Reducing complications using minimally invasive retrosigmoid approach for microvascular decompression in patients with trigeminal neuralgia

Background: The most effective treatment for a typical trigeminal neuralgia is microvascular decompression of the trigeminal nerve. An approximately 3–5 cm in diameter retrosigmoid craniotomy with an approximately 12–14 cm long skin incision is considered the standard approach. Modern neurosurgery strives for minimally invasive surgical approaches, which in turn reduces both intraoperative and postoperative complications. The use of minimally invasive approaches in skull base neurosurgery and, in particular, in microvascular decompression of the trigeminal nerve can reduce the risk of complications such as cranial nerve and cerebellar injuries, cerebrospinal fluid (CSF) fistula and sinus thrombosis. The minimally invasive approach also provides a good cosmetic effect. Methods: We conducted a retrospective study of 52 consecutive patients with trigeminal neuralgia. All patients underwent microvascular decompression of the trigeminal nerve via a minimally invasive retrosigmoid approach. The data were compared with date those of the largest published studies. The findings obtained in this patient population were consistent with those of large studies. Results: Treatment efficacy was also in line, with 98.1% of patients showing improved symptoms of trigeminal neuralgia. No major permanent complications were observed. Transient complications included ipsilateral facial hypoesthesia (40.4%), mild facial nerve paresis (7.3%), hypoacusis (3.8%), and trochlear nerve paresis (1.9%), all resolving within three months post-surgery. Conclusion: Minimally invasive retrosigmoid craniotomy result in as good surgical outcomes as standard craniotomy. The reduced size of a surgical approach does not affect the treatment efficacy. The reduced craniotomy size helps avoid traumatization of anatomical structures in the surgical field, reduce possible complications, and shorten postoperative follow-up.