Venous Flow Conversion Technique for Sacrificing the Superior Petrosal Vein During Microvascular Decompression for Trigeminal Neuralgia

BACKGROUND: Microvascular decompression for trigeminal neuralgia (TN) may require sacrifice of the superior petrosal vein (SPV), with potential risks of ischemia and hemorrhagic complications due to impaired venous return. OBJECTIVE: To investigate methods for safely sacrificing the SPV. METHODS: We retrospectively reviewed 21 cases in 346 consecutive microvascular decompression surgeries for TN. They were intraoperatively identified as SPV and its tributaries being the offending vessels causing TN and were intentionally sacrificed. RESULTS: The transverse pontine vein (TPV) was sacrificed in 10 patients. The main trunk of the SPV was sacrificed using the TPV as a collateral flow pathway in 10 patients. No complications occurred related to impaired venous return. CONCLUSION: The venous flow conversion technique can be applied to safely sacrificing the SPV and its tributaries with the TPV acting as a collateral blood flow pathway to prevent postoperative impaired venous return.