Microvascular Decompression Through Cyanoacrylate Glue-Coated Teflon Sling Transposition Technique

Area of Science:

• Neurosurgery
• Vascular Neurology

Background:

• Vertebral artery dolichoectasia, characterized by pathological elongation and dilation, can compress cranial nerves, leading to various neurological deficits.
• The exact pathophysiology remains unclear, but it is associated with arterial wall degeneration, atherosclerosis, and chronic hypertension.
• Current treatment options for nerve compression are often challenging and lack standardization.

Observation:

• A 78-year-old female presented with intractable left trigeminal neuralgia, resistant to medical management and previous interventions.
• The patient had a history of Gasserian ganglion microcompression and two radiofrequency thermorizotomies with only transient relief.
• Her persistent symptoms significantly impacted her quality of life and led to mood decline.

Findings:

• A left suboccipital retrosigmoid craniotomy was performed to address the vertebral artery dolichoectasia.
• A Teflon sling was used to gently pull the vertebral artery away from the trigeminal nerve and brainstem.
• The patient experienced complete resolution of her facial pain following the surgical intervention.

Implications:

• This case demonstrates the efficacy of surgical repositioning of the vertebral artery using a Teflon sling for intractable trigeminal neuralgia.
• The technique offers a potential solution for managing complex neurovascular compression cases.
• Further research into standardized surgical approaches for vertebral artery dolichoectasia is warranted.