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

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Abstract
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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]

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]

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