Optimal Patient Positioning for Microvascular Decompression of Trigeminal Neuralgia Utilizing the "Arrowhead"...

Microvascular decompression (MVD) is a neurosurgical operation used to treat trigeminal neuralgia (TN). The surgery is performed through a retrosigmoid approach, where a Teflon pledget is placed in between the offending vessel (most commonly the superior cerebellar artery) and trigeminal nerve. The surgery is performed within the superior aspect of the cerebellopontine angle (CPA) through a small working corridor that is triangulated by the petrous bone and tentorium. Patient positioning is the foundation to accessing this corridor and performing a successful operation. This article provides a detailed guide on the positioning steps of the park bench position typically employed at Arrowhead Regional Medical Center (ARMC) in Colton, CA, USA. We then review pertinent surgical anatomy in a MVD for trigeminal neuralgia and describe the "Arrowhead" technique to perform this operation.