Snare Technique of Vascular Transposition for Microvascular Decompression. Technical Note.

Abstract

Recurrence of trigeminal neuralgia (TN) or hemifacial spasm (HFS) after microvascular decompression (MVD) is not rare. The prosthesis material eventually adheres to the neurovascular structures and again transmits arterial pulsation to the nerve. A snare ligature technique using a Gore-Tex tape can be used for the transposition of the offending artery. No prosthesis is necessary once the transposition is complete. This technique requires introduction of either Gore-Tex tape or thread around the artery and suture over the petrous dura, so an adequate working space as if operating in a shallow basin is essential. Therefore, the osteoplastic craniotomy is a little larger than usual with the scalp flap entirely reflected using a semicircular skin incision. The Gore-Tex tape can be directly snared around the artery and sutured over the petrous dura. If this procedure is difficult, a thread can be attached to both ends of the Gore-Tex tape to pass the tape around the vessel. Seven patients with TN and 13 patients with HFS have undergone this surgery. Although the follow-up period is not yet long enough, there has been no case of recurrence. The present technique for MVD can provide complete and permanent transposition of the offending artery.

Microvascular Decompression for Hemifacial Spasm Associated with Vertebrobasilar Artery

“…Therefore, many authors suggested various modified methods other than conventional MVD 4,14,15,19,26,27) . Nevertheless, the outcome of facial spasm caused by the larger arteries is not satisfactory.…”

“…When performing MVD for HFS, the successful surgical outcome depends on precise understanding of the anatomical structure more than anything else. Nagatani et al 26) suggested that the configuration of the vertebrobasilar system has a significant correlation with the presence of perforating branches near the site of microvascular decompression. Our result showed the significant difference in the treatment outcome according to the presence or absence of direct perforators towards the brain stem or cerebellar peduncle.…”

Suture retraction technique to prevent parent vessel obstruction following aneurysm tandem clipping

“…Strategies for manipulation of the location of intracranial vessels have been previously described using slings or suture material tethered to the dura. 6,8 The use of suture tied to a fenestrated clip encircling a vessel, for purposes of transposing it during microvascular decompression, has also been described. 2 In this report, we adapt the same concept to relieve the weight of multiple clips applied to an aneurysm dome, thus preventing parent vessel compromise.…”

Microvascular decompression for hemifacial spasm secondary to vertebrobasilar dolichoectasia: Surgical strategies, technical nuances and clinical outcomes

“…Rarely, an elongated, enlarged and atherosclerotic vertebrobasilar junction in a crowded posterior fossa compartment can result in aberrant compression of the lower cranial nerves and brainstem. Microvascular decompression in cases of vertebrobasilar dolichoectasia (VBD) are surgically challenging for many reasons: a partially calcified, fixed, and tortuous vertebrobasilar junction tethered by critical brainstem perforators is often difficult to mobilize, and transposition using pledgets or vascular slings may result in vascular kinking or occlusion, increasing the risk for ischemic injury [1][2][3]. Limited data are available in the neurosurgical literature on the ideal surgical approach and long term efficacy of this complex subset of patients.…”