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Dr. Ali Al-Bayati

 
Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit  neurosurgery.tv

 
The patient came to the clinic 05-March-2006 with a medical report for one patient, to whom I performed microvascular decompression for trigeminal neuralgia 10 years ago, telling me that he is suffering the same and urging to perform to him the same procedure.

The patient was crying due to pain and he had left sided trigeminal neuralgia with hypalgesia of the left V2 territory. The patient was in mega-doses of tegretol without effect for seven months. The patient was sent to perform MRI of the CPA and it ruled out any other causes, only the tortuous PICA and some constriction of the left trigeminal nerve. The patient was advised to try Neurontine with tegretol, but he came yesterday urging for surgery, because medication did not help.

The patient was operated in the setting position with left retromastoid approach. The arachnoid over the trigeminal nerve was massive and all the arachnoidal membranes were sharply dissected. Dendy vein was stuck with the nerve, for what it was isolated, coagulated and bisected. There was a circular constriction from an abnormal vessel compressing the nerve. It was coagulated and cut to relieve the nerve from constriction.  PICA was under the facial nerve and it was pulled out gently and all the compressive effect upon the facial nerve was eliminated.

There was no traction applied during surgery and it was possible to inspect the entire trigeminal nerve from its emergence from the brainstem down to the Meckel's cave. Considering that, PICA is not stuck with nerve no Teflon patch was applied. Routine closure of the wound and smooth postoperative recovery.

The neuralgia disappeared immediately after the operation.

For academic part about trigeminal neuralgia and MVD please click here!


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[2006] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved