Management strategies of superior petrosal vein during microvascular decompression for primary trigeminal neuralgia
Objective To investigate the relationship between the position of the superior petrosal vein and the trigeminal nerve during microvascular decompression(MVD)for primary trigeminal neuralgia and the corresponding management strategies.Methods The clinical data of 69 patients with primary trigeminal neuralgia treated by the same surgeon at the Department of Neurosurgery,China-Japan Friendship Hospital from October 2022 to March 2023 were retrospectively analyzed.The relative positional relationship between the superior petrous vein and the trigeminal nerve was divided into three types.Type 1 was crossed type,typeⅡ was concomitant type,and type Ⅲ was parallel type.For type Ⅰ patients,the arachnoid membrane between the superior petrosal vein and the trigeminal nerve and/or tentorium cerebellum was fully dissected and separated.The offending vessels in the first space should be decompressive through this space.For type Ⅱpatients,the superior petrous vein was separated from the arachnoid membrane of the trigeminal nerve and its nerve root entry/exit zone of the brainstem(REZ)as far as possible,and cotton pad was placed to isolate it.For type Ⅲ patients,the superior petrosal vein was gently pushed away with an aspirator,and the first space was completely exposed for decompression.The outcome was assessed by the Barrow Neurological Institute(BNI)pain scale.The BN1 classification of patients was followed up by outpatient visits and telephone interviews from discharge to the end of follow-up.Results Among 69 patients,52.2％(36 cases),30.4％(21 cases)and 17.4％(12 cases)were type Ⅰ,type Ⅱ and type Ⅲ respectively.The superior petrosal vein was completely preserved during MVD.Within 7 days after operation,there were 68 cases of BNI grade Ⅰand 1 case of BNI grade Ⅱ.No complications such as hearing disorder or venous drainage disorder occurred after operation.The follow-up time[median(Q1,Q3)]of 69 patients was 6(4,7)months.At the last follow-up,the symptoms of trigeminal neuralgia were completely disappeared in all patients(BNI grade Ⅰ).Conclusion According to the different position relationship between the superior petrosal vein and the trigeminal nerve,the corresponding surgical strategy should be adopted to preserve the superior petrosal vein as completely as possible,which can not only relieve trigeminal neuralgia,but also avoid the occurrence of complications related to the injury of the superior petrosal vein.
万方数据
维普
