Use of the Arachnoid Membrane of the Cerebellopontine Angle to Transpose the Superior Cerebellar Artery in Microvascular Decompression for Trigeminal Neuralgia: Technical Note

BACKGROUND: Microvascular decompression is an accepted, safe, and useful surgical technique for the treatment of trigeminal neuralgia. Autologous muscle or implant materials such as shredded Teflon are used to separate the vessel from the nerve but may occasionally be inadequate, become displaced or create adhesions and recurrent pain. OBJECTIVE: The authors evaluated the use of arachnoid membrane of the cerebellopontine angle to maintain the transposition of vessels from the trigeminal nerve. METHODS: The authors conducted a retrospective review of microvascular decompression operations in which the offending vessel was transposed and then retained by the arachnoid membrane of the cerebellopontine cistern, specifically by the lateral pontomesenchepalic membrane. RESULTS: This technique was used in 30 patients of the most recently operated series. Postoperatively, complete pain relief was achieved in 90% of the patients without any observed surgical complications. CONCLUSION: To the authors' knowledge this is the first report in which the arachnoid membrane is used in the microvascular decompression of the trigeminal nerve. While this technique can be used only for selected cases, the majority of the vascular compressions on the trigeminal nerve are due to the SCA, so this sling transposition technique can be useful and effective.