title: 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.
authors.affiliation: Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Kanagawa. taku-sgn@ja2.so-net.ne.jp
authors.forename: Taku
authors.initials: T
authors.lastname: Shigeno
authors.forename: Junichiro
authors.initials: J
authors.lastname: Kumai
authors.forename: Masaru
authors.initials: M
authors.lastname: Endo
authors.forename: Soichi
authors.initials: S
authors.lastname: Oya
authors.forename: Shinji
authors.initials: S
authors.lastname: Hotta
mesh_terms: D019299:Decompression, Surgical; D005260:Female; D019569:Hemifacial Spasm / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008833:Microcirculation; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D055502:Secondary Prevention; D013537:Sutures; D014276:Trigeminal Nerve / Q000098:blood supply*; D014277:Trigeminal Neuralgia / Q000517:prevention & control / Q000601:surgery*; D014656:Vascular Surgical Procedures
chemical_list: D011138:Polytetrafluoroethylene