Microvascular Decompression for Trigeminal Neuralgia: Zone Exploration and Decompression Techniques.
OBJECTIVE
The aim of this study is to introduce zone exploration of the trigeminal nerve and decompression techniques for different types of vasculars.


METHODS
The trigeminal nerve was sectioned into 5 zones. Zone 1, 2, 3, 4 was located at the rostral, caudal, ventral, and dorsal part of the nerve root entry zone (REZ) respectively, and zone 5 was located at the distal of the nerve root. This study contained 86 patients with trigeminal neuralgia underwent microvascular decompression. Every zone was exposed through preoperative imaging. During the operation, offending vessels were explored from zone 1 to zone 5, and different decompression techniques were used for different types of vessels.


RESULTS
Through zone exploration, the sensitivity of preoperative imaging was 96.5% and specificity was 100%. Location of the neurovascular conflict was in the zone 1 in 53.5% of the patients, zone 2 in 32.6%, zone 3 in 45.3%, zone 4 in 29.1%, and zone 5 in 34.9%. In total, 2 zones were both involved in 59.3%, and 3 zones were involved in 18.6%. All offending arteries were moved away and interposed with Teflon sponge. Offending veins of 11 patients were too small to interpose, and coagulated and cut was adopted. The other offending veins were interposed with wet gelatin and Teflon sponge, respectively.


CONCLUSIONS
Zone exploration is helpful in finding offending vessels and adequate decompression can be achieved by choosing different methods according to different types of offending vessels.
*Department of Neurosurgery, Xin Hua Hospital (The Cranial Nerve Disease Center of Shanghai) †Department of Radiology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Bao-Hui
BH
Feng
Xue-Sheng
XS
Zheng
Ming
M
Liu
Xiao-Qiang
XQ
Wang
Xu-Hui
XH
Wang
Ting-Ting
TT
Ying
Shi-Ting
ST
Li
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery / Q000379:methods*; D008875:Middle Aged; D013126:Spinal Nerve Roots / Q000601:surgery; D014276:Trigeminal Nerve / Q000601:surgery; D014277:Trigeminal Neuralgia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*