Taking the shooting pain away
With the exposure of the dura of the brain (the thick membrane that surrounds the brain), the buddy-halo retractor is put into place to keep the axis in the deep structures of the posterior fossa (a small space in the skull, found near the brain stem and cerebellum).
- Thereafter, the 7th nerve is identified and secured and the arachnoid (the delicate middle membrane of the three membranes covering the brain) opened up. This is to unearth the trigeminal nerve emerging from the pons (a structure in the upper part of the brain stem) and entering the ganglion (nerve cell cluster) as well as the vascular loop (a branch of the superior cerebellar artery) impinging on the nerve route.Then the artery is dissected carefully, keeping a close eye on the perforators (small blood vessels) to avoid damage.
- The vascular loop which is impinging on the trigeminal nerve is then separated from the nerve.
- The space so created is secured with a synthetic fabric such as talfar or gel-foam.
- To prevent vascular spasms, the area is infiltrated with papaverine.
- After performing haemostasis (stoppage of blood flow), there is routine closure.
The surgery takes about four hours.