Cristian Son

Microvascular decompression has been shown in multiple long-term series to provide durable pain freedom in 75–95% of patients with classical trigeminal neuralgia, defined as neuralgia related to an identified neurovascular conflict, frequently arterial. Surgical success relies on an effective decompression, achieved by displacing the offending arteries while avoiding neo-compression(s) by implanted material. The procedure is performed through a keyhole retrosigmoid (retromastoid) craniectomy, using an infratentorial, supracerebellar corridor to the trigeminal root that minimizes traction on the facial–vestibulocochlear complex. In this video, we demonstrate the step-by-step technique as applied in patients in whom high-resolution MRI demonstrated the conflict preoperatively.

When a neurovascular conflict is demonstrated on high-resolution MRI in patients with drug-refractory Vago-Glossopharyngeal neuralgia microvascular decompression is regarded as the most effective therapeutic option. The aim of surgery is to relieve the conflict, most often produced by the posterior inferior cerebellar artery, not infrequently in association with a compressive megadolicho-vertebrobasilar artery. This can be safely achieved by exposure of the Vago-Glossopharyngeal nerve complex through a retromastoid-retrosigmoid infrafloccular approach through the cisterna magna, allowing exposure the lateral medulla and root entry zone of the lower cranial nerves. This report provides our step-by-step recommended technique for optimal efficacy and safety.