The “hanging technique” of vascular transposition in microvascular decompression for trigeminal neuralgia: technical report of four cases

Mitsos, Aristotelis P.; Georgakoulias, Nikolaos; Lafazanos, Spiridon A; Konstantinou, Evangelos

doi:10.1007/s10143-008-0144-6

Cited by 23 publications

(11 citation statements)

References 19 publications

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“…21,22 The first transposition method for treating HFS used Teflon tape. 5 Various materials have since been employed in transposition procedures, including strips of dura, 3,12 fascia, 17 sutures, 3,18 tapes, 16 fibrin tissue-adhesive collagen fleece product, 14 silicone (polydimethylsiloxane) tube, 25 fenestrated aneurysm clip, 1 or expanded polytetrafluoroethylene. 18,20 However, these transposition procedures are more complicated, more time consuming, and more hazardous than interposition techniques because suturing with a needle is required in the vicinity of the brainstem.…”

Section: Discussionmentioning

confidence: 99%

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

Otani

Toyo’oka

Fujii

et al. 2018

Journal of Neurosurgery

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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.

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Section: Discussionmentioning

confidence: 99%

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

Otani

Toyo’oka

Fujii

et al. 2018

Journal of Neurosurgery

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“…Based on these experiences, some authors have recently advocated alternative techniques such as the “hanging technique”, where the offending vessel is transposed from the nerve by using strips of autologous tissue or fenestrated clips for aneurysm surgery [31,32]. This technique, used in our case and already suggested by our group for the treatment of medulla oblongata compression by vertebral artery [33,34], seems to be a useful method, especially in cases such as we report, in which recurrence of the TN can be related to compression or adhesion caused by the material used in the first MVD.…”

Section: Discussionmentioning

confidence: 99%

Unusual recurrence of trigeminal neuralgia after microvascular decompression by muscle interposal

et al. 2011

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SummaryBackgroundPatients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression (MVD) typically undergo less invasive procedures in the hope of providing pain relief. However, re-operation should be considered in selected patients.Case ReportA 48-year-old woman presented with recurrent trigeminal neuralgia (TN) 3 years following microvascular decompression (MVD). The patient underwent brain magnetic resonance angiography (MRA), which did not reveal neurovascular compression; therefore surgical re-exploration was carried out. During the operation, the fifth cranial nerve was seen without impingement from any blood vessels; however, a very firm tissue was observed and identified as the muscle fragment from the previous MVD procedure. The fifth cranial nerve was carefully separated from the muscle. Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura.ConclusionsOur findings, along with similar cases reported in the literature, support the development of new inert materials and alternative surgical strategies that can limit TN recurrence.

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“…4,9 Teflon is the most used material for decompression of the trigeminal nerve because it is considered an inert substance. 12,13,15 However, numerous reports of inflammatory reactions related to Teflon use have been described within the neurosurgical literature, as well as within other surgical subspecialties. 2,4,5,9,10,15 It has been proposed that Teflon granuloma formation is the cause of delayed recurrence of facial pain after initial surgical success.…”

mentioning

confidence: 99%

“…2,4,5,9,10,15 Other foreign materials used in MVD procedures have also been found to cause inflammatory reactions. 13 Alternative decompressive techniques for trigeminal neuralgia are described in the literature, including the use of a slinging method to reposition the compressive vessel away from the trigeminal nerve. The first report of this method was described by Fukushima in 1982, in which a Dacron sling technique was used.…”

mentioning

confidence: 99%

“…These studies have predominantly used foreign materials for sling creation, including Dacron, suture, Gore-Tex tape, aneurysm clips, and gelatin sponge. 9,13 However, Melvill and Baxter described the use of an autologous dural sling created from the underside of the tentorium. 11 This method was used in 7 patients with a follow-up period ranging from 1 to 8 months.…”

mentioning

confidence: 99%

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Tentorial sling for microvascular decompression in patients with trigeminal neuralgia: a description of operative technique and clinical outcomes

Steinberg

Sack

Wilson

et al. 2019

Journal of Neurosurgery

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OBJECTIVETrigeminal neuralgia is a debilitating pain disorder most often caused by arterial compression of the trigeminal nerve, although there are other etiologies. Microvascular decompression (MVD) remains the most definitive treatment for this disorder, with cure rates reported between 60% and 80%. Traditional MVD techniques involve a retrosigmoid craniotomy with placement of an inert foreign material, such as Teflon, between the nerve and compressive vessel. Recurrence of trigeminal neuralgia after MVD has been associated with vessel migration, adhesion formation, and arterial pulsation against the Teflon abutting the nerve. Additionally, foreign materials such as Teflon have been reported to trigger inflammatory responses, resulting in recurrence of trigeminal pain. An alternative method for decompression involves the use of a sling to transpose the compressive vessel away from the nerve. Results of various sling techniques as a decompressive strategy are limited to small series and case reports. In this study, the authors present their experience utilizing a tentorial sling for MVD in patients with trigeminal neuralgia.METHODSInstitutional review board approval was obtained in order to contact patients who underwent MVD for trigeminal neuralgia via the tentorial sling technique. Clinical outcomes were assessed utilizing the Barrow Neurological Institute (BNI) pain intensity score immediately after surgery and at the time of the study.RESULTSThe tentorial sling technique was performed in 45 patients undergoing MVD for trigeminal neuralgia. In 41 of these patients, this procedure was their first decompressive surgery. Immediate postoperative relief of pain (BNI score I) was achieved in 80% of patients undergoing their first decompressive procedure. At last follow-up, 73% of these patients remained pain free. Three patients experienced recurrent trigeminal pain, with surgical exploration demonstrating an intact tentorial sling. The complication rate was 6.6%.CONCLUSIONSTransposition techniques for MVD have been described previously in small series and case reports. This study represents the largest experience in which the utilization of a tentorial sling for MVD in patients with trigeminal neuralgia is described. The technique represents a novel method for decompression of the trigeminal nerve by transposition of the offending vessel without the use of foreign material. Although the authors’ preliminary results parallel the historical cure rate, further outcome data are required to assess long-term durability of this method.

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The “hanging technique” of vascular transposition in microvascular decompression for trigeminal neuralgia: technical report of four cases

Cited by 23 publications

References 19 publications

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

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

Unusual recurrence of trigeminal neuralgia after microvascular decompression by muscle interposal

Tentorial sling for microvascular decompression in patients with trigeminal neuralgia: a description of operative technique and clinical outcomes

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