• World Neurosurg · Jan 2021

    Review

    Transposition of Vessels for Microvascular Decompression of Posterior Fossa Cranial Nerves: Review of Literature and Intraoperative Decision-Making Scheme.

    • Samer S Hoz, Zahraa F Al-Sharshahi, Ali Adnan Dolachee, Silky Chotai, Hayder Salih, Saja A Albanaa, and Haya Jasim Mohammed.
    • Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq.
    • World Neurosurg. 2021 Jan 1; 145: 64-72.

    IntroductionMicrovascular decompression with transposition of the involved vessels provides good surgical outcomes in cases of complex and recurrent neurovascular compression syndromes. We conducted a literature review to illustrate the variations in the surgical techniques used for transposition and to provide a practical decision-making scheme for transposition of the involved vessel.MethodsA PubMed Medline database record search was conducted using the following algorithm ("Microvascular Decompression Surgery"[Mesh]) OR (((Microvascular) OR (Macrovascular)) AND decompression AND surgery) AND (transposition). Only articles that detailed the intraoperative techniques were included.ResultsA total of 48 articles were included. The adjacent anatomical walls to which the compressing vessel can be anchored were divided into 4 groups; A: roof (tentorium cerebelli), B: anterior wall (posterior surface of petrous bone and clivus), C: posterior wall (petrosal surface of the cerebellum), and D: "no wall" required. A new decision-making scheme based on the following 2 questions was designed: 1) is the conflicting vessel amenable to transposition to a nearby wall in the cerebello-brainstem space? 2) what is the closest wall to secure the transposed vessel?ConclusionsTransposition of the involved vessel is a valuable procedure for microvascular decompression of the posterior fossa cranial nerves. Anchoring the vessel to the adjacent anatomical wall ensures secure transposition. The proposed algorithm provides a systemic scheme to identify the optimal anatomical wall, and to determine the technique and material that can be used to anchor involved vessel. This scheme is an efficient method to inform the intraoperative decision-making process.Copyright © 2020 Elsevier Inc. All rights reserved.

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