Trigeminal neuralgia is most often caused by an artery or a vein or a combination of both coming in contact with the trigeminal nerve. They are exceedingly rare situation where an artery or a vein can actually transect the sensory root of the trigeminal nerve and in this situation, mobilization of these vessels, these intraneural Vessels can be quite challenging. Let's review the case of this patient who presented with right-sided trigeminal neuralgia. In this situation, MRI preoperatively was all remarkable. As you can see, the dura being open in a curvilinear fashion, parallel to the sigmoid and transfer sinuses. The edges of the dura are tacked up to mobilize the dura out of our operative corridor. The circle of pontine angle was accessed and the right side of trigeminal nerve nerve was exposed. You can see this sensory root of the trigeminal nerve that is being transected into anterior and posterior, fascicles. And in this situation, mobilization of the vein can be quite challenging and requires significant manipulation of the nerve. Such manipulation can lead to significant post-operative facial numbness and paresthesias, and therefore should be avoided. In this situation, I tend to, to slightly mobilize the vein, however, slight amount of bleeding occurred, as you can see, and I therefore abandon further manipulation of the vein. The vein remained intact. You can see how their vein is truly transecting the sensory, root of the nerve a gentle rhizotomy, using forceps was there for completed. And this is often adequate to provide pain relief without necessarily placing these pontine veins at risk of injury and also potentially causing venous infarction. Thank you.
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