October 28, 2019
This is another video describing the basic principles and techniques for microvascular decompression surgery for trigeminal neuralgia. This is a 62-year-old female who presented with left-sided pain. MRI evaluation revealed some vascular crowding as you can see at the tip of the arrow along the left trigeminal nerve following left side retromastoid craniotomy. To draw us open, here's a transfer sinus, sigmoid sinus, mastoid air cells, dual opening. Here's the left trigeminal nerve, a vein over the nerve. Can see the vascular loop hiding at the axilla of the nerve. A fair amount of dissection will be required to mobilize the artery. Couple branches of the superior cerebellar artery. You can see the bimanual dissection technique using the suction and the number six . This sector in order to mobilize the artery effectively, here's the fourth nerve hiding within the arachnoid bands. Short dissection of the arachnoid bands is necessary to effectively mobilize the artery along the brainstem and the entire cisternal segment of the trigeminal nerve. Multiple pieces of Teflon were placed between the artery and the nerve. You can see that the brainstem has to be very well decompressed in addition to the nerve itself. There's no further point of contact between the brain stem or the nerve and the artery. In magnified view, irrigation is used to make sure that the Teflon pledges will not be moving during the post operative period. And this patient made an excellent recovery, and her pain completely disappeared. Thank you.
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