Complication Caused by Use of Fibrin Glue in Vessel Transposition for Trigeminal Neuralgia -Case Report-

Abstract

A 64-year-old man underwent microvascular decompression of the left superior cerebellar artery (SCA) for left trigeminal neuralgia (TN) using a sling of Teflon tape fixed to the tentorium with fibrin glue. The TN disappeared immediately after surgery, but recurred unusually rapidly at 2 weeks later at the same intensity as before. Second surgery revealed the SCA was suspended from the tentorium, but the trigeminal nerve was stretched and displaced superolaterally because of adhesion to the superior petrosal vein. The adhesion was thought to involve the fibrin glue used during the sling retraction procedure. The nerve was meticulously dissected from the adhesion, and the trigeminal nerve was placed in the correct position. The postoperative course was uneventful, and the TN disappeared completely. We recommend that the smallest amount of the fibrin glue possible be used to avoid adhesion to the surrounding neurovascular elements.

Endoscopic Microvascular Decompression with Transposition for Trigeminal Neuralgia and Hemifacial Spasm: Technical Note

“…The transposition method is considered to prevent recurrence by avoiding the formation of adhesions and granulomas between the prosthesis and affected nerve. [13][14][15][16] Decompression methods under fully endoscopic surgery have not been sufficiently discussed, and we focused on decompression methods under endoscopic surgery in this study. Transposition methods involve moving the offending vessel away from the affected nerve and fixing the offending vessel to a distant structure.…”

“…However, recurrence with this method has been reported due to adhesion and granuloma around the decompression site. [13][14][15][16] In contrast, transposition techniques move the offending vessel away from the affected nerve and fix the offending vessel to adjacent structures such as the cerebellar tentorium or petrosal dura mater. This method prevents the adhesion and granuloma around the decompression site, providing better surgical results.…”

Experimental Study on the Viscosity and Adhesive Performance of Exogenous Liquid Fibrin Glue

“…Its superior usability has been reported when applied with healthy tissues and their periphery in some neurosurgical procedures. 1 – 3) However, aggravation of symptoms attributable to FG 7) and triggering of inflammation in healthy tissues 8) have also been reported. In the wrapping of cerebral aneurysms, parent artery narrowing was reported to be caused by FG.…”

Recurrent Hemifacial Spasm following Minor Trauma: Report of a Case

“…Fibrin glue offers an alternative to Teflon pledgets for vessel translocation, avoiding rare but potentially serious complications such as granuloma formation [6][7][8][9] . However, fibrin carries its own reported consequences [10] . Teflon has a long history of success in MVD; we see no reason to alter the practice of using Teflon as an initial material for decompression.…”