Thought it would be interesting to share…
It was enlightening to read, I was told 3 blood vessels were found compressing the nerve when in fact the compression included 2 arteries, and a vein.
If I’m to understand it correctly …
Remember no compressions were ever seen on MRI and my left sided TN was predominantly Type 2 and some Type 1 that became resistant to meds.
The patient underwent general anesthesia with endotracheal intubation and was positioned right lateral decubitus with her head secured in a three-pin mayfield head brace. The left retroauricular region was prepped and draped and local anesthetic infiltrated. A linear incision was opened through successive layers nd a self-retaining retractor placed. A retrosigmoid craniectomy was fashioned with a high speed bur and rongeurs to the limits of the sigmoid sinus and transverse sinus. The mastoid air cells were entered and thoroughly sealed with wax. The dura was then opened and reflected anteriorly.
The operating microscope was brought into use. A rubber dam and cottonoid slider were advanced over the anterior superior aspect of the cerebellum that was gently elevated. The deep arachnoid over the 8th cranial nerve was widely opened. A large leash of petrosal bridging veins was encountered. The most inferior of these going from the anterior cerebellum was coagulated and divided, allowing for some gentle retraction of the cerebellum and good exposure of the Trigeminal nerve root from its root entry zone out to the porus trigeminus.
Significant neurovascular compression was identified, caused by a loop of the anterior inferior cerebellar artery tightly impinging on the lateral aspect of the root entry zone. I was able to mobilize this AICA loop anteriorly and hold it in a new position with a shredded felt implant placed between the artery and nerve.
Additional neurovascular compression was evident, with the superior aspect of the Trigeminal nerve root adherent and tightly apposed to a large vein, as well as an associated superior cerebellar artery. I was able to carefully lyse the adhesions between the vessels and nerve and mobilize the vessels more superiorly towards the tentorium cerebelli, while the Trigeminal nerve fell nicely away from the vessels after opening of the adhesions. Two shredded Teflon felt implants were placed between the vessel and nerve to maintain the decompression.
The dura was closed with 4-0 Nurolon suture and reinforced with surgical and Tisseel glue. Edges of bone were again sealed with wax. The bony opening was was filled with a cranioplasty of methyl methacrylate. A multilayer mayo cutaneous closure was completed and sterile dressing applied.
It should be noted that intraoperative monitoring was employed, with a maximum 0.6 millisecond delay of brainstorm auditory evoked latencies compared to early operative baseline. There were no injury potentials to from motor monitoring of the 5th and 7th cranial nerves.
My recovery issues make a lot more sense to me now after reading through this report.
I’m pain free, have reduced my meds from 3 to only one now. ( I still have TN on my right)
I’m low energy and find my recovery is a lot slower than I anticipated BUT, I went from intense horrid pain levels everyday with no meds even touching it, to NO pain!!!
I’m very happy with my outcome to date.
Grateful doesn’t even begin to describe it… Thanks for asking. : )
Ohhhh Mimi! Three pin mayfield head brace…how about medieval torture device after removal!
I don’t know how you had watched MVD video…I can’t bear to read some of those sentences!
Whenever you think you should be perfectly healed…take a hi-lighter pen to some of those phrases!
Glad you are getting there!
Hey KC, reading this helped tremendously. Had to google a lot of terms and look at some images/diagrams to understand better, but boy does it all make sense now.
That 3 point halo thing…well I still feel bruised in the locations that were pinned to my head.
The pressure type pain I get is in exactly the location where one of the arteries was moved too.
None of the above is constant, just part of the healing process.
So it does make more sense…I’ll grab a hi lighter just in case I forget though, ha, ha.
Watching the MVD video fed my curiosity and helped me to better understand what the heck he was going to be doing up there on the surface of my brain. LoL
Thanks for the smile!
I'm glad you were able to make sense of the report and how it relates to your recovery issues. I would have had to Google all of that report! I hope you continue to feel better each day!
Found an image that shows the 2 arteries that were compressing my Trigeminal nerve.
#2 the superior cerebellar artery as well as a vein were on top of my nerve near the nerve root.
#6 the anterior inferior cerebellar artery was quite large compressing underneath my Trigeminal nerve.
I’ve included this as I’m a visual person, this helped me understand my surgical report.
Check out the image attached.
290-image.jpg (44.4 KB)
I did have to google some of it. Then pieced it together with what my doctor told me.
awesome !!! i m so happy for you! Al
Fascinating reading. How did you get a copy of this? Can you just ask for it? Thanks for sharing it.
Does dr. K give a paper copy and other medias on request to all his patients?
Thanks so much for sharing this report. I can imagine that you had a lot of emotions reading it. I had visceral reaction reading the part about successfully removing the adhesions from the trigeminal nerve, and then a sensation of relief. I’m so glad to hear the pain is gone. A lot was moved around in there, no wonder recovery is taking its own sweet time. Time and patience. Like a newborn!
Peace and Happiness
@Bobbyt & Patty,
When I spoke with Dr. K’s assistant for my 8 week post-op follow up, I requested it. They mailed it to my home.
@Bellalarke, my slow recovery makes so much more sense now, especially seeing the image I attached above and then picturing everything. I do find my patience is a little better as a result of truly knowing what went on up there! Thanks for your note.
Yes, forgot to mention to say that I did look at the jpeg you attached and I was quite fascinated and so went though what you had done following along. I already know I have issues with the superior cerebellum artery so am familiar with the anatomy but that image you provided was extremely clear. So thanks. Knowledge of what is or has been causing the pain is so powerful. From what I understand, there will have been a lot of micro cellular debris (that was occurring pre- op when you were in such desperate pain) left around the site of compression and it takes quite sometime for the new astrocytes to grow and get in do the clean up. Astrocytes are one of four kinds of glia cells that form the white matter of our brain. They do all the tending to the neurones etc and one kind also forms the fatty myelin sheath. Others are little scrubbers, some are messengers.
Anyway, I think about you everyday in your recovery. We are having the most perfect weather out here on the coast so sending good vibes-
Thanks Bellalarke, interesting stuff, astrocytes and glia cells, I had no idea. Thanks for your kind thoughts, so appreciated! I was thinking of the Island today really yearning for a visit there again, picture myself walking long the beach by the ocean or in the rainforest amongst the enormous trees. Enjoy the weather!
You are truly a Woman who Runs with Wolves. So brave. To look into the face of your monster. I am inspired. Best wishes in your journey to recovery,
Pain free! What a blessing. I’m very, very happy for you. Thanks so much for sharing this. I already watched the video on this site as well. I’ve learned so much. Take good care.
Thank you for sharing your experience I cannot imagine the emotions you were going through before & after this surgery! Your story has helped me with other possibilities to speak with my doctor about. Keep looking forward, hugs!
Thanks Lou, Hope and Knottytree!
(( hugs )) Mimi
Yay!!! Woo hoo!!! So happy for you, Mimi! :0)
I'm pain free, have reduced my meds from 3 to only one now. ( I still have TN on my right)
I'm low energy and find my recovery is a lot slower than I anticipated BUT, I went from intense horrid pain levels everyday with no meds even touching it, to NO pain!!!!!
I'm very happy with my outcome to date.
Grateful doesn't even begin to describe it... Thanks for asking. : )