January 16, 2015
During microvascular decompression surgery, we often run into situations where, a questionable vein, maybe found during surgery, which is most likely not the, convincing cause of her general neuralgia. Or, we find no vessel around the nerve, to decompress. In these situations I recommend, proceeding with an open forceps rhizotomy. In order to be able to provide the patient with some relief, of his or her pain. I'm going to show you this case of mine, where a vein which was relatively equivocal was the cause of Trigeminal Neuralgia in a 68 year old female with typical right-sided V3 Trigeminal Neuralgia. You can see this is a right sided, Retromastoid Craniotomy. These are the mastoid air cells that have been waxed, since the bone over transfer sinus. This is the sigmoid sinus that's been decompressed. And the dural has been open along, the venous sinuses. We'll go ahead and access the Cerebellopontine Angle Cistern. And in this case you can see a vein, that's transversing just posterior to the nerve. However it's really not, causing much compression or conflict or impression on the nerve. And therefore we have to do something besides transecting the vein, in order to achieve reliable pain freedom after surgery. Looking in and around the nerve no other, vessel is found. He was looking under the vein, again has minimal contact, with the, nerve. We'll go ahead and transect the vein, as it's very superficial, and most likely nonvital. After which I will proceed to use the forceps to cause gentle rhizotomy at the, corresponding topper craft called distribution, of the pain on the nerve. In this situation the patient's pain was in the V3 distribution. So I have grabbed, the inferior half to one third of the nerve with my fine forceps, and I'm gently squeezing or pinching, the nerve only once. And this technique provided a patient with very effective long-term pain freedom. Thank you.
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