Cerebellar infarction following division of Dandy's vein in microvascular decompression for trigeminal neuralgia
General Surgery (East Africa)
Objectives: Does dividing Dandy's (superior petrosal) or other tentorial veins increase the risk of cerebellar infarction following microvascular decompression (MVD) of the trigeminal nerve?
Design: A retrospective review of all patients with trigeminal neuralgia who underwent MVD by the senior author between 1999 and 2012.
Materials and Methods: Patients were identified from operative logbooks and discharge summaries. Data were collected from the medical notes.
Results: Of 162 patients who underwent microvascular decompression of the trigeminal nerve, we had a 96% follow-up rate, which provided 156 of the operative cases for review. Over 75% report to be neuralgia free at first follow-up. Cerebellar infarction occurred in six patients, all of whom had division of the superior petrosal or tentorial veins. Fifty-one patients did not suffer cerebellar infarction following division of Dandy's or other tentorial veins. In our series, this gives an overall risk of 3.85% of cerebellar infarction following microvascular decompression of the trigeminal nerve. In the group of patients that had division of the veins, 9.5% experienced cerebellar infarction.
Conclusions: Since Walter Dandy's original description of microvascular decompression of the trigeminal nerve through a retrosigmoid approach, it has been suggested that it is safe to divide the superior petrosal or any other bridging vein. In this series of 156 cases, 6 patients experienced a cerebellar infarction associated with the division of part of Dandy's vein alone or in association with division of tentorial veins. We would suggest that with a rate of 9.5% of cerebellar venous infarction, division of any bridging veins should only be considered if absolutely necessary.
Publication (Name of Journal)
Journal of Neurological Surgery Part B: Skull Base
Cheserem, B. J.,
(2012). Cerebellar infarction following division of Dandy's vein in microvascular decompression for trigeminal neuralgia. Journal of Neurological Surgery Part B: Skull Base, 73(S 02), A380.
Available at: https://ecommons.aku.edu/eastafrica_fhs_mc_gen_surg/90