Trigeminal neuralgia caused by dolichoectatic vertebral artery: Reports of two cases

Trigeminal neuralgia (TN) caused by a dolichoectatic vertebral artery is a rare and atypical form of TN, where an enlarged and tortuous vertebral artery compresses the trigeminal nerve at its root entry zone. The term dolichoectatic is of Greek origin and means elongated, torturous or dilated. The vascular anomaly may lead to the characteristic severe, stabbing facial pain. This type of TN is often identified through advanced imaging techniques such as magnetic resonance imaging or angiography, which reveal the vascular anomaly impinging on the nerve. Treatment options for the type of TN secondary to dolichoectatic vertebrobasilar artery include primarily microvascular decompression or Gamma knife treatment to alleviate nerve compression and reduce symptoms.

The authors present two illustrative cases of elderly patients: an 82-year-old with the right-sided and a 68-year-old patient with the left-sided facial pain, respectively. Both patients presented with lancinating and irritating facial pain. Magnetic resonance imaging in both patients confirmed compression of the trigeminal nerve secondary to a vertebrobasilar dolichoectatic artery. The authors performed microvascular decompression in both patients, which resulted in instant pain relief.

Early diagnosis and surgical intervention are crucial for effective pain management and improved patient outcomes.