Intraoperative and Postoperative Bleeding in Microvascular Decompression for Trigeminal Neuralgia

Objective: The surgical approach for the trigeminal nerve involves veins connected to the superior petrosal and tentorial sinus, and we should pay special attention to these veins. We investigated intraoperative and postoperative bleeding using our database.

Methods: A prospectively accumulated database of 247 microvascular decompression surgeries for trigeminal neuralgia over the past 10 years was analyzed. Intraoperative and postoperative bleeding was confirmed with surgical records, videos, and computed tomography. Of 235 patients, 161 were female; 85 patients were >70 years old at the time of surgery; 96 surgeries involved the left side.

Results: Intraoperative venous bleeding was encountered in 29 surgeries (12%): from the superior petrosal vein/sinus in 18 and the hemispheric bridging vein/tentorial sinus in 11. Massive bleeding occurred from the superior petrosal sinus owing to tear of the entrance of the superior petrosal vein in 4 surgeries and from the tentorial sinus in 3; bleeding was controlled by Surgicel with fibrin glue. Postoperative bleeding occurred in 11 surgeries (4%): intracerebellar hematoma in 2, subarachnoid hemorrhage in 3, subdural hemorrhage in 3, supratentorial subdural hemorrhage in 2, and supratentorial epidural hematoma in 1. These lesions were associated with intraoperative bleeding in 1 case, a trans-horizontal fissure approach in 1 case, coagulation of the petrosal vein in 2 cases, and unknown reasons in 7 cases. Cure without medication was achieved in 218 surgeries at an average follow-up of 4.2 years.

Conclusions: Microvascular decompression for trigeminal neuralgia involves potential risks of intraoperative and postoperative bleeding.