Biomedical Glue Sling Technique in Microvascular Decompression for Trigeminal Neuralgia Caused by Atherosclerotic Vertebrobasilar Artery: A Description of Operative Technique and Clinical Outcomes

BACKGROUND: Microvascular decompression (MVD) is the most definitive surgical treatment for trigeminal neuralgia (TN). In the case in which an atherosclerotic vertebrobasilar artery (aVBA) offends the trigeminal nerve, the postoperative outcomes have been reported to be less satisfactory in terms of symptom recurrence and complications. In this study, the authors present their experience using a biomedical sling for MVD in patients with aVBA-associated TN. METHODS: A retrospective study of 22 consecutive patients who underwent the biomedical glue sling technique in MVD for TN with aVBA was conducted between September 2016 and June 2017. RESULTS: Intraoperatively, aVBA was regarded as the direct or indirect offending vessel in 22 patients. In addition to aVBA, other vessels involved in neurovascular conflict included superior cerebellar artery in 12 patients, veins in 1, and anterior inferior cerebellar artery in 6. All 22 patients underwent the biomedical glue sling technique. Postoperatively, TN was completely resolved in 20 (91%) patients and partially relieved in 2 (9%) patients. During the follow-up period of 18-27 months, pain developed severely in those 2 patients but could be relieved with carbamaze-pine. As for complications, postoperative hypoacusia occurred immediately in 1 case, with complete resolution in 2 months. CONCLUSIONS: The biggest advantage of the biomedical glue sling technique is its simplicity in achieving complete decompression, requiring relatively less space and time. Because the outcome of traditional MVD regarding aVBA-associated TN remains controversial, the biomedical glue sling technique in MVD provides an alternative decompressive method for patients with TN associated with aVBA. However, further studies with a larger series and control group are required to prove the high effectiveness of this method.