Management of different kinds of veins during microvascular decompression for trigeminal neuralgia: technique notes

During microvascular decompression surgery for trigeminal neuralgia, surgeons will encounter various kinds of veins that block the approach to or compress the trigeminal nerve. The aim of this study was to present our experience in managing different kinds of veins.

This was a retrospective study of 21 patients with trigeminal neuralgia, in whom one or more veins were encountered during surgery. The techniques used in treating 4 types of veins during microvascular decompression were assessed, and the surgical outcomes and operative complications were analysed.

For the first type, large veins blocking the approach towards the root entry zone (REZ) of the trigeminal nerve were bypassed via cerebellar fissure approach. Second, veins lying on the brainstem surface and compressing the REZ were detached using a gelatin-assisted dissecting technique and then interposed. Third, veins rising from the surface of the brainstem and crossing the cisternal portion of the trigeminal nerve were interposed. Fourth, intraneural veins, which were generally small, were coagulated and cut. In this series, there was no intentional sacrifice or unintentional rupture of large veins, and the sacrifice rate of medium and small veins was only 19.0%. Thirteen patients (61.9%) gained complete pain relief immediately after surgery (i.e. "excellent" result), while the remaining eight patients (38.1%) achieved "good" pain relief.

Different surgical techniques were used based on the different kinds of veins encountered. This allowed preservation of almost all the large veins. There were no serious complications postoperatively.