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Combined transhorizontal-supracerebellar approach for microvascular decompression of trigeminal neuralgia

A combined approach for microvascular decompression of trigeminal neuralgia is reported. Arachnoid dissection of the cerebellar horizontal fissure (transhorizontal approach) allowed easy identification of the root exit zone of the trigeminal nerve. The superior semilunar lobule was pulled back rostrally so that retraction of the acoustic nerve was minimal. After identification of the offending vessels, the supracerebellar artery was mobilized and dissected out through the supracerebellar route, which was also less invasive to the acoustic nerve than the standard approach. By combining these two approaches, the whole surface of the trigeminal nerve can be observed easily. Thus, the offending vessels can be readily identified, mobilized and moved away from the trigeminal nerve with minimal retraction of the acoustic nerve.