• Francesco Tomasello, Felice Esposito, Rosaria V Abbritti, Filippo F Angileri, Alfredo Conti, Salvatore M Cardali, and Domenico La Torre.
• Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Università degli Studi di Messina, Messina, Italy.
• World Neurosurg. 2016 Oct 1; 94: 26-31.

BackgroundMicrovascular decompression (MVD) represents the most effective and safe surgical option for the treatment of trigeminal neuralgia since it was first popularized by Jannetta 50 years ago. Despite several advances, complications such as cerebellar and vascular injury, hearing loss, muscular atrophy, cerebrospinal fluid (CSF) leak, postoperative cutaneous pain, and sensory disturbances still occur and may negatively affect the outcome. We propose some technical nuances of the surgical procedure that were used in our recent series.MethodsWe used a novel hockey stick-shaped retromastoid skin incision, preserving the major nerves of the occipital and temporal areas. Microsurgical steps were performed without the use of retractors. CSF leakage was prevented with a watertight dural closure and multilayer osteodural reconstruction.ResultsThe refined surgical steps were perfected in the last consecutive 15 cases of our series. In these cases we did not record any cutaneous pain, sensory disturbances, or CSF leakage. The average diameter of the craniectomy was 18 mm. No patient reported major complications related to the intradural microsurgical maneuvers. In all cases the neurovascular conflict was found and solved with a good outcome in terms of pain disappearance.ConclusionsOur minimally invasive approach was demonstrated to guarantee an optimal exposure of the cerebellopontine angle and minimize the rate of complications related to skin incision and muscular dissection, microsurgical steps, and closure.Copyright © 2016 Elsevier Inc. All rights reserved.

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