Basilar Artery Ectasia Causing Trigeminal Neuralgia: An Evolved Technique of Transpositional Suture-Pexy.

Abstract

BACKGROUND:

Microvascular decompression for patients with trigeminal neuralgia (TGN) is widely accepted as one of the modalities of treatment. The standard approach has been retrosigmoid suboccipital craniotomy with placement of a Teflon pledget to cushion the trigeminal nerve from the offending artery, or cauterize and divide the offending vein(s). However, in cases of severe compression caused by a large artery, the standard decompression technique may not be effective.

OBJECTIVE:

To describe a unique technique of vasculopexy of the ectatic basilar artery to the tentorium in a patient with TGN attributed to a severely ectatic and tortuous basilar artery. A case series of patients who underwent this technique of vasculopexy for arterial compression is presented.

METHODS:

The patient underwent a subtemporal transtentorial approach and the basilar artery was mobilized away from the trigeminal nerve. A suture was then passed through the wall of the basilar artery (tunica media) and secured to the tentorial edge, to keep the artery away from the nerve.

RESULTS:

The neuralgia was promptly relieved after the operation, with no complications. A postoperative magnetic resonance imaging scan showed the basilar artery to be away from the trigeminal root. In a series of 7 patients who underwent this technique of vasculopexy, no arterial complications were noted at short- or long-term follow-up.

CONCLUSION:

Repositioning and vasculopexy of an ectatic basilar artery for the treatment of TGN is safe and effective. This technique can also be used for other neuropathies that result from direct arterial compression.

• Authors: Harminder Singh, Harley Brito da Silva, Mehdi Zeinalizadeh, Turki Elarjani, David Straus, Laligam N Sekhar
• Journal: Operative neurosurgery (Hagerstown, Md.) (Oper Neurosurg (Hagerstown)) Vol. 14 Issue 2 Pg. 194-199 (02 01 2018) ISSN: 2332-4260 [Electronic] United States
• PMID: 29351686 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2017 by the Congress of Neurological Surgeons

Topics

• Aged
• Basilar Artery (diagnostic imaging, surgery)
• Dilatation, Pathologic (complications, diagnostic imaging, radiotherapy, surgery)
• Humans
• Male
• Radiculopathy (diagnostic imaging, etiology, radiotherapy, surgery)
• Retreatment
• Sutures
• Trigeminal Nerve
• Trigeminal Neuralgia (diagnostic imaging, etiology, radiotherapy, surgery)
• Vascular Surgical Procedures (methods)