery. 2000;46:356–61; discussion 361–2.

    Article  CAS  PubMed  Google Scholar 

  • Lemos L, Alegria C, Oliveira J, Machado A, Oliveira P, Almeida A. Pharmacological versus microvascular decompression approaches for the treatment of trigeminal neuralgia: clinical outcomes and direct costs. J Pain Res. 2011;4:233–44.

    CAS  PubMed Central  PubMed  Google Scholar 

  • Li GW, Zhang WC, Yang M, Ma QF, Zhong WX. Clinical characteristics and surgical techniques of trigeminal neuralgia caused simply by venous compression. J Craniofac Surg. 2014;25:481–4.

    Article  PubMed  Google Scholar 

  • Linskey ME, Jho HD, Jannetta PJ. Microvascular decompression for trigeminal neuralgia caused by vertebrobasilar compression. J Neurosurg. 1994;81:1–9.

    Article  CAS  PubMed  Google Scholar 

  • Ma X, Sun X, Yao J, Ni S, Gong J, Wang J, Li X. Clinical analysis of trigeminal neuralgia caused by vertebrobasilar dolichoectasia. Neurosurg Rev. 2013;36:573–7; discussion 577–8.

    Article  PubMed  Google Scholar 

  • Masuoka J, Matsushima T, Hikita T, Inoue E. Cerebellar swelling after sacrifice of the superior petrosal vein during microvascular decompression for trigeminal neuralgia. J Clin Neurosci. 2009;16:1342–4.

    Article  PubMed  Google Scholar 

  • Matsushima T, Huynh-Le P, Miyazono M. Trigeminal neuralgia caused by venous compression. Neurosurgery. 2004;55:334–7; discussion 338–9.

    Article  PubMed  Google Scholar 

  • McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK. Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg. 1999;90:1–8.

    Article  CAS  PubMed  Google Scholar 

  • Mittal P, Mittal G. Painful tic convulsif syndrome due to vertebrobasilar dolichoectasia. J Neurosci Rural Pract. 2011;2:71–3.

    Article  PubMed Central  PubMed  Google Scholar 

  • Olesen J, Steiner TJ. The international classification of headache disorders, 2nd edn (icdh-ii). J Neurol Neurosurg Psychiatry. 2004;75:808–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Sato O, Kanazawa I, Kokunai T. Trigeminal neuralgia caused by compression of trigeminal nerve by pontine vein. Surg Neurol. 1979;11:285–6.

    CAS  PubMed  Google Scholar 

  • Sekula RF, Marchan EM, Fletcher LH, Casey KF, Jannetta PJ. Microvascular decompression for trigeminal neuralgia in elderly patients. J Neurosurg. 2008;108:689–91.

    Article  PubMed  Google Scholar 

  • Sekula Jr RF, Frederickson AM, Jannetta PJ, Quigley MR, Aziz KM, Arnone GD. Microvascular decompression for elderly patients with trigeminal neuralgia: a prospective study and systematic review with meta-analysis. J Neurosurg. 2011;114:172–9.

    Article  PubMed  Google Scholar 

  • Shulev Y, Trashin A, Gordienko K. Secondary trigeminal neuralgia in cerebellopontine angle tumors. Skull Base. 2011;21:287–94.

    Article  PubMed Central  PubMed  Google Scholar 

  • Sindou M, Howeidy T, Acevedo G. Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients. Acta Neurochir (Wien). 2002;144:1–12; discussion 12–3.

    Article  CAS  Google Scholar 

  • Sindou M, Leston J, Decullier E, Chapuis F. Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg. 2007;107:1144–53.

    Article  PubMed  Google Scholar 

  • Tashiro H, Kondo A, Aoyama I, Nin K, Shimotake K, Nishioka T, Ikai Y, Takahashi J. Trigeminal neuralgia caused by compression from arteries transfixing the nerve. Report of three cases. J Neurosurg. 1991;75:783–6.

    Article  CAS  PubMed  Google Scholar 

  • Wang YN, Zhong J, Zhu J, Dou NN, Xia L, Visocchi M, Li ST. Microvascular decompression in patients with coexistent trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia. Acta Neurochir (Wien). 2014;156:1167–71.

    Article  Google Scholar 

  • Xia L, Zhong J, Zhu J, Wang YN, Dou NN, Liu MX, Visocchi M, Li ST. Effectiveness and safety of microvascular decompression surgery for treatment of trigeminal neuralgia: a systematic review. J Craniofac Surg. 2014;25:1413–7.

    Article  PubMed  Google Scholar 

  • Yang XS, Li ST, Zhong J, Zhu J, Du Q, Zhou QM, Jiao W, Guan HX. Microvascular decompression on patients with trigeminal neuralgia caused by ectatic vertebrobasilar artery complex: technique notes. Acta Neurochir (Wien). 2012;154:793–7; discussion 797.

    Article  Google Scholar 

  • Zheng X, Feng B, Hong W, Zhang W, Yang M, Tang Y, Zhong J, Hua X, Li S. Management of intraneural vessels during microvascular decompression surgery for trigeminal neuralgia. World Neurosurg. 2012;77:771–4.

    Article  PubMed  Google Scholar 

  • Zhong J. An ideal microvascular decompression technique should be simple and safe. Neurosurg Rev. 2012;35:137–40; author reply 140.

    Article  PubMed  Google Scholar 

  • Zhong J, Li ST, Xu SQ, Wan L, Wang X. Management of petrosal veins during microvascular decompression for trigeminal neuralgia. Neurol Res. 2008;30:697–700.

    Article  PubMed  Google Scholar 

  • Zhong J, Zhu J, Li ST, Guan HX. Microvascular decompressions in patients with coexistent hemifacial spasm and trigeminal neuralgia. Neurosurgery. 2011;68:916–20; discussion 920.

    Article  PubMed  Google Scholar 

  • Zhong J, Li ST, Zhu J, Guan HX, Zhou QM, Jiao W, Ying TT, Yang XS, Zhan WC, Hua XM. A clinical analysis on microvascular decompression surgery in a series of 3000 cases. Clin Neurol Neurosurg. 2012;114:846–51.

    Article  PubMed  Google Scholar 

  • Zhong J, Zhu J, Sun H, Dou NN, Wang YN, Ying TT, Xia L, Liu MX, Tao BB, Li ST. Microvascular decompression surgery: surgical principles and technical nuances based on 4000 cases. Neurol Res. 2014;36:882–93.

    Article  PubMed  Google Scholar 

  • Zhu J, Zhong J, Jiao W, Zhou QM, Guan HX, Dou NN, Wang YN, Xia L, Li ST. Via-cerebellar-fissures approach for microvascular decompression of trigeminal nerve. J Craniofac Surg. 2014;25:1438–40.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China

    Jun Zhong MD, PhD & Hui Sun MD, PhD

Authors
  1. Jun Zhong MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hui Sun MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Shanghai, China

    Shi-Ting Li

  2. Dept. Neurosurgery, XinHua Hospital, Shanghai, China

    Jun Zhong

  3. UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania, USA

    Raymond F. Sekula, Jr.

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Zhong, J., Sun, H. (2016). Surgical Technique of Microvascular Decompression Surgery for Trigeminal Neuralgia. In: Li, ST., Zhong, J., Sekula, Jr., R. (eds) Microvascular Decompression Surgery. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-7366-9_6

Download citation

  • DOI: https://doi.org/10.1007/978-94-017-7366-9_6

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-017-7365-2

  • Online ISBN: 978-94-017-7366-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation