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Arachnoid Membranes Around the Cisternal Segment of the Trigeminal Nerve: A Cadaveric Anatomic Study and

Peter Kurucz1, Oliver Ganslandt2, Michael Buchfelder3

  • 1Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany; Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.

World Neurosurgery
|January 27, 2019
PubMed
Abstract

Insights

Understanding the arachnoid membranes surrounding the trigeminal nerve is crucial for safe microvascular decompression (MVD) surgery. This study details the complex organization of these membranes, aiding surgeons in complex dissections.

Area of Science:

  • Neurosurgery
  • Neuroanatomy

Background:

  • Microvascular decompression (MVD) for trigeminal neuralgia presents surgical challenges.
  • Endoscopic assistance can improve visualization during MVD procedures.
  • Targeted dissection of arachnoid membranes is key for an extended view of the trigeminal nerve.

Purpose of the Study:

  • To analyze the three-dimensional organization of arachnoid membranes around the trigeminal nerve.
  • To provide anatomical insights for safer MVD surgery.

Main Methods:

  • Performed microsurgical, endoscopic, and macroscopic anatomic examinations on 50 human cadaveric specimens.
  • Conducted retrospective analysis of 50 MVD video documentations.
  • Described the surgical relevance of examined arachnoid membranes.

Main Results:

  • Identified four inner arachnoid membranes surrounding the trigeminal nerve: trigeminal membrane (TM) and superior cerebellar membrane (SCM).
  • The superior cerebellar artery was consistently found cranial to the SCM, serving as a safety dissection plane.
  • Adherence between SCM and TM complicated arachnoid dissection; the transverse pontine vein was embedded within the membrane complex.

Conclusions:

  • Detailed knowledge of the arachnoid membrane anatomy is essential for safe MVD.
  • Understanding these anatomical relationships enhances surgical precision and patient safety.
Keywords:
Arachnoid membranesEndoscopic anatomyMicrovascular decompressionPosterior fossaRetrosigmoid keyhole approachTrigeminal nerveTrigeminal neuralgia

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