title: Via-cerebellar-fissures approach for microvascular decompression of trigeminal nerve.
abstract: Although the infratentorial superior-lateral cerebellar approach has been traditionally chosen for exposure of the V cranial nerve root in the process of microvascular decompression for treatment of trigeminal neuralgia, those petrosal veins often block this surgical corridor. To detour these petrosal veins, we require a new approach. We provide a via-cerebellar-fissures approach to expose well the trigeminal nerve. With microscopy, cerebrospinal fluid was drained sufficiently to relax the cerebellum. Caudally to petrosal veins, the dissection was started from the cerebellar fissures. With the arachnoid membranes around the petrosal fissure and superior cerebellopontine fissures being opened thoroughly, the root entry zone of V nerve was visualized directly. This new approach was used in 106 patients. Among them, the block veins were encountered in 17 (16.0%). Among the 17 vein-blocked cases, 1 or 2 branches of the veins were finally cut in 2 (1.9%). The postoperative relief rate was 95.3% without complications. This via-cerebellar-fissures approach may access the root entry zone of the V cranial nerve without killing those petrosal veins, which is worth to be recommended and popularized.
authors.affiliation: From the Department of Neurosurgery, Xinhua Hospital/The Cranial Nerve Disease Center of Shanghai, Shanghai JiaoTong University School of Medicine, Shanghai, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Zhu
authors.forename: Jun
authors.initials: J
authors.lastname: Zhong
authors.forename: Wei
authors.initials: W
authors.lastname: Jiao
authors.forename: Qiu-Meng
authors.initials: QM
authors.lastname: Zhou
authors.forename: Hong-Xin
authors.initials: HX
authors.lastname: Guan
authors.forename: Ning-Ning
authors.initials: NN
authors.lastname: Dou
authors.forename: Yong-Nan
authors.initials: YN
authors.lastname: Wang
authors.forename: Lei
authors.initials: L
authors.lastname: Xia
authors.forename: Shi-Ting
authors.initials: ST
authors.lastname: Li
mesh_terms: D001099:Arachnoid / Q000601:surgery; D002426:Cavernous Sinus / Q000033:anatomy & histology; D002530:Cerebellopontine Angle / Q000033:anatomy & histology; D002531:Cerebellum / Q000098:blood supply / Q000601:surgery*; D002550:Cerebral Veins / Q000033:anatomy & histology; D006801:Humans; D061145:Microvascular Decompression Surgery / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D014276:Trigeminal Nerve / Q000601:surgery*; D014277:Trigeminal Neuralgia / Q000601:surgery*