Skip to main content
SpringerLink
Log in

Anesthetic Management of Microvascular Decompression for Trigeminal Neuralgia

  • Chapter
  • First Online:
Trigeminal Neuralgia

  • 564 Accesses

Abstract

Microvascular decompression (MVD) surgery for trigeminal neuralgia (TN) is usually performed under general anesthesia, although some surgeons have recently attempted awake MVD surgery to increase the success rate. In general, MVD is safe. However, it has potential problems that may arise during posterior fossa surgery. Position-related problems, trigemino-cardiac reflex (TCR), intraoperative neurophysiologic monitoring (IONM), and postoperative pain should also be considered.

In this chapter, we describe the intraoperative and postoperative anesthetic management of MVD surgery, especially focusing on TN.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Liu B, Wang Y, Liu S, Zhao T, Zhao B, Jiang X, et al. A randomized controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing elective craniotomy. Clin Nutr. 2019;38(5):2106–12. https://doi.org/10.1016/j.clnu.2018.11.008.

    Article  CAS  PubMed  Google Scholar 

  2. Stumpo V, Staartjes VE, Quddusi A, Corniola MV, Tessitore E, Schröder ML, et al. Enhanced recovery after surgery strategies for elective craniotomy: a systematic review. J Neurosurg. 2021:1–25. https://doi.org/10.3171/2020.10.Jns203160.

  3. Rozet I, Vavilala MS. Risks and benefits of patient positioning during neurosurgical care. Anesthesiol Clin. 2007;25(3):631–53., x. https://doi.org/10.1016/j.anclin.2007.05.009.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Park J, Min JJ, Kim SJ, Ahn JH, Kim K, Lee JH, et al. Effects of lowering inspiratory oxygen fraction during microvascular decompression on postoperative gas exchange: a pre-post study. PLoS One. 2018;13(11):e0206371. https://doi.org/10.1371/journal.pone.0206371.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Nunes RR, Bersot CDA, Garritano JG. Intraoperative neurophysiological monitoring in neuroanesthesia. Curr Opin Anaesthesiol. 2018;31(5):532–8. https://doi.org/10.1097/aco.0000000000000645.

    Article  PubMed  Google Scholar 

  6. Huang H, Jiang H, Liu J, Chen J, Qiu L, Wang J, et al. Facial nerve monitoring under different levels of neuromuscular blockade with Cisatracurium Besilate in parotid tumour surgery. Biomed Res Int. 2021;2021:5655061. https://doi.org/10.1155/2021/5655061.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Jellish WS, Leonetti JP, Buoy CM, Sincacore JM, Sawicki KJ, Macken MP. Facial nerve electromyographic monitoring to predict movement in patients titrated to a standard anesthetic depth. Anesth Analg. 2009;109(2):551–8. https://doi.org/10.1213/ane.0b013e3181ac0e18.

    Article  CAS  PubMed  Google Scholar 

  8. Kong DS, Park K, Shin BG, Lee JA, Eum DO. Prognostic value of the lateral spread response for intraoperative electromyography monitoring of the facial musculature during microvascular decompression for hemifacial spasm. J Neurosurg. 2007;106(3):384–7. https://doi.org/10.3171/jns.2007.106.3.384.

    Article  PubMed  Google Scholar 

  9. Ying T, Bao B, Yuan Y, Zhong W, Zhu J, Tang Y, et al. Blink reflex monitoring in microvascular decompression for trigeminal neuralgia. Neurol Res. 2021;43(7):591–4. https://doi.org/10.1080/01616412.2021.1900705.

    Article  CAS  PubMed  Google Scholar 

  10. Chowdhury T, Mendelowith D, Golanov E, Spiriev T, Arasho B, Sandu N, et al. Trigeminocardiac reflex: the current clinical and physiological knowledge. J Neurosurg Anesthesiol. 2015;27(2):136–47. https://doi.org/10.1097/ANA.0000000000000065.

    Article  PubMed  Google Scholar 

  11. Schaller B. Trigemino-cardiac reflex during microvascular trigeminal decompression in cases of trigeminal neuralgia. J Neurosurg Anesthesiol. 2005;17(1):45–8.

    PubMed  Google Scholar 

  12. Sandu N, Chowdhury T, Meuwly C, Schaller B. Trigeminocardiac reflex in cerebrovascular surgery: a review and an attempt of a predictive analysis. Expert Rev Cardiovasc Ther. 2017;15(3):203–9. https://doi.org/10.1080/14779072.2017.1286983.

    Article  CAS  PubMed  Google Scholar 

  13. Butterworth Iv JF, Mackey DC, Wasnick JD. Anesthesia for neurosurgery. In: Morgan & Mikhail’s clinical anesthesiology, 6th ed. McGraw-Hill Education: New York, NY; 2018.

    Google Scholar 

  14. Toung TJ, McPherson RW, Ahn H, Donham RT, Alano J, Long D. Pneumocephalus: effects of patient position on the incidence and location of aerocele after posterior fossa and upper cervical cord surgery. Anesth Analg. 1986;65(1):65–70.

    Article  CAS  PubMed  Google Scholar 

  15. He Z, Cheng H, Wu H, Sun G, Yuan J. Risk factors for postoperative delirium in patients undergoing microvascular decompression. PLoS One. 2019;14(4):e0215374. https://doi.org/10.1371/journal.pone.0215374.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Haldar R, Khandelwal A, Gupta D, Srivastava S, Rastogi A, Singh PK. Valsalva maneuver: its implications in clinical neurosurgery. Neurol India. 2016;64(6):1276–80. https://doi.org/10.4103/0028-3886.193832.

    Article  PubMed  Google Scholar 

  17. Gracia I, Fabregas N. Craniotomy in sitting position: anesthesiology management. Curr Opin Anaesthesiol. 2014;27(5):474–83. https://doi.org/10.1097/aco.0000000000000104.

    Article  CAS  PubMed  Google Scholar 

  18. Kurihara M, Nishimura S. Estimation of the head elevation angle that causes clinically important venous air embolism in a semi-sitting position for neurosurgery: a retrospective observational study. Fukushima J Med Sci. 2020;66:67–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Xia L, Liu MX, Zhong J, Dou NN, Li B, Sun H, et al. Fatal complications following microvascular decompression: could it be avoided and salvaged? Neurosurg Rev. 2017;40(3):389–96. https://doi.org/10.1007/s10143-016-0791-y.

    Article  PubMed  Google Scholar 

  20. Lee JJ. Anesthetic management of MVD. In: Park K, Park JS, editors. Hemifacial spasm: a comprehensive guide. Singapore: Springer; 2020. p. 111–8.

    Chapter  Google Scholar 

  21. Brockerville M, Venkatraghavan L, Manninen P. Macroglossia in neurosurgery. J Neuroanesthesiol Crit Care. 2017;04(02):78–84. https://doi.org/10.4103/jnacc-jnacc-64.16.

    Article  Google Scholar 

  22. Tan C, Ries CR, Mayson K, Gharapetian A, Griesdale DE. Indication for surgery and the risk of postoperative nausea and vomiting after craniotomy: a case-control study. J Neurosurg Anesthesiol. 2012;24(4):325–30. https://doi.org/10.1097/ANA.0b013e3182611a30.

    Article  PubMed  Google Scholar 

  23. Meng L, Quinlan JJ. Assessing risk factors for postoperative nausea and vomiting: a retrospective study in patients undergoing retromastoid craniectomy with microvascular decompression of cranial nerves. J Neurosurg Anesthesiol. 2006;18(4):235–9.

    Article  PubMed  Google Scholar 

  24. Gottschalk A, Berkow LC, Stevens RD, Mirski M, Thompson RE, White ED, et al. Prospective evaluation of pain and analgesic use following major elective intracranial surgery. J Neurosurg. 2007;106(2):210–6. https://doi.org/10.3171/jns.2007.106.2.210.

    Article  CAS  PubMed  Google Scholar 

  25. Durieux ME, Himmelseher S. Pain control after craniotomy: off balance on the tightrope? J Neurosurg. 2007;106(2):207–9. https://doi.org/10.3171/jns.2007.106.2.207.

    Article  CAS  PubMed  Google Scholar 

  26. De Benedittis G, Lorenzetti A, Migliore M, Spagnoli D, Tiberio F, Villani RM. Postoperative pain in neurosurgery: a pilot study in brain surgery. Neurosurgery. 1996;38(3):466–9. discussion 9–70. https://doi.org/10.1097/00006123-199603000-00008.

    Article  PubMed  Google Scholar 

  27. Klimek M, Ubben JF, Ammann J, Borner U, Klein J, Verbrugge SJ. Pain in neurosurgically treated patients: a prospective observational study. J Neurosurg. 2006;104(3):350–9. https://doi.org/10.3171/jns.2006.104.3.350.

    Article  PubMed  Google Scholar 

  28. Rimaaja T, Haanpää M, Blomstedt G, Färkkilä M. Headaches after acoustic neuroma surgery. Cephalalgia. 2007;27(10):1128–35. https://doi.org/10.1111/j.1468-2982.2007.01410.x.

    Article  CAS  PubMed  Google Scholar 

  29. Galvin IM, Levy R, Day AG, Gilron I. Pharmacological interventions for the prevention of acute postoperative pain in adults following brain surgery. Cochrane Database Syst Rev. 2019;2019(11):CD011931. https://doi.org/10.1002/14651858.CD011931.pub2.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Zetlaoui PJ, Gauthier E, Benhamou D. Ultrasound-guided scalp nerve blocks for neurosurgery: a narrative review. Anaesth Crit Care Pain Med. 2020;39(6):876–82. https://doi.org/10.1016/j.accpm.2020.06.019.

    Article  PubMed  Google Scholar 

  31. Ghali MGZ, Viswanathan A, Burchiel KJ. Trigeminal ganglion/rootlets ablation for pain. In: Functional neurosurgery and neuromodulation. Elsevier; 2019.

    Google Scholar 

  32. Renda T, Corrado A, Iskandar G, Pelaia G, Abdalla K, Navalesi P. High-flow nasal oxygen therapy in intensive care and anaesthesia. Br J Anaesth. 2018;120(1):18–27. https://doi.org/10.1016/j.bja.2017.11.010.

    Article  CAS  PubMed  Google Scholar 

  33. Fleming NW, Singh A, Lee L, Applegate RL 2nd. Oxygen reserve index: utility as an early warning for desaturation in high-risk surgical patients. Anesth Analg. 2021;132(3):770–6. https://doi.org/10.1213/ane.0000000000005109.

    Article  PubMed  Google Scholar 

  34. Scheeren TWL, Belda FJ, Perel A. The oxygen reserve index (ORI): a new tool to monitor oxygen therapy. J Clin Monit Comput. 2018;32(3):379–89. https://doi.org/10.1007/s10877-017-0049-4.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Ji-Hye Kwon & Jeong Jin Lee

Authors
  1. Ji-Hye Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeong Jin Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeong Jin Lee .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea (Republic of)

    Kwan Park

  2. Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea (Republic of)

    Kyung Rae Cho

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kwon, JH., Lee, J.J. (2023). Anesthetic Management of Microvascular Decompression for Trigeminal Neuralgia. In: Park, K., Cho, K.R. (eds) Trigeminal Neuralgia. Springer, Singapore. https://doi.org/10.1007/978-981-19-9171-4_9

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-9171-4_9

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-9170-7

  • Online ISBN: 978-981-19-9171-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation