The hanging technique using the superior petrosal vein in surgical transposition for trigeminal neuralgia

Recently, transposition of the offending vessel has become the gold standard technique in microvascular decompression for trigeminal neuralgia. Teflon felt is the main material used, and the effectiveness of transposing the offending vessel to the cerebellar tentorium using Teflon felt has been widely demonstrated. However, foreign body reaction occurs in some cases causing granulation tissue formation and recurrence of trigeminal neuralgia. We investigated an alternative technique where the offending vessel (superior cerebellar artery) is transposed to the superior petrosal vein without use of Teflon felt for treating trigeminal neuralgia. This study involved 12 patients who underwent surgery using the hanging technique for trigeminal neuralgia in which the superior cerebellar artery was the offending vessel. Surgery was performed using the retrosigmoid approach. The horizontal fissure of the cerebellum was opened, the root entry zone of the trigeminal nerve was accessed via the infratentorial supracerebellar approach, and the superior cerebellar artery was detached and released. The artery was then moved to the tentorium, formed into a loop, hung on the superior petrosal vein, and affixed with fibrin glue. Facial pain improved in all cases and sufficient decompression of the trigeminal nerve was confirmed on imaging postoperatively. This hanging technique is expected to have low risk of recurrence of trigeminal neuralgia because it does not use foreign materials potentially causing granulation tissue formation and adhesion around the trigeminal nerve. This simple practical technique using existing anatomical structures and no foreign materials appears promising, although long-term follow-up is required.