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Safety of superior petrosal vein sacrifice during microvascular decompression of the trigeminal nerve.
World Neurosurg. 2017 Apr 01;:
Authors: Pathmanaban ON, O'Brien F, Al-Tamimi YZ, Hamerbeck-Ward CL, Rutherford SA, King AT
Abstract
BACKGROUND: Microvascular decompression (MVD) is a safe and effective treatment for trigeminal neuralgia (TGN). Cerebellar venous infarction is a complication associated with surgical sacrifice of the superior petrosal vein (SPV). The SPV intervenes between the trigeminal nerve and the surgeon. Optimal exposure of the cisternal trigeminal nerve, particularly at the brain stem, can be achieved by sacrificing the SPV. We analysed a cohort of 224 patients to determine the frequency of cerebellar venous infarction.
METHODS: Retrospective analysis of records and neuroradiology for patients undergoing trigeminal MVD at the Manchester Skull Base Unit between August 1st 2008 and July 31st 2015.
RESULTS: 184/224 (82%) patients had coagulation and division of the main stem of the SPV . There were no cases of venous infarction. There was one case of mild, transient, cerebellar symptoms and signs, with no radiological evidence of venous infarction. This patient had SPV sacrifice at surgery, but also had post-operative thrombosis of the transverse sinus. Venous sinus thrombosis affected 5/184 (2.7%) patients. 208/224 (93%) patients had a good outcome with improvement or resolution of their TGN at 3 months.
CONCLUSIONS: The overall rate of venous complications in this study was 2.7%, however we had no cases of venous infarction in 184 patients who had sacrifice of the SPV. The incidence of venous infarction associated with SPV obliteration during MVD surgery is therefore <0.5%. SPV sacrifice may be used where necessary to maximize visualization of the REZ and maximize the chance of effective decompression of the trigeminal nerve.
PMID: 28377255 [PubMed - as supplied by publisher]
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