Basilar Artery Dolichoectasia With Multiple Vessel Compression ("Vessel Sandwich") in Trigeminal Neuralgia: A Case...

Basilar artery (BA) dolichoectasia is a rare vascular anomaly characterized by elongation, dilatation, and tortuosity of the BA. A dolichoectatic BA can cause neurovascular compression of the trigeminal nerve, resulting in classical trigeminal neuralgia (TN). Diagnosis and surgical management are often challenging due to the complex anatomy and the frequent presence of multiple neurovascular conflicts.

We report the case of a 70-year-old man with multiple comorbidities and an 8-year history of right-sided TN refractory to pharmacological and interventional treatments. High-resolution brain MRI revealed BA dolichoectasia compressing the trigeminal nerve, with no additional neurovascular conflicts identified. Intraoperatively, multiple offending vessels were identified compressing the trigeminal nerve (BA, superior cerebellar artery, superior petrosal vein, and anterior inferior cerebellar artery). The patient underwent a successful 360° microvascular decompression, achieving complete decompression of all neurovascular conflicts. Postoperative recovery was uneventful, and the patient experienced immediate and sustained pain relief without complications.

TN caused by BA dolichoectasia with multiple neurovascular conflicts represents a complex diagnostic and surgical challenge. However, meticulous intraoperative exploration and complete decompression can result in rapid and long-lasting symptom resolution. This case underscores the importance of comprehensive preoperative imaging and individualized surgical planning.