Nerve Splitting and Vascular Transposition for Trigeminal Neuralgia Attributed to Nerve Penetrating Trigeminocerebellar Artery: 2-Dimensional Operative Video.

The trigeminocerebellar artery (TCA) is an infrequent anatomic anomaly of the branches originating from the basilar artery. It is clinically identifiable by the presence of the ipsilateral superior cerebellar artery and the anterior inferior cerebellar artery, and its course from the basilar artery to the cerebellar hemisphere. Because of its anatomic proximity to the trigeminal nerve root, the TCA often causes trigeminal neuralgia (TGN). Unlike other common arteries, repositioning the TCA is not always feasible when it penetrates the trigeminal nerve root (the intraneural type of TCA). In addition, the rich perforators originating from the TCA may limit its movability. The nerve decompression technique in such a rare condition has not yet been fully assessed. In this video, we present the nerve-splitting method for the intraneural type of TCA, in which sufficient isolation of the sensory root is achieved. The motor root of the trigeminal nerve originates from the brainstem slightly rostral of the root entry zone of the sensory root. Dissecting the motor root from its exit to the porous trigeminus allows mobilization of the root together with penetrating TCA away from the sensory root. The movability of the TCA increases by dissecting its perforators to the nerve root and brain stem. Sufficient separation of the sensory root contributes to ensuring the surgical result of nerve decompression and reducing the risk of recurrence due to adhesion. No complications of motor root retraction, such as masseter weakness and malocclusion, were noted in our experience. All data identifying the patients were anonymized. All procedures performed in this study were in accordance with the ethical standards of our institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study also obtained approval from the ethics committee of our institution. Written informed consent was obtained from all individual participants, as well as their first-degree relatives, included in this study.