BACKGROUND Endoscopic-microvascular decompression (E-MVD) is a well described treatment for trigeminal neuralgia (TGN), but there has been debate of the safety of intraoperative sacrifice of the petrosal vein (PV) due… Click to show full abstract
BACKGROUND Endoscopic-microvascular decompression (E-MVD) is a well described treatment for trigeminal neuralgia (TGN), but there has been debate of the safety of intraoperative sacrifice of the petrosal vein (PV) due to concern for subsequent venous insufficiency. OBJECTIVE To investigate the risk of PV sacrifice during E-MVD in TGN and subsequent post-operative complications and pain outcomes. METHODS A five-year review yielded 201 patients undergoing MVD for TGN. PV sacrifice, vascular compressive anatomy and post-operative complications attributable to venous insufficiency were analyzed. Preoperative and postoperative pain outcomes were analyzed. RESULTS PV was sacrificed in 118/201 (59%) of patients, with 43/201 (21%) of patients undergoing partial sacrifice versus 75/201 (37%) with complete sacrifice. No cases of venous infarction, cerebellar swelling, or fatal complications were noted in either cohort. Non-neurologic complications occurred in 1.69% (2/118) of patients with PV sacrifice and 0% (0/83) of patients with PV preservation. Neurologic deficits (facial palsy, conductive hearing loss, gait instability, memory deficit) occurred in equal proportions in PV preservation and sacrifice groups (2.41% vs 1.69%) Overall, 87.3% (145/166) patients reported their pain as "very much improved" or "much improved" at one month, and no difference between groups was identified. CONCLUSIONS This study did not find higher complication rates in patients undergoing petrosal vein sacrifice during E-MVD for trigeminal neuralgia. In this series where petrosal vein was sacrificed only 59% of the time, it appears to be a safe technique, but larger studies will be needed to determine true incidence of complications following PV sacrifice.
               
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