[Use of a fenestrated aneurysm clip for transposition of the tortuous vertebral artery].

A 69-year-old female was admitted to our clinic on August 19, 1985 with a 5 year history of intermittent left facial pain. She had undergone various types of medical treatment and multiple procedures of nerve blocking which resulted in only a temporary relief of pain. On admission, the intermittent facial pain and hypesthesia were recognized in the 2nd and 3rd divisions of the left trigeminal nerve. CT scan with contrast enhancement showed a shift of the basilar artery to the left side. An elongated and tortuous vertebral artery was recognized at the left cerebello-pontine angle both by CT scan and vertebral angiograms. This tortuous vertebral artery compressed the trigeminal nerve entry zone causing neuralgia. Vascular decompression was carried out by inserting a muscle piece sandwiched in the lyodura between the artery and brain stem. Facial pain disappeared but recurred nine months after this operation. At the 2nd operation, the vertebral artery was passed through the fenestrated aneurysm clip and fixed on the petrous bone. With this procedure the vertebral artery was successfully transposed and the patient was discharged without any episodes of facial pain.