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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
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Endoscopic Infraorbital Microdissection for Localized V2 Trigeminal Neuralgia
Max Ward1, Neil Majmundar2, Antonios Mammis3
1Medical Student, Department of Neurological Surgery, New Jersey Medical School, Newark, NJ.
Summary
Endoscopic microdissection of the infraorbital nerve offers a new surgical option for trigeminal neuralgia (TN) when medical treatments fail. This technique effectively manages refractory V2 TN by selectively treating affected nerve branches, preserving sensation elsewhere.
Area of Science:
- Neurosurgery
- Pain Management
- Facial Anatomy
Background:
- Trigeminal neuralgia (TN) is a chronic pain condition affecting the face.
- Medically refractory cases often require surgical intervention.
- Neurovascular compression is a common cause, but not always present.
Purpose of the Study:
- To describe an endoscopic microdissection technique for the infraorbital nerve.
- To evaluate this technique for refractory V2 TN without neurovascular compression.
- To assess the preservation of sensation in unaffected facial areas.
Main Methods:
- Endoscopic microdissection of the infraorbital nerve.
- Performed on two patients with refractory V2 TN localized to the lateral midface.
- Symptomatic nerve branches were identified, separated, and cauterized, sparing unaffected fascicles.
Main Results:
- Both patients achieved complete pain resolution post-surgery.
- Patients experienced some hypoesthesia in the lateral face.
- Sensation was retained in the medial upper lip, midface, and nose.
Conclusions:
- Endoscopic infraorbital nerve microdissection is a safe and effective treatment for refractory V2 TN.
- The technique allows for targeted treatment while preserving sensation in asymptomatic facial regions.
- This peripheral nerve management offers an alternative for patients without neurovascular compression.
