A tentorial sling in microvascular decompression for trigeminal neuralgia

Technical note

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✓ The key to the successful microvascular decompression of the trigeminal nerve is the maintenance of the separation between the trigeminal nerve and the offending vessel. The authors describe a technique whereby a dural sling is fashioned from the tentorium cerebelli (the anatomy of which is briefly reviewed), which is used to suspend the vessel away from the nerve and is secured by a single hemoclip.

Article Information

Address correspondence to: Roger L. Melvill, M.D., 212 Constantiaberg Medi Clinic, Burnham Road, Plumstead, Cape Town, South Africa.

© AANS, except where prohibited by US copyright law.

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    Drawings depicting a case of left trigeminal neuralgia as seen from the suboccipital approach. Left: The superior cerebellar artery is seen anterior to the fifth cranial nerve (CN V) and a 3- to 4-mm by 15-mm dural sling is fashioned from the inferior layer of the tentorium. Right: Microvascular decompression is achieved by placing the dural sling around the offending vessel, suspending it away from the trigeminal nerve, and securing the encircling sling to itself with a single hemoclip.

References

1.

Bederson JBWilson CB: Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 71:3593671989Bederson JB Wilson CB: Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 71:359–367 1989

2.

Hamlyn PJKing TT: Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg 76:9489541992Hamlyn PJ King TT: Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg 76:948–954 1992

3.

Jannetta PJ: Treatment of trigeminal neuralgia by suboccipital and transtentorial cranial operations. Clin Neurosurg 24:5385491977Jannetta PJ: Treatment of trigeminal neuralgia by suboccipital and transtentorial cranial operations. Clin Neurosurg 24:538–549 1977

4.

Jannetta PJAbbasy MMaroon JCet al: Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg 47:3213281977Jannetta PJ Abbasy M Maroon JC et al: Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg 47:321–328 1977

5.

Klintworth GK: The ontogeny and growth of the human tentorium cerebelli. Anat Rec 158:4334421967Klintworth GK: The ontogeny and growth of the human tentorium cerebelli. Anat Rec 158:433–442 1967

6.

Klun B: Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients. Neurosurgery 30:49521992Klun B: Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients. Neurosurgery 30:49–52 1992

7.

Laws ER JrKelly PJSundt TM Jr: Clip-grafts in microvascular decompression of the posterior fossa. Technical note. J Neurosurg 64:6796811986Laws ER Jr Kelly PJ Sundt TM Jr: Clip-grafts in microvascular decompression of the posterior fossa. Technical note. J Neurosurg 64:679–681 1986

8.

Piatt JH JrWilkins RH: Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships. Neurosurgery 14:4624711984Piatt JH Jr Wilkins RH: Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships. Neurosurgery 14:462–471 1984

9.

Wilkins RH: Historical perspectives in Rovit RLMurali RJannetta PJ (eds): Trigeminal Neuralgia. Baltimore: Williams & Wilkins1990 pp 125Wilkins RH: Historical perspectives in Rovit RL Murali R Jannetta PJ (eds): Trigeminal Neuralgia. Baltimore: Williams & Wilkins 1990 pp 1–25

10.

Williams PLWarwick RDyson Met al (eds): Gray's Anatomyed 37. London: Churchill Livingston1989 pp 10861087Williams PL Warwick R Dyson M et al (eds): Gray's Anatomy ed 37. London: Churchill Livingston 1989 pp 1086–1087

11.

Zhang KWZhao YHShun ZTet al: Microvascular decompression by retrosigmoid approach for trigeminal neuralgia: experience in 200 patients. Ann Otol Rhinol Laryngol 99:1291301990Zhang KW Zhao YH Shun ZT et al: Microvascular decompression by retrosigmoid approach for trigeminal neuralgia: experience in 200 patients. Ann Otol Rhinol Laryngol 99:129–130 1990

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