Skip to main content
SpringerLink
Log in

The “hanging technique” of vascular transposition in microvascular decompression for trigeminal neuralgia: technical report of four cases

  • Technical Note
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

The successful long-term outcome of microvascular decompression for trigeminal neuralgia is largely dependent on the maintenance of the isolation between the trigeminal nerve and the offending vessel, avoiding also the development of scar tissue around the nerve. We propose an alternative technique to achieve this target by “hanging” the offending vessel from the overlying tentorium using a strip of autologous tissue without interposing any foreign material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ammar A, Lagenaur C, Jannetta P (1990) Neural tissue compatibility of Teflon as implant material for microvascular decompression. Neurosurg Rev 13:299–303

    Article  PubMed  CAS  Google Scholar 

  2. Barker FG, Janneta PJ, Bissonette DJ, Larkins MV, Jho HD (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 25; 334(17):1077–1083

    Article  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  4. Burchiel KJ, Clarke H, Haglund M, Loeser JD (1988) Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 69:35–38

    PubMed  CAS  Google Scholar 

  5. Cho DY, Chang CGS, Wang YC, Wang FH, Shen CC, Yang DY (1994) Repeat operations in failed decompression for trigeminal neuralgia. Neurosurgery 35:665–670

    Article  PubMed  CAS  Google Scholar 

  6. Fujimaki T, Hoya K, Sasaki T (1996) Recurrent trigeminal neuralgia caused by an inserted prosthesis. Report of two cases. Acta Neurochir (Wien) 138:1307–1309

    Article  CAS  Google Scholar 

  7. Fukushima T (1986) Surgery for hemifacial spasm. Clin Neurosci (Jpn) 4:584–585

    Google Scholar 

  8. Gardner WJ (1962) Concerning the cause of trigeminal neuralgia and hemifacial spasm. J Neurosurg 19:947–958

    PubMed  CAS  Google Scholar 

  9. Goya T, Wakisaka S, Kinoshita K (1990) Microvascular decompression for trigeminal neuralgia with special reference to delayed recurrence. Neurol Med Chir 30:462–467

    Article  CAS  Google Scholar 

  10. Hamlyn PJ, King TT (1992) Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg 76:948–954

    PubMed  CAS  Google Scholar 

  11. Janetta PJ (1976) Microsurgical approach to trigeminal nerve for tic doulourex. Prog Neurol Surg 7:180–200

    Google Scholar 

  12. Jannetta PJ, Abbasy M, Maroon JC et al (1977) Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg 47:321–328

    Article  PubMed  CAS  Google Scholar 

  13. Jannetta PJ, Bissonette DJ (1985) Management of the failed patient with trigeminal neuralgia. Clin Neurosurg 32:334–347

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  15. Kureshi SA, Wilkins RH (1998) Posterior fossa reexploration for persistent or recurrent trigeminal neuralgia or hemifacial spasm: surgical findings and therapeutic implications. Neurosurgery 43:111–1117

    Google Scholar 

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

    PubMed  Google Scholar 

  17. Matsushima T, Yamaguchi T, Inoue K, Matsukado K, Fukui M (2000) Recurrent trigeminal neuralgia after microvascular decompression using an interposing technique. Teflon felt adhesion and the sling retraction technique. Acta Neurochir (Wien) 142:557–561

    Article  CAS  Google Scholar 

  18. Mendosa N, Illingworth RD (1995) Trigeminal neuralgia treated by microvascular decompression: a long-term follow-up study. Br J Neurosurg 9:13–19

    Article  Google Scholar 

  19. Melvill RL, Baxter BL (1996) A tentorial sling in microvascular decompression for trigeminal neuralgia. Technical note. J Neurosurg 84:127–128

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  21. Premsager IC, Moss T, Coakham HB (1997) Teflon-induced granuloma following treatment of trigeminal neuralgia by microvascular decompression. Report of two cases. J Neurosurg 87:454–457

    Article  Google Scholar 

  22. Rawlinson JN, Coakham HB (1988) The treatment of hemifacial spasm by sling retraction. Br J Neurosurg 2:173–178

    Article  PubMed  CAS  Google Scholar 

  23. Shigeno T, Kumai J, Endo M, Ova S (2002) Snare technique of vascular transposition for microvascular decompression-technical note. Neurol Med Chir (Tokyo) 42(4):184–189

    Article  Google Scholar 

Download references

Acknowledgments

We would like to thank Dr G. Sfakianos for his nice drawing representing our surgical technique.

Author information

Authors and Affiliations

  1. Wolfson College, University of Oxford, Linton Road, Oxford, OX2 6UD, UK

    Aristotelis P. Mitsos

  2. Department of Neurosurgery, Athens General Hospital, 154 Mesogion Street, Athens, Greece

    Nikolaos Georgakoulias & Spiridon A. Lafazanos

  3. Faculty of Surgical Nursing, University of Athens, 123 Papadiamantopoulou Street, 11527, Athens, Greece

    Evangelos A. Konstantinou

Authors
  1. Aristotelis P. Mitsos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikolaos Georgakoulias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Spiridon A. Lafazanos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Evangelos A. Konstantinou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aristotelis P. Mitsos.

Additional information

Comments

Dattatraya Muzumdar, Mumbai, India

Mistos et al. describe the hanging technique of vascular transposition for trigeminal neuralgia with relatively good results. Various treatment options for trigeminal neuralgia are available and have been studied across different centers specializing in cranial nerve decompression syndromes. The range is wide and varied from rhizotomy or glycerol injection in the past to mircovascular decompression to radiosurgery in the present era. The experience is still evolving, and MVD has stood the test of time. Although mentioned, the incidence of sequelae or complications related to the use of Teflon are still not alarming, and it still remains the first choice in most centers treating cranial nerve disorders. The present technique using autologous tissue for hanging the vascular loop is novel and exciting, as it obviates the problems related to the use of foreign material and maintains effective vascular loop isolation from the nerve. The technique is simple, and procedural time is also not remarkably prolonged. Although the authors mention it to be relatively easy, it is still preliminary, as the experience is limited. A robust data comprising of a multicenter randomized controlled trial with a good follow-up period is needed for any firm conclusion. The efficacy of this procedure in the presence of a venous loop compression remains to be seen. Additional retraction resulting in sixth or eighth cranial nerve injuries and subsequent diplopia or hearing impairment are possibilities. The limitations of this study are the small number of patients and intermediate follow-up period, which preclude the validation of effectiveness of the described technique or prove its efficacy. The technical considerations and the safety of the procedure also need to be evolved, and we strongly urge the authors to present their experience in the future with larger number of patients.

Damianos Sakas, Athens, Greece

The “hanging technique” holds the promise of preventing recurrence of trigeminal neuralgia. It may also prove particularly beneficial in long-standing cases of trigeminal neuralgia in which the continuous vascular irritation may induce pathophysiological changes and trigeminal neuropathic pain; in such cases, it may be better to leave the nerve entirely free from any pressure because even the pressure of the vessel through the Teflon may be sufficient to irritate it and cause pain. From a technical perspective, however, it should be pointed out that transposing the vessel may not be easy in many cases, especially in recurrences. One needs to retract the cerebellum more than in the standard MVD to create room for inserting and maneuvering the needle holder while suturing the fascia to the tentorium. This increases the risk of complications and particularly the risk of deafness after the retraction of the eighth nerve. During this stage of the procedure, there is also an increased risk of inadvertent injury to the superior cerebellar artery.

Another shortcoming of the technique is that the muscle could gradually degenerate or get stretched, and hence, the artery could again come in contact with the nerve. The follow-up in this small series is short, and therefore, the long-term efficacy of this technique has not been proven. Only time will tell whether the authors are right in their assertions.

Toshio Matsushima, Saga, Japan

In the microvascular decompression procedure for trigeminal neuralgia, there still remains a problem of recurrence. The authors report the technique which is the use of a sling piece of autologous fascia to wrap the offending arterial loop and hang it from the overlying tentorium. Transposing technique is much better than interposing technique because interposing technique causes adhesion. I also reported the sling retraction technique in the recurrent cases [1]. Since then, I have been using the tentorial stitched sling retraction technique, in which the SCA is transposed by a sling of the suture stitched to the tentrium [2]. Stitching the tentorium is not difficult, provided that the surgeon is careful not to injure the tentorial sinus.

References

1. Matsushima T, Yamaguchi T, Inoue TK, et al (2000) Recurrent trigeminal neuralgia after microvascular decompression using an interposing technique. Teflon felt adhesion and the sling retraction technique. Acta Neurchir 142:557–561

2. Matsushima T (2006) Microsurgical anatomy and surgery of the posterior fossa. Chapter 12. Microvascular decompression procedure, infratentorial lateral supracerebellar approach and tentorial stitched sling retraction method. SciMed Publications, Tokyo, pp 101–108

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mitsos, A.P., Georgakoulias, N., Lafazanos, S.A. et al. The “hanging technique” of vascular transposition in microvascular decompression for trigeminal neuralgia: technical report of four cases. Neurosurg Rev 31, 327–330 (2008). https://doi.org/10.1007/s10143-008-0144-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-008-0144-6

Keywords

Search

Navigation