title: Surgical skills of adhesions and transposition of trigeminal nerve for primary trigeminal neuralgia.
abstract: OBJECTIVE
  The aims of this study were to investigate disposal of adhesions and transposition of the trigeminal nerve during microvascular decompression and evaluate its surgical effect.
  
  
  METHODS
  By collecting the clinical data of typical trigeminal neuralgia patients we treated from January 2013 to May 2013, we chose 120 patients with adhesions and transposition of trigeminal nerve, analyzed their preoperative imaging features and surgical procedures, and evaluated postoperative effect after 3-month follow-up.
  
  
  RESULTS
  Among these 120 patients, 113 cases showed positive effect in magnetic resonance imaging (three-dimensional time-of-flight); the positive rate was 94.2%. During the operation, firstly we proceed to separate the nerve and artery, secondly we released the vascular compression, finally we removed the superior cerebellar artery to the nerve's head end. Postoperative effect evaluation stated that 101 patients showed immediate remission and 13 patients showed delayed remission (3 min after operation) and the surgery was ineffective for 6 patients; the remission rate was 95%. There were no severe complications.
  
  
  CONCLUSIONS
  Magnetic resonance imaging (three-dimensional time-of-flight) before operation could clearly display the neurovascular relationship of trigeminal neuralgia patients. It offers great help for preoperative evaluation. Separation between arachnoid, nerve, and artery; vascular decompression; and removal of the superior cerebellar artery to the head end could resolve adhesions and transposition of trigeminal nerve during microvascular decompression, which showed significant effects.
authors.affiliation: From the Department of Neurosurgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Guo-wei
authors.initials: GW
authors.lastname: Li
authors.forename: Wen-chuan
authors.initials: WC
authors.lastname: Zhang
authors.forename: Yang
authors.initials: Y
authors.lastname: Min
authors.forename: Qiu-feng
authors.initials: QF
authors.lastname: Ma
authors.forename: Wen-xiang
authors.initials: WX
authors.lastname: Zhong
mesh_terms: D000368:Aged; D001158:Arteries / Q000601:surgery; D002531:Cerebellum / Q000098:blood supply; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D061145:Microvascular Decompression Surgery / Q000379:methods*; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000601:surgery*; D000267:Tissue Adhesions / Q000175:diagnosis / Q000601:surgery*; D014276:Trigeminal Nerve / Q000601:surgery*; D014277:Trigeminal Neuralgia / Q000175:diagnosis / Q000601:surgery*