Variation of Vascular Compression in Trigeminal Neuralgia

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This video reviews a variation of a vascular loop located along the very medial aspect of the axilla of the nerve that can be often challenging to decompress. This patient was suffering from medical refractory left-sided trigeminal neuralgia. On a regular MRI without high resolution imaging of the posterior fossa in this case, you can see very dialogue static basilar artery with potentially evidence of a vast conflict on the left side. Following completion of a left sided retromastoid craniotomy the arachnoid membranes between the veins and the nerve as well as the arachnoid membranes that in this case were very thick and hiding the vascular loop along the very medial axilla of the nerve are being opened. It is important to inspect this area of the nerve very thoroughly as these vessels that are often hiding along the very medial aspect of the axilla can be missed. This is along the superior aspect of the nerve the route of the arteries is often unknown in this location, the nerve is being mobilized superiorly illustrating potentially the very torturous route of the artery. A piece of shredded Teflon is placed superiorly and since the artery is moving completely inferiorly and it's not in clear view of the surgeon, the shredder piece of Teflon is being mobilized from the superior aspect of the nerve to the inferior direction. I'm going to stop the video right here to illustrate this nuance. So because the artery was very medially located and it was not clearly in view of the surgeon, a piece of shredded Teflon was placed superiorly and then squeezed between the nerve and the artery all the way inferiorly until I was able to see the shutter Teflon again along the inferior aspect of the nerve. And this maneuver assured me that entire medial aspect of the nerve is decompressed.

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