• World Neurosurg · May 2019

    Arachnoid Membranes Around the Cisternal Segment of the Trigeminal Nerve: A Cadaveric Anatomic Study and Intraoperative Observations During Minimally Invasive Microvascular Decompression Surgery.

    • Peter Kurucz, Oliver Ganslandt, Michael Buchfelder, and Laszlo Barany.
    • Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany; Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany. Electronic address: kuruczp@gmail.com.
    • World Neurosurg. 2019 May 1; 125: e262-e272.

    ObjectiveThe minimally invasive microvascular decompression (MVD) for trigeminal neuralgia is technically a more challenging operation compared with the standard retrosigmoidal approach. Endoscopic assistance could help to widen the field of view of the microscope during MVD. An extended view around the cisternal segment of the trigeminal nerve can be achieved only with the targeted dissection of the arachnoid membranes. The goal of our study was to analyze the three-dimensional organization of these membranes around the trigeminal nerve.MethodsMicrosurgical, endoscopic, and macroscopic anatomic examinations were performed on 50 fresh human cadaveric specimens. Retrospective analysis of the video documentations of 50 MVDs was performed to describe the surgical relevance of the examined membranes.ResultsThe trigeminal nerve is surrounded circumferentially by 4 inner arachnoid membranes: laterally and caudally by the trigeminal membrane (TM), cranially by the superior cerebellar membrane (SCM), and medially by the junction between the cranial edge of the anterior pontine membrane and the lateral edge mesencephalic leaf of the Liliequist membrane complex. The superior cerebellar artery was located in every case cranial from the SCM. This membrane served as a safety plane to dissect the vessel from the nerve. The SCM was laterally adherent to the TM, which made the arachnoid dissection challenging. The superior petrosal vein was located cranially and laterally from the described inner arachnoid membranes, but the transverse pontine vein was embedded into the membrane complex.ConclusionsKnowledge of the described anatomy of the arachnoid membranes around the trigeminal nerve is essential to safely perform an MVD.Copyright © 2019 Elsevier Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…