Ahmed Nazmin, Komatsu Fuminari, Kato Yoko
Department of Neurosurgery, Ibrahim Cardiac Hospital and Research Institute (A Centre for Cardiovascular, Neuroscience and Organ Transplant Units), Dhaka, Bangladesh.
Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan.
Surg Neurol Int. 2025 Apr 4;16:116. doi: 10.25259/SNI_6_2025. eCollection 2025.
Involvement of the trigeminocerebellar artery (TCA) in trigeminal neuralgia (TN) is rare, and reports of decompression using an endoscopic retro sigmoid keyhole approach are limited. This study, the largest of its kind, examines TCA-related TN cases to highlight the anatomical and surgical importance of the TCA, discuss technical difficulties in decompression, and review strategies for managing complications, along with a summary of previous cases.
Between April and September 2024, 56 endoscopic microvascular decompression (eMVD) procedures for TN were conducted using a 0° endoscope through the retrosigmoid keyhole approach in the Department of Neurosurgery, Fujita Health University Bantane Hospital, Japan. Among these, five cases involved the TCA as the compressive artery. We analyzed patient demographics, clinical presentations, neurovascular conflict (NVC) types, decompression techniques, surgical challenges, and outcomes, including a pictorial review of the TCA's developmental background, surgical anatomy, and clinical relevance.
Of the 56 patients treated with eMVD, 5 (8.9%) were confirmed to have TCA-induced TN. These patients, predominantly female (60%) with an average age of 70.3 years, presented mainly with V2 or V3 distribution pain, primarily on the left side. Intraoperative analysis revealed multiple NVC points in 80% of cases due to the TCA's complex course, with variations in conflict type. Postoperative outcomes were positive, with immediate pain relief in all cases and 80% achieving complete symptom remission. No perioperative complications were observed. Preoperative imaging with 3D reconstruction and computed tomography angiography was valuable for planning, though intraoperative indocyanine green angiography was essential to confirm NVCs and the status of perforating arteries.
eMVD through a retro sigmoid keyhole approach is safe and effective for TCA-induced TN. Surgeons should consider potential TCA involvement and multiple NVCs to optimize decompression strategies.
三叉神经小脑动脉（TCA）累及三叉神经痛（TN）的情况较为罕见，关于采用内镜乙状窦后锁孔入路进行减压的报道有限。本研究是同类研究中规模最大的，旨在研究与TCA相关的TN病例，以突出TCA的解剖学和手术重要性，讨论减压中的技术难点，并回顾并发症的处理策略，同时总结既往病例。
2024年4月至9月期间，日本藤田保健大学阪田医院神经外科采用0°内镜经乙状窦后锁孔入路对56例TN患者进行了内镜微血管减压术（eMVD）。其中，5例患者的压迫动脉为TCA。我们分析了患者的人口统计学特征、临床表现、神经血管冲突（NVC）类型、减压技术、手术挑战及结果，包括对TCA的发育背景、手术解剖及临床相关性进行图像回顾。
在接受eMVD治疗的56例患者中，5例（8.9%）被证实为TCA导致的TN。这些患者以女性为主（60%），平均年龄70.3岁，主要表现为V2或V3分布区疼痛，主要位于左侧。术中分析显示，由于TCA走行复杂，80%的病例存在多个NVC点，冲突类型各异。术后效果良好，所有病例均立即缓解疼痛，并80%实现症状完全缓解。未观察到围手术期并发症。术前3D重建和计算机断层血管造影成像对手术规划有重要价值，不过术中吲哚菁绿血管造影对于确认NVC及穿支动脉的状况至关重要。
经乙状窦后锁孔入路的eMVD治疗TCA导致的TN安全有效。外科医生应考虑TCA可能的累及情况及多个NVC，以优化减压策略。
