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Updated: Jun 5, 2025

Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Fully Endoscopic Microvascular Decompression of the Trochlear Nerve for Treatment of Medically Refractory Superior
Rashad Jabarkheel1, Samuel Tomlinson, Austin J Borja
1Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia , Pennsylvania , USA.
Background And Importance:
We describe, to our knowledge, the first report of fully endoscopic microvascular decompression (MVD) of the trochlear nerve in a patient with superior oblique myokymia (SOM).
Clinical Presentation:
A 51-year-old female presented with multiple years of intermittent, "jumpy," and "shimmering" visual disturbances. She was diagnosed with SOM. Magnetic resonance imaging showed right trochlear nerve compression within the perimesencephalic cistern between the free edge of the right tentorial leaflet and the right superior cerebellar artery. She underwent fully endoscopic MVD of the trochlear nerve with complete resolution of symptoms.
Conclusion:
Endoscopic MVD of the trochlear nerve is technically feasible and may be used to treat medically refractory SOM.
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