title: Safety of Superior Petrosal Vein Sacrifice During Microvascular Decompression of the Trigeminal Nerve.
abstract: BACKGROUND
  Microvascular decompression (MVD) is a safe and effective treatment for trigeminal neuralgia. Cerebellar venous infarction is a complication associated with surgical sacrifice of the superior petrosal vein (SPV). The SPV intervenes between the trigeminal nerve and the surgeon. Optimal exposure of the cisternal trigeminal nerve, particularly at the brainstem, can be achieved by sacrificing the SPV. We analyzed a cohort of 224 patients to determine the frequency of cerebellar venous infarction.
  
  
  METHODS
  Retrospective analysis of records and neuroradiology for patients undergoing trigeminal MVD at the Manchester Skull Base Unit between August 1st 2008 and July 31st 2015.
  
  
  RESULTS
  A total of 184 of 224 (82%) patients had coagulation and division of the main stem of the SPV. There were no cases of venous infarction. There was one case of mild, transient, cerebellar symptoms and signs, with no radiologic evidence of venous infarction. This patient had SPV sacrifice at surgery but also had postoperative thrombosis of the transverse sinus. Venous sinus thrombosis affected 5 of 184 (2.7%) patients. A total of 208 of 224 (93%) patients had a good outcome with improvement or resolution of their trigeminal neuralgia at 3 months.
  
  
  CONCLUSIONS
  The overall rate of venous complications in this study was 2.7%; however, we had no cases of venous infarction in 184 patients who had sacrifice of the SPV. The incidence of venous infarction associated with SPV obliteration during MVD surgery is therefore <0.5%. SPV sacrifice may be used where necessary to optimize visualization of the root entry zone and maximize the chance of effective decompression of the trigeminal nerve.
authors.affiliation: Manchester Skull Base Unit, Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Salford Royal Hospital, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom. Electronic address: omar.pathmanaban@manchester.ac.uk.
authors.forename: Omar N
authors.initials: ON
authors.lastname: Pathmanaban
authors.affiliation: Manchester Skull Base Unit, Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Salford Royal Hospital, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Frazer
authors.initials: F
authors.lastname: O'Brien
authors.affiliation: Manchester Skull Base Unit, Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Salford Royal Hospital, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Yahia Z
authors.initials: YZ
authors.lastname: Al-Tamimi
authors.affiliation: Manchester Skull Base Unit, Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Salford Royal Hospital, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Charlotte L
authors.initials: CL
authors.lastname: Hammerbeck-Ward
authors.affiliation: Manchester Skull Base Unit, Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Salford Royal Hospital, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Rutherford
authors.affiliation: Manchester Skull Base Unit, Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Salford Royal Hospital, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: King
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology; D002426:Cavernous Sinus / Q000601:surgery*; D002531:Cerebellum / Q000098:blood supply / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D020227:Lateral Sinus Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D061145:Microvascular Decompression Surgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014276:Trigeminal Nerve; D014277:Trigeminal Neuralgia / Q000601:surgery*; D055815:Young Adult
keywords: Complications; Microvascular decompression; Petrosal vein; Superior petrosal vein; Trigeminal neuralgia; Venous infarction