How I do it: microvascular decompression for classical trigeminal neuralgia by arterial compression

Microvascular decompression has been shown in multiple long-term series to provide durable pain freedom in 75-95% of patients with classical trigeminal neuralgia, defined as neuralgia related to an identified neurovascular conflict, frequently arterial. Surgical success relies on an effective decompression, achieved by displacing the offending arteries while avoiding neo-compression(s) by implanted material. The procedure is performed through a keyhole retrosigmoid (retromastoid) craniectomy, using an infratentorial, supracerebellar corridor to the trigeminal root that minimizes traction on the facial-vestibulocochlear complex. In this video, we demonstrate the step-by-step technique as applied in patients in whom high-resolution MRI demonstrated the conflict preoperatively.