Venous Decompression-Trigeminal Neuralgia
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I have at times questioned the validity of venous compression as the sole and only cause of trigeminal neuralgia. Typically if I see a vessel possibly compressing or offending the trigeminal nerve I mobilize the vein and also perform a gentle rhizotomy. However, there are circumstances where venous compression could be unequivocally the cause of trigeminal neuralgia if it's causing an impression or discoloration on the surface of the trigeminal nerve. And I'm going to show you this video that describes this phenomenon. A patient presented with left-sided trigeminal neuralgia. As you can see, this is the left side of the trigeminal nerve. These are two large veins that are embracing the nerve. As you can see when I mobilize this bigger vein, there's evidence of impression and discoloration on the nerve. Here what is critical is to look very thoroughly around. And as you can see here on the nerve there is evidence of the impression and distortion of the nerve. And again, discoloration that you will see better momentarily as I move the sector. It is important for the surgeon to really dissect around and make sure there is no arterial offending vessel around the nerve more medially that will be necessarily ignored since the operator is focusing on the veins. Here is my attempts to be really thoroughly looking anteriorly above and below the nerve to make sure no other offending vessel is found. And then Teflon patches are used to decompress the nerve. As you can see here is the patch for the upper vein, and here is another patch for the more distal vein. And here is the nerve embraced again by both implants to assure no further compression is evident and also the nerve is mostly in it's physiological posture.
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