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The patient came to the clinic 05-March-2006 with a medical report
for one patient, to whom I performed microvascular decompression for
trigeminal neuralgia 10 years ago, telling me that he is suffering
the same and urging to perform to him the same procedure. The
patient was crying due to pain and he had left sided trigeminal
neuralgia with hypalgesia of the left V2 territory. The patient was
in mega-doses of tegretol without effect for seven months. The patient
was sent to perform MRI of the CPA and it ruled out any other
causes, only the tortuous PICA and some constriction of the left
trigeminal nerve. The patient was advised to try Neurontine with
tegretol, but he came yesterday urging for surgery, because
medication did not help.
The patient was operated in the setting position with left
retromastoid approach. The arachnoid over the trigeminal nerve was
massive and all the arachnoidal membranes were sharply dissected.
Dandy vein was stuck with the nerve, for what it was isolated,
coagulated and bisected. There was a circular constriction from an
abnormal vessel compressing the nerve. It was coagulated and cut to
relieve the nerve from constriction. PICA was under the facial
nerve and it was pulled out gently and all the compressive effect
upon the facial nerve was eliminated.
There was no traction applied during surgery and it was possible
to inspect the entire trigeminal nerve from its emergence from the
brainstem down to the Meckel's cave. Considering that, PICA is not
stuck with nerve no Teflon patch was applied. Routine closure of the
wound and smooth postoperative recovery.
The neuralgia disappeared immediately after the operation.
For academic part about trigeminal neuralgia and MVD please
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