Microvascular Decompression for Trigeminal Neuralgia: Technical Refinement for Complication Avoidance

BACKGROUND: Microvascular decompression (MVD) represents the most effective and safe surgical option for the treatment of trigeminal neuralgia since it was first popularized by Jannetta 50 years ago. Despite several advances have been proposed, the rate of complications as cerebellar and vascular injury, hearing loss, muscular atrophy, cerebrospinal fluid (CSF) leak, postoperative cutaneous pain and sensory disturbances, remain still actual and may negatively affect the outcome. We propose some technical nuances of the surgical procedure we used in our recent series. METHODS: We used a novel hockey stick-shaped retromastoid skin incision, preserving the major nerves of the occipital and temporal areas. The microsurgical steps are performed without the use of retractors. The CSF leak is prevented through a watertight dural closure and a multilayer osteodural reconstruction. RESULTS: The refined surgical steps were perfected in the last consecutive 15 cases of our series. In such last cases we did not record any case of cutaneous pain nor sensory disturbances and any case of CSF leakage. The average diameter of the craniectomy was 18 mm. No patient reported major complications related to the intradural microsurgical maneuvres. In all cases the neuro-vascular conflict was found and solved with a good outcome in terms of pain disappearance. CONCLUSIONS: Our minimal invasive approach demonstrated to guarantee an optimal exposure of the CPA and to minimize the rate of complications related to skin incision and muscular dissection, microsurgical steps and closure.