The Principal Surgical Techniques for Microvascular Decompression: Surgical Treatment for Trigeminal Neuralgia

Trigeminal neuralgia is caused by compression of blood vessels on the trigeminal nerve in 80-85% of cases. In this case, good results can be obtained by properly decompressing [1]. It is usually accessed to trigeminal nerve through the retrosigmoid approach. When the culprit vessel is identified, decompression is performed using decompressive materials such as Teflon. Sometimes a vein is the offending vessel, and sometimes the culprit vessel is not observed. In this case, rhizotomy or internal neurolysis is performed [2]. Nevertheless, the reasons for not performing invasive surgery are: (1) Various treatments other than surgery and good treatment results [3, 4]. (2) Surgical anatomy is unfamiliar and the operation field is narrow and deep. (3) There are factors that affect the difficulty of surgery, such as protrusion of petrosal bone and the route of superior petrosal vein. (4) The offending vessel was confirmed on the preoperative MR images and surgery was performed, but it is difficult to manage when there is no clear offender, or a small perforator or vein is the culprit vessel.