Kawase approach for dolichoectactic basilar artery macrovascular decompression in a patientwith trigeminal neuralgia: Case report

Seungwon Yoon, Justin R Mascitelli, Michael A. Mooney, Sirin Gandhi, Tsinsue Chen, Tyler S. Cole, Michael T. Lawton

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and Importance: Trigeminal neuralgia (TN) secondary to a dolichoectatic basilar artery (DBA) is an extremely rare phenomenon. The Kawase approach for macrovascular decompression of this rare pathology been used rarely. CLINICAL PRESENTATION: This report describes macrovascular decompression and basilar artery transposition in a 69-yr-old male presenting with progressively worsening left-sided typical TN secondary to a DBA compression. The DBA was successfully decompressed off of the trigeminal nerve via a pterional craniotomy and anterior petrosectomy. The patient had immediate improvement in TN symptoms postoperatively. The patient remained symptom free with nonbothersome facial numbness in the V3 segment at 8-mo postoperative follow-up in clinic. The patient suffered a sixth nerve palsy following surgery, whichwas later corrected by strabismus surgery. The natural history and epidemiology of TN, results of macrovascular decompression secondary to DBA compression via a traditional suboccipital retrosigmoid approach, and potential advantages of the Kawase approach are also discussed. CONCLUSION: The macrovascular decompression strategy succeeded because the compressive force was applied by the DBA to the nerve in a superolateral direction, and the decompressive sling pulled the DBA away fromthe nerve in an inferomedial direction. The working space and access to the clival dura through the Kawase approach allowed proper corrective pull with a sling.

Original languageEnglish (US)
Pages (from-to)E178-E183
JournalOperative Neurosurgery
Volume16
Issue number6
DOIs
StatePublished - Jun 1 2019
Externally publishedYes

Fingerprint

Trigeminal Neuralgia
Basilar Artery
Decompression
Abducens Nerve Diseases
Trigeminal Nerve
Hypesthesia
Craniotomy
Strabismus
Natural History
Epidemiology
Pathology

Keywords

  • Basilar artery
  • Kawase approach
  • Macrovascular decompression
  • Trigeminal neuralgia
  • Vertebrobasilar dolichoectasia

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Kawase approach for dolichoectactic basilar artery macrovascular decompression in a patientwith trigeminal neuralgia : Case report. / Yoon, Seungwon; Mascitelli, Justin R; Mooney, Michael A.; Gandhi, Sirin; Chen, Tsinsue; Cole, Tyler S.; Lawton, Michael T.

In: Operative Neurosurgery, Vol. 16, No. 6, 01.06.2019, p. E178-E183.

Research output: Contribution to journalArticle

Yoon, Seungwon ; Mascitelli, Justin R ; Mooney, Michael A. ; Gandhi, Sirin ; Chen, Tsinsue ; Cole, Tyler S. ; Lawton, Michael T. / Kawase approach for dolichoectactic basilar artery macrovascular decompression in a patientwith trigeminal neuralgia : Case report. In: Operative Neurosurgery. 2019 ; Vol. 16, No. 6. pp. E178-E183.
@article{f4ca23b4e6ba4a758f9da5954dd8d6ad,
title = "Kawase approach for dolichoectactic basilar artery macrovascular decompression in a patientwith trigeminal neuralgia: Case report",
abstract = "Background and Importance: Trigeminal neuralgia (TN) secondary to a dolichoectatic basilar artery (DBA) is an extremely rare phenomenon. The Kawase approach for macrovascular decompression of this rare pathology been used rarely. CLINICAL PRESENTATION: This report describes macrovascular decompression and basilar artery transposition in a 69-yr-old male presenting with progressively worsening left-sided typical TN secondary to a DBA compression. The DBA was successfully decompressed off of the trigeminal nerve via a pterional craniotomy and anterior petrosectomy. The patient had immediate improvement in TN symptoms postoperatively. The patient remained symptom free with nonbothersome facial numbness in the V3 segment at 8-mo postoperative follow-up in clinic. The patient suffered a sixth nerve palsy following surgery, whichwas later corrected by strabismus surgery. The natural history and epidemiology of TN, results of macrovascular decompression secondary to DBA compression via a traditional suboccipital retrosigmoid approach, and potential advantages of the Kawase approach are also discussed. CONCLUSION: The macrovascular decompression strategy succeeded because the compressive force was applied by the DBA to the nerve in a superolateral direction, and the decompressive sling pulled the DBA away fromthe nerve in an inferomedial direction. The working space and access to the clival dura through the Kawase approach allowed proper corrective pull with a sling.",
keywords = "Basilar artery, Kawase approach, Macrovascular decompression, Trigeminal neuralgia, Vertebrobasilar dolichoectasia",
author = "Seungwon Yoon and Mascitelli, {Justin R} and Mooney, {Michael A.} and Sirin Gandhi and Tsinsue Chen and Cole, {Tyler S.} and Lawton, {Michael T.}",
year = "2019",
month = "6",
day = "1",
doi = "10.1093/ons/opy215",
language = "English (US)",
volume = "16",
pages = "E178--E183",
journal = "Operative Neurosurgery",
issn = "2332-4252",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Kawase approach for dolichoectactic basilar artery macrovascular decompression in a patientwith trigeminal neuralgia

T2 - Case report

AU - Yoon, Seungwon

AU - Mascitelli, Justin R

AU - Mooney, Michael A.

AU - Gandhi, Sirin

AU - Chen, Tsinsue

AU - Cole, Tyler S.

AU - Lawton, Michael T.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background and Importance: Trigeminal neuralgia (TN) secondary to a dolichoectatic basilar artery (DBA) is an extremely rare phenomenon. The Kawase approach for macrovascular decompression of this rare pathology been used rarely. CLINICAL PRESENTATION: This report describes macrovascular decompression and basilar artery transposition in a 69-yr-old male presenting with progressively worsening left-sided typical TN secondary to a DBA compression. The DBA was successfully decompressed off of the trigeminal nerve via a pterional craniotomy and anterior petrosectomy. The patient had immediate improvement in TN symptoms postoperatively. The patient remained symptom free with nonbothersome facial numbness in the V3 segment at 8-mo postoperative follow-up in clinic. The patient suffered a sixth nerve palsy following surgery, whichwas later corrected by strabismus surgery. The natural history and epidemiology of TN, results of macrovascular decompression secondary to DBA compression via a traditional suboccipital retrosigmoid approach, and potential advantages of the Kawase approach are also discussed. CONCLUSION: The macrovascular decompression strategy succeeded because the compressive force was applied by the DBA to the nerve in a superolateral direction, and the decompressive sling pulled the DBA away fromthe nerve in an inferomedial direction. The working space and access to the clival dura through the Kawase approach allowed proper corrective pull with a sling.

AB - Background and Importance: Trigeminal neuralgia (TN) secondary to a dolichoectatic basilar artery (DBA) is an extremely rare phenomenon. The Kawase approach for macrovascular decompression of this rare pathology been used rarely. CLINICAL PRESENTATION: This report describes macrovascular decompression and basilar artery transposition in a 69-yr-old male presenting with progressively worsening left-sided typical TN secondary to a DBA compression. The DBA was successfully decompressed off of the trigeminal nerve via a pterional craniotomy and anterior petrosectomy. The patient had immediate improvement in TN symptoms postoperatively. The patient remained symptom free with nonbothersome facial numbness in the V3 segment at 8-mo postoperative follow-up in clinic. The patient suffered a sixth nerve palsy following surgery, whichwas later corrected by strabismus surgery. The natural history and epidemiology of TN, results of macrovascular decompression secondary to DBA compression via a traditional suboccipital retrosigmoid approach, and potential advantages of the Kawase approach are also discussed. CONCLUSION: The macrovascular decompression strategy succeeded because the compressive force was applied by the DBA to the nerve in a superolateral direction, and the decompressive sling pulled the DBA away fromthe nerve in an inferomedial direction. The working space and access to the clival dura through the Kawase approach allowed proper corrective pull with a sling.

KW - Basilar artery

KW - Kawase approach

KW - Macrovascular decompression

KW - Trigeminal neuralgia

KW - Vertebrobasilar dolichoectasia

UR - http://www.scopus.com/inward/record.url?scp=85058625016&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058625016&partnerID=8YFLogxK

U2 - 10.1093/ons/opy215

DO - 10.1093/ons/opy215

M3 - Article

C2 - 30124963

AN - SCOPUS:85058625016

VL - 16

SP - E178-E183

JO - Operative Neurosurgery

JF - Operative Neurosurgery

SN - 2332-4252

IS - 6

ER -