Microvascular decompression for trigeminal neuralgia due to compression by the vertebral artery: report of 3 cases.

BACKGROUND: Trigeminal neuralgia elicited by the vertebral artery is unusual. According to a large trigeminal neuralgia series, only 4 of 1,404 (0.3%) consecutive patients with typical trigeminal neuralgia presented with vertebral artery compression. In such cases the vertebrobasilar system tends to be atherosclerotic, ectatic, and tortuous, requiring, in addition to an ordinary microvascular decompression method, technical modifications of this procedure. We report on 3 patients with trigeminal neuralgia due to compression by a tortuous vertebral artery.

PATIENTS: All 3 patients underwent microvascular decompression via a small lateral suboccipital craniotomy. Operative exposure demonstrated that the root of the trigeminal nerve was compressed directly and stretched by a loop of the vertebral artery. The compression was successfully released by dislocation of the loop using Teflon (polytetrafluoroethene) slings. Immediately after the operation all 3 patients became pain-free.

CONCLUSION: Among the surgical procedures used in microvascular decompression surgery, dislocation of the offending vessel with Teflon slings is a useful surgical technique to treat trigeminal neuralgia due to a tortuous vertebral artery.