Endoscopic-assisted microvascular decompression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia: Case reports and literature review

Abstract Introduction: Trigeminal neuralgia (TN) secondary to vertebrobasilar dolichoectasia (VBD) was a rare condition with limited cases reported in the medical literature. This paper reported two successful cases of endoscopic-assisted microvascular decompression (MVD) for TN secondary to VBD. Case presentation no. 1: A 53-year-old male with a history of myocardial infarction and heart failure was diagnosed of left trigeminal neuralgia V2 and V3 for three years. The pain did not respond to medical therapy with Tegretol at the dose of 800mg per day. Brain magnetic resonance imaging (MRI) revealed a neurovascular conflict between VBD and the left trigeminal nerve. The endoscopic-assisted MVD was indicated and we used keyhole retrosigmoid craniotomy. The shredded neurosurgical sponges were interposed between VBD and trigeminal nerve. The 0o and 30o rigid rod-lens endoscope was used to explore and confirm the complete decompression. Postoperatively, TN was disappeared entirely. At one-year postoperative, no facial pain and paraesthesia were found. Case presentation no. 2: A 71-year-old male with healthy history was diagnosed of right trigeminal neuralgia V2 for four years. The pain did not respond to medical therapy with Tegretol at the dose of 800mg per day. Brain MRI demonstrated a neurovascular conflict between VBD and the right trigeminal nerve. He was received endoscopic-assisted MVD via keyhole retrosigmoid craniotomy. After the operation, his facial pain disappeared permanently and he has paraesthesia at right upper lip. He was discharged after a week. At 6 months postoperative, no facial pain were found. Conclusion: Endoscope-assisted MVD allowed better visualization of REZ and neurovascular conflicts behind neural structures and least cerebellar retraction in management of trigeminal neuralgia secondary to VBD. Keywords: Trigeminal neuralgia, vertebrobasilar dolichoectasia, microvascular decompression, endoscope-assisted.