Abstract
Trigeminal neuralgia is a chronic pain disorder affecting the face. In approximately
80% of cases, it is most commonly caused, when the root entry zone (REZ) of the trigeminal
nerve is compressed by the superior cerebellar artery (SCA). The etiology of the remaining
20% of cases is distributed among venous, arteriovenous malformations, posterior fossa
tumors, multiple sclerosis plaque compressions, and other pathologies. Combinations
of those compressive factors are very rare.[1]
[2]
[3]
[4] Herein, we present a video clip of microvascular decompression (MVD) in a 73-year-old
female, who has failed conservative treatment with 6 medications over 10 years. She
was affected by a unique triple compression of the right REZ by the SCA, anterior
inferior cerebellar artery (AICA), and petrosal vein complex ([Fig. 1A]). Right-sided microsurgical decompression of the REZ of the trigeminal nerve through
standard retrosigmoid craniotomy was performed by the senior author (K.I.A.). The
SCA and AICA were separated from the nerve using Teflon pledgets. The petrosal vein
complex was coagulated and divided, freeing up the right trigeminal nerve ([Fig. 1B]). The patient was discharged home on the third postoperative day with complete resolution
of trigeminal neuralgia.
The link to the Video can be found at: https://youtu.be/PYVvImGW0yE.
Keywords
trigeminal neuralgia - microvascular decompression - suboccipital craniotomy - arterial
compression - venous compression
