Vascular Loop at the Axilla of the Nerve in Trigeminal Neuralgia

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This video demonstrates another variation of the arterial loop at the axilla of the nerve to cause trigeminal neuralgia by vascular compression. This actual T2 weighted MRI of a patient who was suffering from left sided trigeminal neuralgia, demonstrates the trigeminal nerve at the tip of the arrow, as well as a vascular segment of the vessel compressing the nerve along its very medial and axillary aspect. After a left sided, retromastoid craniotomy you can appreciate the trigeminal nerve and the artery, which is very much adherent to the very medial and inferior aspect of the nerve at this location. Microsurgical techniques are used to mobilize the artery, which is transversing, just medial to the root entry zone of the nerve. In this situation, I am going to place a shorter piece of Teflon. And since I cannot see just in front of the nerve very adequately, I will mobilize the piece of Teflon and squeeze it between the nerve and the artery until I can see the edge of the Teflon just above the nerve. And this assures me that the entire segment of the nerve more medially has been decompressed.

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