Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
Department of Neuroelectrophysiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
BMC Neurol. 2022 Jul 4;22(1):244. doi: 10.1186/s12883-022-02765-4.
An anterior inferior cerebellar artery (AICA) that crosses the right trigeminal nerve is an uncommon arterial anatomic variation. In this anatomical position, it is difficult to separate or move the offending blood vessels and nerves. We report an uncommon case of trigeminal neuralgia (TN) caused by compression of the trigeminal ganglion by a branch of the AICA.
A 34-year-old man with 5 years history who complained of pain on the right side of the face (area V1). The symptoms gradually worsened, and the pain episodes became intense and frequent. Magnetic resonance imaging (MRI) of the cerebrum showed a small blood vessel passing through the right trigeminal nerve. Microvascular decompression (MVD) was performed,because medication was ineffective. Intraoperative exploration confirmed that the vessel which was a branch of the AICA passing through the right trigeminal nerve. As while the artery was temporarily clipped, electrophysiological monitoring showed a decrease in the amplitude of nerve activity. As the artery was considered too important to be sacrificed, the space between the nerves was enlarged mildly, the artery was liberated, the Teflon implant was shredded and placed between the artery branches and nerve to make the blood vessels as perpendicular as possible to the nerve. The patient had no neurological dysfunction and no pain after 8 months of follow-up.
MVD is an effective treatment for artery-induced trigeminal nerve compression, but we report a novel procedure that avoids the complication of facial numbness caused by cutting the offending vessels and incision of the trigeminal nerve.
小脑前下动脉（AICA）越过右侧三叉神经是一种不常见的动脉解剖变异。在这种解剖位置，分离或移动有问题的血管和神经很困难。我们报告了一例由 AICA 分支压迫三叉神经节引起的不常见三叉神经痛（TN）病例。
一名 34 岁男性，病史 5 年，右侧面部疼痛（V1 区）。症状逐渐加重，疼痛发作变得剧烈和频繁。大脑磁共振成像（MRI）显示一小段血管穿过右侧三叉神经。由于药物治疗无效，进行微血管减压术（MVD）。术中探查证实该血管为穿过右侧三叉神经的 AICA 分支。由于动脉暂时夹闭，电生理监测显示神经活动幅度降低。由于认为该动脉太重要而不能牺牲，因此仅轻度扩大神经之间的空间，解放动脉，将特氟隆植入物切碎并放置在动脉分支和神经之间，使血管尽可能垂直于神经。患者术后 8 个月随访无神经功能障碍，无疼痛。
MVD 是治疗动脉引起的三叉神经压迫的有效方法，但我们报告了一种新的手术方法，可以避免因切断致病血管和切开三叉神经引起的面部麻木并发症。
