Patient nerve from Meckel cave to pons were

Patient was kept in supine position and the head was turned to opposite side. A 4-cm incision on the skin posterior to ear was used. The bone cut of about 3 cm was performed. About 3 cm dural opening behind junction of transverse and sigmoid sinus was performed. All the procedure from here onward was performed under endoscopic control. Karl Storz telescope of 4 mm diameter and the zero-degree angle was held by scope holder. It was directed towards cisterna magna to drain cerebrospinal fluid (CSF). A lax brain is essential before doing any dissection adjacent to the trigeminal nerve. Although lumbar drain was not needed in our study, it can be performed for CSF drainage. Brain retractors were not used in any case. Telescope was positioned toward an area of interest with the help of holder and instruments were brought in from both sides of the telescope using both hands. Arachnoid membrane adjacent to fifth cranial nerve was incised and was moved away. The compressing vessel was identified and separated at a distance from trigeminal nerve (figure 1). All the vessels in relation to the fifth cranial nerve from Meckel cave to pons were dissected free. A small size of the dural patch (G patch made from polypropylene supplied by Surgiwear company) was positioned between vessel and nerve (Video). This interposition material was placed in such a way to avoid contact of the patch with dura or tentorium. Tissue glue was used to avoid movement of the dural patch. Most of the surgery was performed with the help of the 0° scope, the 30- degree angled telescope was used for visualization and dissection of vessels placed anterior to the nerve. The 30 -degree angled scope was also used to assess completeness of decompression. A zero -degree telescope was stationed in the center of surgical field and instruments for surgery were passed from both sides of the scope. A 30 -degree scope was stationed at the edge of the operative field.

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