Awake microvascular decompression with fat-teflon sandwich technique: Clinical implications of a novel approach for cranial nerve neuralgias

Ratha, Vishwaraj; Kumar, V.R. Roopesh; Subramaniam, Sudhakar; Kumar, Senthil; Sankaran, Vijay G.; Bapu, K.R. Suresh

doi:10.1016/j.jocn.2019.04.007

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…This was shown to be as reliable as Penfield’s classic technique with reduced risk of intra-op seizures [26]. This technique proved to be more reliable in quantitatively predicting the distance from the CST in subcortical stimulation during tumor surgery and had significantly lower risk of seizures [25-27]. Schucht et al [28] in their series of 8 pediatric patients with 4 preadolescents found that the quantitative mapping thresholds for assessing the risk of direct damage to the motor cortex were similar to the established values found in adults [26].…”

Section: Discussionmentioning

confidence: 99%

Technical Considerations in Awake Craniotomy with Cortical and Subcortical Motor Mapping in Preadolescents: Pushing the Envelope

Ratha¹,

Sampath²,

Subramaniam

et al. 2021

Pediatr Neurosurg

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Introduction: Unlike adult gliomas, the utility of combined application of awake anesthesia and intraoperative neurophysiological monitoring (IONM) for maximal safe resection in eloquent region gliomas (ERG) has not been established for pediatric population while it remains unexplored in preadolescents (below 11 years old). Case Presentation: We report 2 cases of awake craniotomy with IONM in an 8 and 9 year old for safe maximal resection of ERG. In both the cases, repeated preoperative visits of the operating room was performed to familiarize and educate the children about intraoperative communication, comfortable positioning, and neurological assessment. Under conscious sedation protocol, cortical and subcortical mapping, and electrocorticography, gross total resection was achieved. In both the cases, there were no postoperative neurodeficits or perioperative complications. Conclusion: Our 2 cases illustrate the first instance of successful use of awake IONM for maximal safe resection of ERG in preadolescent age-group. We believe, with proper preoperative planning and careful titration of anesthetics, it is safe and feasible. The blanket notion that preadolescent age-group should be excluded from awake mapping needs to be challenged, rather curated on a case basis.

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Section: Discussionmentioning

confidence: 99%

Technical Considerations in Awake Craniotomy with Cortical and Subcortical Motor Mapping in Preadolescents: Pushing the Envelope

Ratha¹,

Sampath²,

Subramaniam

et al. 2021

Pediatr Neurosurg

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“…Besides, this low-density hollow structure facilitates the flow and circulation of cerebrospinal fluid, flushing away the blood clots left during surgery, and reduces the chance of adhesion between Teflon and trigeminal nerve and the formation of granulomas. As Vishwaraj Ratha described 11 , the culprit vessel and the trigeminal nerve were first divided by a Teflon pledget, and then a fat globule was placed between the Teflon and the trigeminal nerve. They called this Fat-Teflon sandwich technique and thought it could prevent the occurrence of Teflon granuloma.…”

Section: Interposition Techniquesmentioning

confidence: 99%

Surgical technique management of microvascular decompression for trigeminal neuralgia

Yang

Cheng

2022

Ideggyógyászati szemle

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Trigeminal neuralgia is a severe neuropathic disorder, affecting the distribution area of the trigeminal nerve and often impairs the quality of life of patients. More and more scholars agree that one of the pathogenesis of trigeminal neuralgia is due to the demyelinating lesion caused by vascular compression or arachnoid bundle wrapping on the root exit zone of trigeminal nerve. In this regard, the most effective method is microvascular decompression, which can relieve the compression of the offending vessels and the thickened arachnoid on the trigeminal nerve. However, it still has some disadvantages, such as the possibility of fatal complications. In recent years, with the advancement of neurosurgical treatment technology, new progress has been made in microvascular decompression. This article mainly introduces the surgical techniques and new methods of the microvascular decompression.

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Awake neurosurgery: Advancements in microvascular decompression for trigeminal neuralgia

Fareed,

Iftikhar,

Haider

et al. 2024

Surgical Neurology International

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Background: The treatment landscape for trigeminal neuralgia (TN) involves various surgical interventions, among which microvascular decompression (MVD) stands out as highly effective. While MVD offers significant benefits, its success relies on precise surgical techniques and patient selection. In addition, the emergence of awake surgery techniques presents new opportunities to improve outcomes and minimize complications associated with MVD for TN. Methods: A thorough review of the literature was conducted to explore the effectiveness and challenges of MVD for TN, as well as the impact of awake surgery on its outcomes. PubMed and Medline databases were searched from inception to March 2024 using specific keywords “Awake Neurosurgery,” “Microvascular Decompression,” AND “Trigeminal Neuralgia.” Studies reporting original research on human subjects or preclinical investigations were included in the study. Results: This review highlighted that MVD emerges as a highly effective treatment for TN, offering long-term pain relief with relatively low rates of recurrence and complications. Awake surgery techniques, including awake craniotomy, have revolutionized the approach to MVD, providing benefits such as reduced postoperative monitoring, shorter hospital stays, and improved neurological outcomes. Furthermore, awake MVD procedures offer opportunities for precise mapping and preservation of critical brain functions, enhancing surgical precision and patient outcomes. Conclusion: The integration of awake surgery techniques, particularly awake MVD, represents a significant advancement in the treatment of TN. Future research should focus on refining awake surgery techniques and exploring new approaches to optimize outcomes in MVD for TN.

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Awake microvascular decompression with fat-teflon sandwich technique: Clinical implications of a novel approach for cranial nerve neuralgias

Cited by 3 publications

References 23 publications

Technical Considerations in Awake Craniotomy with Cortical and Subcortical Motor Mapping in Preadolescents: Pushing the Envelope

Technical Considerations in Awake Craniotomy with Cortical and Subcortical Motor Mapping in Preadolescents: Pushing the Envelope

Surgical technique management of microvascular decompression for trigeminal neuralgia

Awake neurosurgery: Advancements in microvascular decompression for trigeminal neuralgia

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