Neurosurg Focus 59(3):E12, 2025
Sectioning the superior petrosal vein at its main trunk while maintaining venous crossflow is a safe and effective strategy during microvascular decompression for trigeminal neuralgia, improving surgical access without significantly increasing venous-related complications, according to a large retrospective study.
• Management of the superior petrosal vein (SPV) during microvascular decompression (MVD) for trigeminal neuralgia (TN) is controversial, with concerns about operative field access and potential complications.
• A retrospective study evaluated a technique of SPV division at its main trunk near the superior petrosal sinus, maintaining venous crossflow through contributories, in 171 out of 217 patients (79%).
• No statistically significant increase in venous-related complications was observed in the SPV division group compared to the preservation group.
• Only 3 possibly venous-related complications occurred in the SPV division group, all of which were mild and transient.
• Anatomical variations of the SPV require careful intraoperative assessment and preservation of collateral venous drainage for safety.
• Preoperative imaging and intraoperative techniques (e.g., indocyanine green angiography) are recommended to assess collateral flow before SPV division.
• The study concludes that SPV division at the main trunk with preservation of crossflow is a safe strategy that improves surgical exposure during MVD for TN.
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