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Acta Neurochir (2014) 156:11811187 DOI 10.1007/s00701-014-2092-y
CLINICAL ARTICLE - NEUROSURGICAL TECHNIQUES
Microvascular decompression for trigeminal neuralgia using the Stitched Sling Retraction technique in recurrent cases after previous microvascular decompression
Ali Tayebi Meybodi & Zohreh Habibi & Mojtaba Miri &
Seyed Ali Fakhr Tabatabaie
Received: 12 November 2013 /Accepted: 31 March 2014 /Published online: 27 April 2014 # Springer-Verlag Wien 2014
AbstractBackground Microvascular decompression is a well-known therapeutic option for trigeminal neuralgia. It is considered safe and effective, and is the surgical treatment of choice for the malady. However, there is no standard technique for it and different authors have proposed different techniques of performing it. In this study, we observe the clinical results of the so-called stitched sling retraction technique for recurrent cases of trigeminal neuralgia.
Methods Twelve consecutive patients with recurrent trigeminal neuralgia after previous microvascular decompression(s) were admitted to our institution form February 2009 to February 2011 and underwent microvascular decompression of the trigeminal nerve using the stitched sling retraction technique. In this technique, the offending loop of the superior cerebellar artery is retracted from the nerve and, using a silk thread loop around it, is suspended to the adjacent tentorium. Results All patients experienced pain resolution during the immediate post-operative period or within the first 6 months after surgery. They were followed for 24 to 38 months. No recurrence occurred.
Conclusions The stitched sling retraction technique shows promising preliminary results in recurrent cases of trigeminal neuralgia after previous microvascular decompression(s). Since it is a transposing technique, it might be associated with less recurrence rates (due to resuming of the neurovascular conflict) than the classic interposing technique, which uses a prosthesis between the offending vessel and the trigeminal nerve.
Keywords Trigeminal neuralgia . Retrosigmoid craniotomy . Microvascular decompression . Tentorium . Sling retraction
Background
Microvascular decompression (MVD) is currently accepted as the treatment of choice for medically intractable cases of trigeminal neuralgia (TN) [3, 5, 14, 17, 39]. However, this technique is far from perfection (immediate recovery from pain: 86 % and a recurrence rate of 330 %), and such an imperfection could be considered the primary cause of several modifications and elaborations of MVD as well as attempts to develop other treatment modalities [34, 38]. MVD does not have a standardized technique....