“Birdlime” technique using TachoSil tissue sealing sheet soaked with fibrin glue for sutureless vessel transposition in microvascular decompression: operative technique and nuances

Abstract

OBJECTIVE Microvascular decompression (MVD) is effective for the treatment of trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia. The transposition technique is the standard procedure to avoid adhesions and granuloma around the decompression site but is more complex and difficult to perform than the interposition technique. The authors describe a simple and safe MVD transposition procedure they call the "birdlime" technique, which uses a tissue glue-coated collagen sponge soaked with fibrin glue, and the results of this technique. METHODS The authors retrospectively reviewed the medical charts and radiographic findings of 27 consecutive patients with TN (8 patients) and HFS (19 patients) who, between January 2012 and December 2015, had undergone an MVD transposition procedure utilizing a tissue glue-coated collagen sponge (TachoSil tissue sealing sheet) soaked with fibrin glue (Tisseel 2-component fibrin sealant, vapor heated). Offending arteries among the patients with TN were the superior cerebellar artery (SCA) in 5 patients, the SCA and anterior inferior cerebellar artery (AICA) in 2, and the AICA in 1. Those among the patients with HFS were the vertebral artery (VA) in 3 patients, the VA and AICA in 4, the VA and posterior inferior cerebellar artery (PICA) in 3, the PICA in 4, the AICA in 1, the AICA-PICA in 3, and the PICA and AICA in 1. Operations were performed according to the Jannetta procedure. The offending artery was transposed and fixed to the dura mater of the petrous bone using TachoSil pieces soaked with fibrin glue. Postoperative constructive interference in steady-state MRI was performed to evaluate the change in the position of the offending artery. RESULTS Transposition of the offending artery was easily and safely performed in all patients. All patients had total remission of symptoms directly after the procedure. No severe complications occurred. The postoperative course was uneventful. No recurrences, adhesions, or dysfunction of the cranial nerves was observed in any of the patients. Postoperative MRI showed that the offending vessels were displaced and fixed in the appropriate position. CONCLUSIONS The described transposition technique provides an easy and adjustable way to perform MVD safely and effectively. In addition, this transposition and fixation technique is simple and avoids the risk of needle injury close to the cranial nerves and vessels. This simple sutureless technique is recommended for MVD to reduce the risk of intraoperative neurovascular injury.

Vein-related Trigeminal Neuralgia: How to Determine the Treatment Method of the Causative Vein: A Technical Note

“…3) Therefore, it is desirable to pull the causative vein together with the surrounding arachnoid and stuck the arachnoid and petrosal dura by the Birdlime technique. 13) In our Case 1, slight symptoms persisted after treatment; however, it is unknown whether this was due to nerve injury associated with surgical manipulation or repeated nerve block. Thus, the treatment of venous TN is far more difficult than that of arterial TN in terms of curability.…”

Validation of Efficacy and Safety of TachoSil® Tissue Sealant for Vessel Transposition in Microvascular Decompression

“…22 The safety of intradural use of TachoSil ® has not been fully examined, but no adverse effect has been reported. 8,23 Hearing loss remains a significant risk with MVD especially for HFS. 24 A systematic review showed that the incidences of hearing loss after MVD for HFS and TN were 8.25% and 5.58%, respectively.…”

Surgical Treatment for Trigeminal Neuralgia

“…surgical glue or other surgical products, such as tachosil, have recently been used instead of suturing due to the complexity of this surgical technique [ 1 , 45 , 46 ]. these studies have been recently published, and although the initial effect is acceptable, the durability is controversial because there is not enough follow-up.…”