Microvascular Decompression for Trigeminal Neuralgia based on Knowledge of the Microsurgical Anatomy with Reference to the Infratentorial Lateral Supracerebellar Approach and the Petrosal Vein(<SPECIAL ISSUES>Veins of the Skull Base (2): Petroclival Region)

Abstract

The authors presented microvascular decompression procedures based on the microsurgical anatomy. Attention is paid in this approach to the trigeminal nerve and the petrosal vein as obstacles. The infratentorial lateral supracerebellar approach is recommended instead of Dandy's cerebellar route. The microsurgical anatomy of the superior petrosal vein and its tributaries is also reviewed. The superior petrosal vein should be preserved during microvascular decompression for trigeminal neuralgia as much as possible. However, neurosurgeons often meet venous complex using this approach and have to make a surgical decision to sacrifice the tributaries for optimal exposure of the trigeminal nerve. Even in this situation, the authors emphasize that the vein of the cerebellopontine fissure should always be preserved in order to avoid congestive venous complications.