Difference between revisions of "Craniotomy for decompression of cranial nerves"

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'''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.
A '''craniotomy for decompression''' '''of cranial nerves''' 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 ==
== Overview ==
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* Noninvasive blood pressure monitoring is typically sufficient<ref>{{Cite journal|last=Xu|first=Risheng|last2=Nair|first2=Sumil K.|last3=Materi|first3=Josh|last4=Raj|first4=Divyaansh|last5=Medikonda|first5=Ravi|last6=Shah|first6=Pavan P.|last7=Kannapadi|first7=Nivedha V.|last8=Wang|first8=Andrew|last9=Mintz|first9=David|last10=Gottschalk|first10=Allan|last11=Antonik|first11=Laurie J.|date=2022-05-01|title=Case Series in the Utility of Invasive Blood Pressure Monitoring in Microvascular Decompression|url=https://pubmed.ncbi.nlm.nih.gov/35315836/|journal=Operative Neurosurgery (Hagerstown, Md.)|volume=22|issue=5|pages=262–268|doi=10.1227/ons.0000000000000130|issn=2332-4260|pmid=35315836}}</ref>
* Noninvasive blood pressure monitoring is typically sufficient<ref>{{Cite journal|last=Xu|first=Risheng|last2=Nair|first2=Sumil K.|last3=Materi|first3=Josh|last4=Raj|first4=Divyaansh|last5=Medikonda|first5=Ravi|last6=Shah|first6=Pavan P.|last7=Kannapadi|first7=Nivedha V.|last8=Wang|first8=Andrew|last9=Mintz|first9=David|last10=Gottschalk|first10=Allan|last11=Antonik|first11=Laurie J.|date=2022-05-01|title=Case Series in the Utility of Invasive Blood Pressure Monitoring in Microvascular Decompression|url=https://pubmed.ncbi.nlm.nih.gov/35315836/|journal=Operative Neurosurgery (Hagerstown, Md.)|volume=22|issue=5|pages=262–268|doi=10.1227/ons.0000000000000130|issn=2332-4260|pmid=35315836}}</ref>
*Intraoperative neuromonitoring may be used


=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===


* Oxygen mask may exacerbate neuralgia symptoms
* Oxygen mask may exacerbate neuralgia symptoms
*For glossopharyngeal neuralgia, if neuromonitoring, will require a neuromonitoring endotracheal tube
**Consider video laryngoscopy to ensure correct electrode placement across vocal cords


=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
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=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
* Consider hyperventilation and/or mannitol to reduce intracranial volume to improve surgical conditions


=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
* Resume home regimen of neuropathic agents


=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===


== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
* Nerve injury
 
* Vascular injury/hemorrhage
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!Variant 1
!Variant 2
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|Unique considerations
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|EBL
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== References ==
== References ==


[[Category:Surgical procedures]]
[[Category:Surgical procedures]]
<references />
[[Category:Neurosurgery]]
[[Category:Intracranial neurosurgery]]

Latest revision as of 08:39, 29 August 2022

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

A craniotomy for decompression of cranial nerves 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[1]
  • Intraoperative neuromonitoring may be used

Induction and airway management

  • Oxygen mask may exacerbate neuralgia symptoms
  • For glossopharyngeal neuralgia, if neuromonitoring, will require a neuromonitoring endotracheal tube
    • Consider video laryngoscopy to ensure correct electrode placement across vocal cords

Positioning

  • Pinned frame

Maintenance and surgical considerations

  • Consider hyperventilation and/or mannitol to reduce intracranial volume to improve surgical conditions

Emergence

Postoperative management

Disposition

  • Typically PACU

Pain management

  • Resume home regimen of neuropathic agents

Potential complications

  • Nerve injury
  • Vascular injury/hemorrhage

References

  1. ↑ Xu, Risheng; Nair, Sumil K.; Materi, Josh; Raj, Divyaansh; Medikonda, Ravi; Shah, Pavan P.; Kannapadi, Nivedha V.; Wang, Andrew; Mintz, David; Gottschalk, Allan; Antonik, Laurie J. (2022-05-01). "Case Series in the Utility of Invasive Blood Pressure Monitoring in Microvascular Decompression". Operative Neurosurgery (Hagerstown, Md.). 22 (5): 262–268. doi:10.1227/ons.0000000000000130. ISSN 2332-4260. PMID 35315836 Check |pmid= value (help).

Top contributors: Chris Rishel

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