Trigeminal neuralgia secondary to compression by a microsurgical aneurysm clip

Microvascular Decompression for Trigeminal Neuralgia: A Durable, Noncompressive Technique Using Teflon Secured With Mini Clip

Operative Neurosurgery ◽

10.1093/ons/opy212 ◽

2018 ◽

Vol 16 (5) ◽

pp. 580-582

Author(s):

Robert E Breeze ◽

Daniel B Craig

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Microvascular Decompression ◽

Recent Literature ◽

Peripheral Vascular ◽

Aneurysm Clip ◽

Surgical Video ◽

Nerve Decompression

Abstract BACKGROUND In cases of trigeminal neuralgia, the importance of durable separation of involved vessels from the trigeminal nerve as well as avoiding ongoing or recurrent compression by implanted material has been affirmed in recent literature. OBJECTIVE To demonstrate a novel and straightforward technique for trigeminal nerve decompression using a construct of Teflon felt patty (Bard Peripheral Vascular, Tempe, Arizona) secured with an aneurysm mini clip to achieve lasting results with no residual contact between implant or vessels and the nerve. METHODS Description of our technique and accompanying surgical video. RESULTS As demonstrated in the video, this technique achieves an ideal, durable separation of the trigeminal nerve from the offending vasculature. CONCLUSION The authors present a description of a technique for decompression with the goal of leaving no contact between implanted material and the nerve. This is accomplished by securing the Teflon felt (Bard Peripheral Vascular) to the tentorium with an aneurysm clip.

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Use of fenestrated aneurysm clips in microvascular decompression surgery

Journal of Neurosurgery ◽

10.3171/jns.2007.106.5.929 ◽

2007 ◽

Vol 106 (5) ◽

pp. 929-931 ◽

Cited By ~ 31

Author(s):

Najmedden Attabib ◽

Anthony M. Kaufmann

Keyword(s):

Trigeminal Neuralgia ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Decompression Surgery ◽

Consecutive Series ◽

Aneurysm Clip ◽

Microvascular Decompression Surgery ◽

Standard Techniques ◽

Complex Cases

✓The standard techniques of microvascular decompression (MVD) surgery in which implant materials such as shredded Teflon felt are used may be inadequate in some complex cases. The authors evaluated the use of fenestrated aneurysm clips to maintain transposition of culprit vessels in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS). The authors conducted a retrospective review of MVD operations in which the culprit vessel was transposed and then maintained in position with a fenestrated aneurysm clip secured in position by suturing it to the dura mater. Among a consecutive series of more than 450 MVD surgeries, the fenestrated aneurysm clip sling was used in eight of the last 100 cases: six for HFS and two for TN. The follow-up period ranged from 1 to 13 months, and complete symptom resolution was noted in seven of the eight patients. No patient exhibited evidence of any surgical complications. This approach can be safely performed in complicated MVD cases such as reoperations and transpositions of long ectatic arteries. To the best of the authors' knowledge this is the first report in which the use of fenestrated aneurysm clips in MVD surgery is described.

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Neurapraxia in patients with trigeminal neuralgia but no identifiable neurovascular conflict during microvascular decompression: a retrospective analysis of 26 cases

BMC Surgery ◽

10.1186/s12893-022-01469-3 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Juan Li ◽

Min Zhou ◽

Yuhai Wang ◽

Sze Chai Kwok ◽

Jia Yin

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Herpes Labialis ◽

Efficacy And Safety ◽

Neurovascular Conflict ◽

Aneurysm Clip ◽

First Choice ◽

Trigeminal Nerve Root

Abstract Background Microvascular decompression (MVD) is the first choice in patients with classic trigeminal neuralgia (TGN) that could not be sufficiently controlled by pharmacological treatment. However, neurovascular conflict (NVC) could not be identified during MVD in all patients. To describe the efficacy and safety of treatment with aneurysm clips in these situations. Methods A total of 205 patients underwent MVD for classic TGN at our center from January 1, 2015 to December 31, 2019. In patients without identifiable NVC upon dissection of the entire trigeminal nerve root, neurapraxia was performed using a Yasargil temporary titanium aneurysm clip (force: 90 g) for 40 s (or a total of 60 s if the process must be suspended temporarily due to bradycardia or hypertension). Results A total of 26 patients (median age: 64 years; 15 women) underwent neurapraxia. Five out of the 26 patients received prior MVD but relapsed. Immediate complete pain relief was achieved in all 26 cases. Within a median follow-up of 3 years (range: 1.0–6.0), recurrence was noted in 3 cases (11.5%). Postoperative complications included hemifacial numbness, herpes labialis, masseter weakness; most were transient and dissipated within 3–6 months. Conclusions Neurapraxia using aneurysm clip is safe and effective in patients with classic TGN but no identifiable NVC during MVD. Whether this method could be developed into a standardizable method needs further investigation.

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