• World Neurosurg · Aug 2018

    Case Reports

    Novel Technical Variations and Increased Adhesive Strength in the "Birdlime" Transposition Technique for Microvascular Decompression.

    • Naoki Otani, Terushige Toyooka, Satoru Takeuchi, Arata Tomiyama, Kojiro Wada, and Kentaro Mori.
    • Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan. Electronic address: naotani@ndmc.ac.jp.
    • World Neurosurg. 2018 Aug 1; 116: e460-e468.

    BackgroundVessel transposition is the standard procedure in microvascular decompression (MVD), which necessitates more complex and difficult surgical techniques, including suturing in the deep operative field. We recently reported the usefulness of TachoSil tissue sealing sheets soaked with fibrin glue for vessel transposition in MVD, known as the "birdlime" technique. Here we describe various technical variations and improved adhesive strength of this material for safe and optimal vessel transposition without complications.MethodsWe retrospectively reviewed the operative findings of 31 consecutive patients who underwent MVD with the transposition procedure using TachoSil tissue sealing sheet soaked with fibrin glue between January 2012 and June 2017. The adhesive strength of TachoSil soaked with fibrin glue was measured using porcine dura mater.ResultsA single piece of this material was required in 13 patients, a single piece for multiple lesions was required in 5 patients, multiple pieces for a long segment were required in 12 patients, mainly with the offending vertebral artery in 9 patients, stacked pieces in 2 patients, and direct adhesion of vessels in 6 patients. All patients except 1 had total remission of symptoms immediately after the procedure. There were no severecomplications, recurrences, adhesions, or cranial nerve dysfunction in any patient. TachoSil soaked with fibrin glue showed significantly higher adhesive tensile strength compared with fibrin glue or Teflon felt with fibrin glue.ConclusionsModifications of the birdlime technique and reinforcement of the adhesive strength provide an easy and adjustable way to perform MVD safely and effectively to reduce the risk of intraoperative neurovascular injury.Copyright © 2018 Elsevier Inc. All rights reserved.

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