gms | German Medical Science

Objective: Microvascular decompression (MVD) following the technique of neurosurgical pioneer Peter Jannetta, by means of wrapping the nerve with a Teflon felt, has been proven to be the most effective treatment for typical trigeminal neuralgia (TGN) for over 50 years. Yet, a small number of patients experience recurrence of pain, following correct exhibition of operative treatment. Granulomatous and inflammatory reactions to interposed material have been suspected to be responsible for recurrence of pain. As a consequence, we have been performing the sling technique in our institution for the last four years, which aims at permanently displacing the offending vessel, without contact to the trigeminal nerve (CNV).

Methods: We retrospectively examined patients, who had been operated on TGN by means of MVD in our clinic between 2008 and 2020. Sling technique was carried out, by fixating the offending vessel either to the tentorium cerebelli or mastoid bone by means of a Teflon wick. 188 patients (114 wrapping cohort, 74 sling cohort) underwent surgery and were compared for trigeminal pain containment at discharge as well as at follow up, by means of the Barrow Neurological Institute (BNI) Pain Intensity Score (I = No pain, no medications; II = Occasional pain, no medication; IIIA = No pain, continued medication, IIIB = Some pain, adequately controlled with medication; IV= Some pain, not adequately controlled with medication; V = Severe pain/no pain relief) and postoperative complications.

Results: No significant differences were observed between both techniques, neither concerning postoperatively described pain (BNI Score I-III 93.9 vs. 97.3% at discharge and 85.6 vs. 81.8% at follow up; wrapping vs. sling group respectively) nor postoperative complications at a mean follow-up time of 68 vs. 18.6 months. Most frequent complications were facial numbness (20.2 vs. 16.2%) and hypoacusis (5.3 vs. 6.8%).

Conclusion: The sling technique is a safe and effective operative technique to treat typical TGN and poses an elegant alternative to classical wrapping of CNV.