title: Subtemporal transtentorial approach for recurrent trigeminal neuralgia after microvascular decompression via the lateral suboccipital approach: case report.
abstract: Microvascular decompression (MVD) via lateral suboccipital craniotomy is the standard surgical intervention for trigeminal neuralgia (TN). For recurrent TN, difficulties are sometimes encountered when performing reoperation via the same approach because of adhesions and prosthetic materials used in the previous surgery. In the present case report the authors describe the efficacy of the subtemporal transtentorial approach for use in recurrent TN after MVD via the lateral suboccipital approach. An 86-year-old woman, in whom an MVD via a lateral suboccipital craniotomy had previously been performed for TN, underwent surgery for recurrent TN via the subtemporal transtentorial approach, which provided excellent visualization of the neurovascular relationships and the trigeminal nerve without adhesions due to the previous surgery. Her TN disappeared after the MVD. The present approach is ideal for visualizing the trigeminal root entry zone, and the neurovascular complex can be easily dissected using a new surgical trajectory. This approach could be another surgical option for reoperation when the previous MVD had been performed via the suboccipital approach.
authors.affiliation: 1Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto; and.|2Department of Neurosurgery, Nagano Municipal Hospital, Nagano, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Ogiwara
authors.affiliation: 1Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto; and.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Goto
authors.affiliation: 2Department of Neurosurgery, Nagano Municipal Hospital, Nagano, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kusano
authors.affiliation: 1Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto; and.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kuroiwa
authors.affiliation: 1Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto; and.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kiuchi
authors.affiliation: 2Department of Neurosurgery, Nagano Municipal Hospital, Nagano, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Kodama
authors.affiliation: 2Department of Neurosurgery, Nagano Municipal Hospital, Nagano, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Takemae
authors.affiliation: 1Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto; and.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hongo
mesh_terms: D000369:Aged, 80 and over; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D061145:Microvascular Decompression Surgery / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000473:pathology / Q000601:surgery*; D014277:Trigeminal Neuralgia / Q000473:pathology / Q000601:surgery*
keywords: MVD = microvascular decompression; PV = petrosal vein; REZ = root entry zone; SCA = superior cerebellar artery; TN = trigeminal neuralgia; microvascular decompression; peripheral nerve; recurrent trigeminal neuralgia; subtemporal transtentorial approach