Trigeminal neuralgia caused by a transfixed arterial loop: illustrative case

Area of Science:

• Neurosurgery
• Neurology

Background:

• Trigeminal neuralgia (TN) is often caused by vascular compression at the trigeminal nerve's root entry zone (REZ).
• Intraneural transfixion by a blood vessel is a rare cause of TN, presenting surgical difficulties.

Purpose of the Study:

• To describe the surgical management of a rare case of trigeminal neuralgia caused by intraneural vascular compression (type 2).
• To review surgical strategies for intraneural vascular compression of the trigeminal nerve.

Main Methods:

• A 77-year-old male with TN underwent microvascular decompression for intraneural superior cerebellar artery (SCA) loop.
• Surgical procedures included internal neurolysis and Teflon pledget placement at the REZ.
• Literature review of surgical interventions for intraneural TN.

Main Results:

• Complete and sustained pain relief was achieved postoperatively.
• No postoperative numbness was reported.
• Literature review identified common surgical themes: nerve dissection, artery mobilization, and Teflon insertion.

Conclusions:

• For type 1 intraneural penetration, separating motor/sensory roots and mobilizing the motor root/artery is suggested.
• For type 2, internal neurolysis or horizontal transection to free the artery is recommended.
• Balancing sensory loss risk and symptom recurrence is crucial for patient-centered surgical planning.