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MVD for TN-Unremarkable Findings

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This is another video discussing methods to manage trigeminal neuralgia in the presence of unremarkable intraoperative findings. This is a 50 year old female with right-sided V2 trigeminal neuralgia whose MRI demonstrated a questionable offending vessel around the trigeminal nerve. A right-sided retromastoid craniotomy was completed. As you can see, the trigeminal nerve has a very short length. The shoulder of the nerve was generously inspected and no obvious offending or to a vessel was found. A small artery that was present there was not convincing in terms of causing trigeminal neuralgia. Inspection of the axilla of the nerve also did not find any offending vessel. I therefore proceeded with pinching of the nerve using the fine forceps, two or three times gently to complete a rhizotomy. Here you can see the very short segment of the nerve and a typical finding. The small vessel that was found at the shoulder of the vessel was mobilized using a piece of shredded Teflon. This patient did benefit from resolution of her pain after surgery. However, the long-term result of this procedure remains unknown. Thank you.

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