Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Brain / Vascular Case

Microvascular Decompression for Trigeminal Neuralgia

Microvascular decompression for trigeminal neuralgia

Description

65 year-old man with 4 years of right facial pain
Initial response to several medications, but always recurs
Pain shoots down right jaw-line
Triggered by talking, moving face, brushing teeth
Pain last only seconds, but is severe
Several times daily with increasing frequency & severity
Presentation consistent with trigeminal neuralgia

Gallery

Images

Figure 1High-resolution T2 weighted MRI and axial (top left), coronal (bottom left), and sagittal (top right) planes. Demonstrates right trigeminal nerve exiting the brainstem (yellow arrows) and its involvement with local blood vessels (red arrows). Diagram on bottom right demonstrates how the trigeminal nerve branches off of the pons of the brainstem.
Figure 2CTA showing multiple blood vessels (red arrows) around the right trigeminal nerve (yellow arrow)
Figure 3Intraoperative photo showing location of the incision behind the right ear
Figure 4Intraoperative photo showing patient positioning
Figure 5Screenshot captured from navigation station showing trajectory to the cerebral pontine angle
Figure 6Intraoperative photo captured from the surgical microscope showing a number of blood vessels attached to the surface of the right trigeminal nerve
Video 7Video captured from the surgical microscope showing dissection of multiple vessels of the surface of the trigeminal nerve.
Figure 8Intraoperative photo captured from the surgical microscope at the completion of the procedure showing Teflon pledgets separating multiple blood vessels from the underlying trigeminal nerve
Figure 9Immediate postoperative CT showing pledgets adjacent to the trigeminal nerve in the cerebellopontine angle

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