A novel surgical strategy for trigeminal neuralgia associated with vertebrobasilar dolichoectasia: nerve rerouting via the anterior transpetrosal approach. Illustrative case.

Koki Nakazato, Masanori Aihara, Yutaro Itabashi, Tomoko Kunitomi, Naoto Mukada, Soichi Oya
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Abstract

Background: Microvascular decompression for trigeminal neuralgia (TN) caused by vertebrobasilar dolichoectasia is challenging due to severe arteriosclerosis of the offending vessel, and is often associated with poor improvement of the symptoms, recurrence, and increased risk of complications. The authors describe a novel method of treatment: rerouting the trigeminal nerve and not manipulating the offending vessels.

Observations: A 50-year-old male presented with a 7-year history of TN. MRI showed that the anterior inferior cerebellar artery (AICA) was strongly compressing the trigeminal nerve from the inferomedial direction. Given the severe dolichoectatic changes, mobilization of the offending vessels was considered extremely risky. Therefore, decompression was performed by mobilizing the trigeminal nerve instead of manipulating the offending vessels. The surgery was performed via an anterior transpetrosal approach. Meckel's cave was opened to allow sufficient mobilization of the trigeminal nerve. A GORE-TEX sling was used to lift and decompress the trigeminal nerve by separation from the AICA. The patient's facial pain completely disappeared immediately after surgery, and no new neurological deficits were observed.

Lessons: The relative mobility of the trigeminal nerve allows rerouting by opening Meckel's cave. This technique may help reduce surgical risk by avoiding direct manipulation of severely atherosclerotic arteries. https://thejns.org/doi/10.3171/CASE25474.

一种治疗三叉神经痛伴椎基底动脉宽缩症的新手术策略:经前肋经入路神经改道。说明情况。
背景:椎基底动脉宽缩症引起的三叉神经痛(TN)微血管减压治疗具有挑战性,因为累及血管的动脉硬化严重,且常伴有症状改善不良、复发和并发症风险增加。作者描述了一种新的治疗方法:改变三叉神经的路线,而不操纵有问题的血管。观察:50岁男性,TN病史7年。MRI显示小脑前下动脉(AICA)从内侧方向强烈压迫三叉神经。考虑到严重的血管膨胀性改变,对病变血管的动员被认为是非常危险的。因此,通过调动三叉神经来进行减压,而不是操纵有问题的血管。手术通过前路经脊柱入路进行。梅克尔洞穴被打开,以允许三叉神经充分活动。GORE-TEX吊带通过与AICA分离来提升和减压三叉神经。术后患者面部疼痛完全消失,无新的神经功能缺损。经验教训:三叉神经的相对流动性允许通过打开梅克尔洞穴来改变路线。这项技术可以避免直接操作严重动脉粥样硬化的动脉,从而降低手术风险。https://thejns.org/doi/10.3171/CASE25474。
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