Fenestrated Aneurysm Clip Trigeminal Decompression after CyberKnife Treatment Failure

Authors

Christopher S. Graffeo, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Lea Scherschinski, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Sufyan Ibrahim, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Jacob F. Baranoski, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Visish M. Srinivasan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.

Document Type

Article

Abstract

This article describes a novel technique for trigeminal nerve decompression in the setting of refractory trigeminal neuralgia (TN).  Technical note with an illustrative case example and operative video.  Outpatient, inpatient, and operating room of a quaternary neurosurgical referral center.  A woman in her early 70s who had previously undergone linear accelerator-based stereotactic radiotherapy (i.e., CyberKnife) and achieved 2 years of partial pain relief. However, facial pain, numbness, and parasympathetic dysfunction returned and became unbearable.  Durable relief of TN.  Microvascular decompression was recommended for refractory TN. Intraoperatively, the trigeminal nerve was markedly attenuated from previous irradiation, with the superior cerebellar artery (SCA) loop embedded in the nerve at its root entry zone. The arterial loop was mobilized into a new position superior to the nerve, thus liberating it from the impingement. The tentorium was incised, and a fenestrated aneurysm clip was positioned such that the SCA loop was transmitted via the fenestration. The clip was applied across the tentorium, thus suspending the artery in a kink-free orientation that made no contact with the nerve.  This procedure provided excellent neurovascular decompression without placing mechanical strain on the nerve, relieving the patient's persistent postirradiation TN. The technique could have broader applications for other challenging or atypical microvascular decompression procedures.

Publication Date

2-1-2024

Publication Title

Journal of neurological surgery. Part B, Skull base

ISSN

2193-6331

Volume

85

Issue

1

First Page

106

Last Page

108

PubMed ID

38274478

Digital Object Identifier (DOI)

10.1055/s-0042-1760295

Recommended Citation

Graffeo, Christopher S.; Scherschinski, Lea; Ibrahim, Sufyan; Baranoski, Jacob F.; Srinivasan, Visish M.; and Lawton, Michael T., "Fenestrated Aneurysm Clip Trigeminal Decompression after CyberKnife Treatment Failure" (2024). Neurosurgery. 2001.
https://scholar.barrowneuro.org/neurosurgery/2001