Surgical Management of the Trigeminocerebellar Artery in Microvascular Decompression for Trigeminal Neuralgia

Abstract

Abstract BACKGROUND The trigeminocerebellar artery (TCA) is a variant branch of the basilar artery supplying the trigeminal nerve root and cerebellar hemisphere, which may contribute to trigeminal neuralgia (TGN). Despite its unique anatomic description, information regarding the preoperative diagnosis and surgical management of TCA is lacking. OBJECTIVE To evaluate our preoperative diagnosis of TCA using 3-dimensional (3D) images and surgical management of TGN cases with TCA involvement. METHODS We reviewed our 15 patients with TCA involvement (3.3%) among 460 consecutive patients undergoing microvascular decompression for TGN. In this study, all patients were examined using 3D images using GammaPlan (Elekta, Stockholm, Sweden). TCAs were divided into 2 groups based on surgical findings: encircling type and intraneural type. Biographical data, radiological findings, and operative video recordings were reviewed retrospectively. Surgical outcomes and follow-up were assessed and compared between the 2 groups. RESULTS TCA involvement was confirmed preoperatively in 14 of the 15 patients using 3D images. All patients were operated with our unique transposition technique and became pain free immediately after the surgery. Pain-free status was maintained during the follow-up period (3.5 ± 2.6 yr) in all patients but one in whom pain recurred 4 yr after the initial surgery. Re-exploration revealed an adhesion between the Teflon felt and the nerve root. CONCLUSION Although TCA involvement is rare, an accurate preoperative diagnosis is essential because the decompression technique may differ from those used for other common cases. Scrutinizing anatomically rare variation with 3D images is recommended for predicting TCA involvement.