How I do it: endoscopic microvascular decompression for glossopharyngeal neuralgia
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HOW I DO IT - NEUROSURGICAL TECHNIQUE EVALUATION
How I do it: endoscopic microvascular decompression for glossopharyngeal neuralgia Fuminari Komatsu 1
&
Kislay Kishore 1 & Robin Sengupta 1
Received: 27 December 2019 / Accepted: 10 June 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN) is associated with high complication and incomplete cure rates because of its poor ability to visualize neurovascular conflicts. Method Fully endoscopic MVD for GPN was carried out through a retrosigmoid keyhole approach. Neurovascular conflicts were clearly demonstrated with a loop of the posterior inferior cerebellar artery (PICA) under a 30° endoscopic view, and no significant cerebellar retraction was observed. The loop of the PICA was safely decompressed and the perforators were preserved while offering an excellent operative view. Conclusion Endoscopic MVD is a reliable and minimally invasive method for GPN. Keywords Endoscopic keyhole surgery . Posterior cranial fossa . Root entry zone
Relevant surgical anatomy The root entry zone (REZ) of the glossopharyngeal nerve (CN IX) is situated at the posterior edge of the olive in the post-olivary sulcus just caudal to the pontomedullary sulcus. Posterior to CN IX, the choroid plexus protrudes from the foramen of Luschka into the cerebellopontine angle, and the rhomboid lip projects laterally from the ventral margin of the foramen of Luschka. The REZ of CN IX is thus hidden by the choroid plexus and rhomboid lip from the posterior view [2–4]. The rhomboid lip is classified into 3 types according to the relationship between it and the choroid plexus in the cerebellopontine cistern from the posterior view: non-extension type (spreading medially to the lateral edge of the choroid plexus); lateral extension type (spreading laterally over the lateral edge of the choroid plexus); and the jugular type (spreading widely to the This article is part of the Topical Collection on Neurosurgical technique evaluation Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04456-w) contains supplementary material, which is available to authorized users. * Fuminari Komatsu [email protected] 1
Department of Neurosurgery, Institute of Neurosciences Kolkata, 185/1 A. J. C. Bose Road, Kolkata, West Bengal 700017, India
edge of the jugular foramen with strong adhesion to CN IX) [1]. The surgical view of microvascular decompression (MVD) for GPN may be influenced by the type of rhomboid lip. Excessive retraction of the cerebellum for observation of the REZ of CN IX is considered to increase the risk of complications in cases of GPN during conventional microscopic MVD. By contrast, if an angled endoscope is used, a clear view of the REZ of the CN IX and surrounding structures can be achieved without significant cerebellar retraction through the space between the CN IX and vestibulocochlear nerve (CN VIII), as well as behind the choroid plex
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