Keyhole microsurgery for trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia

Abstract

The aim of the study was to describe and evaluate the efficacy of the keyhole microsurgery to manage patients with trigeminal neuralgia (TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GPN). Two hundred and seven patients underwent microvascular decompression (MVD) and neurotomy via retrosigmoid keyhole approach in our department clinic: MVD for trigeminal neuralgia 169 cases, hemifacial spasm 31 cases, glossopharyngeal neuralgia 4 cases and neurotomy for glossopharyngeal neuralgia 3 cases. There was no serious complication such as deaths or infarction in the cerebellum or the brainstem. Complete and partial symptoms relief was obtained in 160 (94.7%) cases and failure 9 (5.3%) cases with MVD for trigeminal neuralgia, postoperatively. Meanwhile, complications occurred in one case with cerebellar hematoma only. The postoperative results of MVD for hemifacial spasm with symptoms relief was noted in 29 (93.5%) cases and failure 2 (6.5%) cases. Postoperative complications occurred in one case with moderate hearing loss, another three cases complained of transient facial paralysis. Symptoms relief achieved in all 7 (100%) cases undergone MVD or neurotomy for glosspharyngeal neuralgia. Postoperative complications occurred in one case with moderate vocal paralysis. We think that microsurgery via retrosigmoid keyhole approach is safe and effective for CPA hyperactive cranial nerve dysfunction syndromes.

International expert consensus statement about methods and indications for keyhole microneurosurgery from International Society on Minimally Invasive Neurosurgery

“…A variety of instruments can be used simultaneously in the keyhole approach, such as two brain spatulas, two aspirator tubes, bipolar forceps, or clip appliers. Furthermore, a neuroendoscope can be used to enhance visualization during the operation [42,82,87].…”

Surgical variation of microvascular decompression for trigeminal neuralgia: A technical note and anatomical study

“…Similar reports showed can reach same objectives with less complicated patient positioning and small craniotomies, such as that reported by Broggi et al . in his paper presenting a similar technique[11217] However, the use of circular Dacron guarantees the attachment to nerve and avoids another surgery for repositioning in case the prosthesis falls. [19]…”

Clinical application of scalp markers and three-dimensional sliced computer tomography reconstructions of the skull transverse-sigmoid sinus groove in the retrosigmoid approach

“…In the past, neurosurgeons generally depend on the asterion and related sutures to determine the position of the transversesigmoid sinus junction (25,27,29). However, the transversesigmoid sinuses and junction sites of different people exhibit different anatomical characteristics (13,18,21,28,30), The most common complication in the retrosigmoid approach is CSF leakage (5), which is partly caused by the incomplete sealing of the opened mastoid air cell (10). Preoperative knowledge of the development of mastoid air cells and intraoperative complete sealing of the opened mastoid air cell would help reduce the incidence of CSF leakage (22).…”