Microvascular Decompression of the Trigeminal Nerve with Petrous Sling Technique: Surgical Video

The retrosigmoid approach for microvascular decompression of the trigeminal nerve (TN) is an established and highly effective technique for the treatment of trigeminal neuralgia due to vascular compression. It is common to place a pledget or other cushion material between the source of vascular compression, typically the superior cerebellar artery (SCA), and the TN after vessel mobilization and decompression. A previous study demonstrated the use of a tentorial sling on the SCA to maintain decompression of the TN, with encouraging results.¹ In this video, we demonstrate a novel technique using a Gore-Tex (W. L. Gore & Associates, Newark, Delaware) sling wrapped around the SCA and secured with a vascular clip on the petrous dura to maintain decompression of the TN (Video 1). Informed consent was obtained from the patient. He tolerated the procedure well with excellent pain relief and was discharged on postoperative day 1.