How I do it: two-step transposition technique during endoscopic microvascular decompression for trigeminal neuralgia

Background: Endoscopic microvascular decompression (eMVD) provides excellent visualization and minimally invasive surgical treatment of trigeminal neuralgia (TN). The transposition technique is desirable for long-term outcomes of TN. Method: A two-step transposition technique is performed during eMVD for TN due to the arch-shaped superior cerebellar artery (SCA). First, the cerebellomesencephalic segment of the SCA is pulled out using oxycellulose balls. Second, the retracted lateral pontomesencephalic segment of the SCA is detached from the trigeminal nerve and is transposed for fixation at the tentorium cerebelli. Conclusion: The two-step transposition technique offers simple, reliable decompression for TN due to the arch-shaped SCA.