Article
Intraoperative ICG angiography in microvascular decompression procedures for trigeminal neuralgia.
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Published: | June 4, 2012 |
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Outline
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Objective: In microvascular decompression procedures of the trigeminal nerve for trigeminal neuralgia occasionally the site of contact is difficult to determine. Endoscopy was described by others to better evaluate the anatomical conflict. ICG-angiography can also be used to better visualize vascular structures and their anatomical relation with cranial nerves. We sought to evaluate our initial experience in this respect.
Methods: We reviewed the video recordings of seven cases of trigeminal neuralgia microvascular decompression operations and assessed visualization of neurovascular structures. We focused on whether ICG-angiography was helpful in determining the site conflict and whether fluorescence was strong enough to shine through the cranial nerves obliterating the direct view of the respective vessel.
Results: A standard retrosigmoid approach in the supine position was used for the decompression procedure. Fluorescence is not powerful enough to visualize vessel loops hidden behind cranial nerves, a shine through only on the very lateral aspect of nerves and with very thin structures. However, we found ICG angiography helpful in appreciating the individual, sometimes distorted anatomy of the cerebello-pontine angle.
Conclusions: Although our initial hope and expectation did not prove true, that ICG-angiography makes it possible to “see through nerves” that obliterate visualization of offending vessels, we found this technique useful to quicker understand the individual complexity of the anatomy of the cerebello-pontine angle.