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Case Reports
. 2022 Jul 18;4(3):CASE22176.
doi: 10.3171/CASE22176.

Simultaneous microvascular decompression for trigeminal neuralgia and hemifacial spasm involving a dolichoectatic vertebral artery in an elderly patient: illustrative case

Neelan J Marianayagam  1   2 , Hanya M Qureshi  1   2 , Sagar Vasandani  1   2 , Shaurey Vetsa  1   2 , Muhammad Jalal  1   2 , Kun Wu  1   2 , Jennifer Moliterno  1   2
Affiliations
Case Reports

Simultaneous microvascular decompression for trigeminal neuralgia and hemifacial spasm involving a dolichoectatic vertebral artery in an elderly patient: illustrative case

Neelan J Marianayagam et al. J Neurosurg Case Lessons. .

Abstract

Background: Hyperactive cranial neuropathies refractory to medical management can often be debilitating to patients. While microvascular decompression (MVD) surgery can provide relief to such patients when an aberrant vessel is compressing the root entry zone (REZ) of the nerve, the arteries of elderly patients over 65 years of age can be less amenable to manipulation because of calcifications and other morphological changes. A dolichoectatic vertebral artery (DVA), in fact, can lead to multiple cranial neuropathies; therefore, a strategy for MVDs in elderly patients is useful.

Observations: A 76-year-old man presented with medically refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). A DVA was the conflicting vessel at the left REZs of the trigeminal and facial nerves. The authors performed a retrosigmoid craniotomy for MVD of the DVA with Teflon padding at both REZs in approximately 1 hour of operative time. The patient was free of facial pain and spasm immediately after surgery and at follow-up.

Lessons: The authors described the case of an elderly patient with both TN and HFS caused by compression of a DVA. Simultaneous MVD with Teflon padding at both REZs provided symptomatic relief with limited surgical time. This can be a particularly useful and straightforward surgical strategy in the elderly population.

Keywords: CN = cranial nerve; DVA = dolichoectatic vertebral artery; HFS = hemifacial spasm; MVD = microvascular decompression; REZ = root entry zone; TN = trigeminal neuralgia; hemifacial spasm; microvascular decompression; trigeminal neuralgia.

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Conflict of interest statement

Disclosures Dr. Moliterno reported personal fees from BK Medical outside the submitted work. No other disclosures were reported.

Figures

FIG. 1.
FIG. 1.
Constructive interference in steady state (CISS) magnetic resonance imaging (MRI) showing a DVA compressing the REZ of CN V (yellow arrow).
FIG. 2.
FIG. 2.
CISS MRI showing a DVA compressing the REZ the CN VII/VIII complex (yellow arrow).
FIG. 3.
FIG. 3.
Intraoperative photograph showing the DVA in relation to the CN VII/VIII complex.
FIG. 4.
FIG. 4.
Intraoperative photograph showing the DVA decompressed with Teflon patties (*).
See this image and copyright information in PMC

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