Microvascular Decompression for Trigmeminal Neuralgia (venous)

Authors:

Gavriel D. Kohlberg, MD – University of Cincinnati

Noga Lipschitz, MD – University of Cincinnati

Charlie Poff, BS – Medical University of South Carolina

Ravi N. Samy, MD, FACS – University of Cincinnati

A 31 year-old male presented with diplopia and was found to have left sixth nerve palsy on physical examination.  Work-up with MRI revealed a hypointense mass on T2 images involving the mid to lower clivus with penetration of the posterior fossa dura.  The patient had no complaints of nasal obstruction, no prior nasal surgery or nasal trauma.  Intraoperative frozen section analysis revealed chordoma.

Author Note: minute 3:41 “rostrum” was spelled incorrectly.

Contributor:

Eric Wang

A 51 year-old male presented to an outside otolaryngologist with recurrent facial pain and congestion. He was found to have a left-sided nasal mass.  A work-up was performed, complete with biopsy, which was diagnosed as non-intestinal type adenocarcinoma.  He underwent resection via the endoscopic endonasal transcribriform approach.  In this video publication, we present our preferred method of reconstruction for sinonasal malignancies treated by endoscopic transcribriform resection using a multilayered closure with the following: a subdural DuraGen inlay graft, a fascia lata onlay graft, and an extradural, extracranial onlay pericranial flap via nasionectomy.  A lumbar drain was placed at the end of the case for CSF diversion until the fifth postoperative day.

Contributors:

Paul A. Gardner, MD, Eric W. Wang, MD, Juan C. Fernandez-Miranda, MD, and Carl H. Snyderman, MD, MBA