Kawase Approach for Dolichoectactic Basilar Artery Macrovascular Decompression in a Patient With Trigeminal Neuralgia: Case Report.

Department

Neurosurgery

Document Type

Article

Abstract

BACKGROUND AND IMPORTANCE: Trigeminal neuralgia (TN) secondary to a dolichoectatic basilar artery (DBA) is an extremely rare phenomenon. The Kawase approach for macrovascular decompression of this rare pathology been used rarely.

CLINICAL PRESENTATION: This report describes macrovascular decompression and basilar artery transposition in a 69-yr-old male presenting with progressively worsening left-sided typical TN secondary to a DBA compression. The DBA was successfully decompressed off of the trigeminal nerve via a pterional craniotomy and anterior petrosectomy. The patient had immediate improvement in TN symptoms postoperatively. The patient remained symptom free with nonbothersome facial numbness in the V3 segment at 8-mo postoperative follow-up in clinic. The patient suffered a sixth nerve palsy following surgery, which was later corrected by strabismus surgery. The natural history and epidemiology of TN, results of macrovascular decompression secondary to DBA compression via a traditional suboccipital retrosigmoid approach, and potential advantages of the Kawase approach are also discussed.

CONCLUSION: The macrovascular decompression strategy succeeded because the compressive force was applied by the DBA to the nerve in a superolateral direction, and the decompressive sling pulled the DBA away from the nerve in an inferomedial direction. The working space and access to the clival dura through the Kawase approach allowed proper corrective pull with a sling.

Medical Subject Headings

Abducens Nerve Diseases; Aged; Basilar Artery; Computed Tomography Angiography; Craniotomy; Decompression, Surgical; Humans; Imaging, Three-Dimensional; Male; Neurosurgical Procedures; Petrous Bone; Postoperative Complications; Trigeminal Neuralgia; Vertebrobasilar Insufficiency

Publication Date

6-1-2019

Publication Title

Oper Neurosurg (Hagerstown)

ISSN

2332-4260

Volume

16

Issue

6

First Page

178

Last Page

178

PubMed ID

30124963

Digital Object Identifier (DOI)

10.1093/ons/opy215

This document is currently not available here.

Share

COinS