Building walls to abolish conflict: a ponto-tentorial teflon bridge technique for microvascular decompression of the Trigeminal Nerve
EANS Academy. Makwana M. 09/25/19; 275593; EP07014
Mr. Milan Makwana
Mr. Milan Makwana

Access to this content is reserved for EANS members and attendees of this event. Click here to become an EANS member and gain your access to the full content of the EANS Academy

Discussion Forum (0)
Rate & Comment (0)
Background: Microvascular decompression (MVD) has proven to be the most elegant and effective (albeit most invasive) nerve preserving surgical remedy for trigeminal neuralgia arising from neurovascular conflict (NVC). The superior cerebellar artery (SCA) is found to be the most common offending vessel. Techniques described include interposed shredded teflon sponge, vascular slings, dural tapes and anchored fenestrated aneurysm clips. In our own experience, re-operation rates were most pronounced in patients who continued to experience pulsatile NVC through either sandwiched shredded sponge or a teflon strip. We postulated that abolition of all relevant vascular contact may provide better and more pronounced facial pain relief, and proceeded to develop a novel technique that freed the trigeminal nerve of any contact with a teflon quadrangle between the dorsolateral pontine surface and the tentorium cerebelli. The positioning is confirmed endoscopically.
Methods: We describe a surgical technique in 25 patients who underwent MVD for trigeminal neuralgia through a retrosigmoid endoscope assisted microsurgical approach, performed by the same surgeon in a University Teaching Hospital within a 12 month period. MRI proven NVC was seen in all patients irrespective of previous procedure type.
Results: All patients were pain free immediately after surgery, and remain without medication. One patient who required prolonged lumbar CSF drainage to treat a delayed (30 days) retrosigmoid wound leak experienced a transient loss of ipsilateral hearing. There were no other complications recorded or reported. Post operative CT and MRI imaging in the first few patients confirmed maintenance of the position of the teflon felt, and abolition of NVC.
Conclusions: Despite the absence of long term data, we are encouraged by the initial results of this technique - which seems at least as effective as other traditionally described ones.

[A. Neurovascular conflict - SCA and CN V. B.Teflon bridge- Pons to Tentorium. C&D. MRI]

Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.

Save Settings