Craniotomy for decompression of cranial nerves

Craniotomy for decompression of cranial nerves

Anesthesia type	General
Airway	ETT
Lines and access	PIV ± Arterial line
Monitors	Standard 5-lead ECG Temperature ± ABP
Primary anesthetic considerations
Preoperative	Cranial nerve exam Oxygen mask may exacerbate symptoms
Intraoperative
Postoperative
Article quality
Editor rating	In development
User likes	0

Microvascular decompression is a surgical procedure used to relieve abnormal pressure on a cranial nerve from an artery or vein, which can alleviate symptoms of several cranial nerve disorders.

Overview

Indications

• Trigeminal neuralgia
• Hemifacial spasm
• Geniculate neuralgia
• Glossopharyngeal neuralgia

Surgical procedure

The procedure is performed through a small craniectomy behind the ear. Retractors are placed to expose the relevant nerves and vascular structures. Under microscopy, a small sponge is placed to separate the suspected blood vessel and nerve. In some circumstances, adherent veins may be cauterized or a rhizotomy may be performed. The dura is then closed and the craniectomy site is covered with a titanium plate.

Preoperative management

Patient evaluation

System	Considerations
Airway	Airway exam may be limited by neurologic symptoms
Neurologic	Cranial nerve exam to identify symptoms and exacerbating factors

Labs and studies

• BMP
• CBC

Patient preparation and premedication

• Consider preoperative multimodal analgesia
• Continue home regimen of neuropathic agents

Intraoperative management

Monitoring and access

• Noninvasive blood pressure monitoring is typically sufficient

Induction and airway management

• Oxygen mask may exacerbate neuralgia symptoms

Positioning

• Pinned frame

Postoperative management

Disposition

• Typically PACU

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications