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Multiple Offending Vessels in MVD for Trigeminal Neuralgia


Let's talk about how we can avoid, missing a vessel, during microvascular decompression surgery. Often, there can be more than one vessel, that would offend or compress, the trigeminal nerve root entry zone. And therefore, the surgeon should always look for an additional vessel, if one is found. I would like to illustrate that point, by using the case of this patient, who, on regular MRI, was really not found to have any significant abnormality, around the left trigeminal nerve, as she was suffering from medically refractory trigeminal neuralgia. Here is a left-sided retromastoid craniotomy. The arachnoid membranes are being opened. I often do not sacrifice the superior petrosal vein, unless absolutely necessary. We don't use fixed retractors. Here you can see that, just behind the nerve, or anterior to it, at the shoulder of the nerve, there is a large vessel, that is causing some compression, on the nerve. It's being mobilized by two pieces of shredded Teflon. However, after finding this very convincing vessel, when I looked a little bit behind the nerve, you can appreciate another offensive vessel, that is being mobilized. So, in this case, even though one vessel was found, another one was also noted at the bottom of the nerve, and therefore, the surgeon should always look around, as much as possible. Thank you.

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