三叉神経痛に対する微小血管減圧術の硬膜内操作

Microsurgical Procedures of Microvascular Decompression for Trigeminal Neuralgia

Point

・安全な手術を行うための術野の展開について概説する．

・一般的な責任動脈である上小脳動脈，前下小脳動脈の移動方法について解説する．

・難易度の高い椎骨脳底動脈が関与した症例の手術について説明する．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2027年2月まで）。

　Microvascular decompression for trigeminal neuralgia was successfully performed following the secure surgical steps. The most crucial step involves creating a safe operative field in the dural opening. The petrotentorial junction should be identified without cerebellar retraction before proceeding to the deeper areas. Dissecting the petrosal vein and opening the horizontal fissure contributed to the expansion of the operative field. Bleeding often occurs from the dorsal cerebellar bridging vein and junction of the petrosal vein into the superior petrosal sinus. Transposition of the most common offenders, the superior and anterior inferior cerebellar arteries, is effectively achieved by dissecting both the proximal and distal sides of the neurovascular compression site. Teflon should be placed at a sufficient distance to prevent contact with the nerve, which can lead to recurrence. Treating vertebrobasilar artery-related cases is challenging and involves the risk of cranial nerve injuries. Multiple offending vessels are commonly involved. In such cases, it is essential to be aware of the course of the trochlear and abducens nerves during decompression. Applying the most effective and least risky maneuver is necessary for treating cases involving the vertebrobasilar artery.