Straightening the trigeminal nerve axis by complete dissection of arachnoidal adhesion and its neuroendoscopic confirmation for trigeminal neuralgia without neurovascular compression

Abstract

Background: Microvascular decompression has been used as an effective surgical treatment for typical trigeminal neuralgia with neurovascular compression. Since microvascular decompression cannot be performed in patients with typical trigeminal neuralgia without neurovascular compression, it has recently been suggested that nerve combing or neurolysis (longitudinally splitting the trigeminal nerve from the root entry zone to the pons by microneedle) be used as a primary surgical treatment. However, postoperative numbness and dysesthesia were present in the patients. Case description: We present a case of a 57-year-old woman with typical trigeminal neuralgia without neurovascular compression, which was evaluated by magnetic resonance imaging. A neurosurgical operation was performed in a supine-lateral position for the retromastoid approach under monitoring by electrophysiological evoked potentials. Since neurovascular compression could not be found, we performed straightening of the trigeminal nerve axis by complete dissection of the arachnoidal adhesion around the trigeminal nerve. Results were confirmed by a neuroendoscope. The patient demonstrated complete resolution of the trigeminal neuralgia without facial numbness and dysesthesia during the three years after the operation. Conclusions: Straightening the trigeminal nerve axis by complete dissection of the arachnoidal adhesion around the trigeminal nerve was effective for typical trigeminal neuralgia without neurovascular compression. Keywords: Trigeminal neuralgia, Microvascular decompression, Endoscope, Electrophysiology