Case report shows successful vertebral artery repositioning to relieve trigeminal neuralgia from vascular compression in a 57-year-old man, suggesting a new treatment approach.
Vertebrobasilar dolichoectasia (VBD) is more common among men, older individuals, and those with a history of hypertension. Trigeminal neuralgia (TN) caused by vascular compression due to VBD is more likely to occur on the left side. We report a case in which we successfully treated a patient with a Gore-Tex sheet to reposition the vertebral artery (VA) and relieve the vascular compression. The patient was a 57-year-old man. Due to progressive worsening of the left TN, surgery was performed. The dolichoectatic right VA was tractioned with the Gore-Tex sheet and sutured to the petrous bone dura mater. Caudal traction of the right VA allowed visualization of the left superior cerebellar artery, the directly responsible vessel, and subsequent decompression with a Teflon sheet as usual. The TN disappeared immediately after surgery. Currently, one and a half years after surgery, the patient's condition is good. Although careful consideration and confirmation of perforator branch injury due to excessive traction on the VA and cranial nerves are needed, VA transfer using a Gore-Tex sheet to pull the VA and basilar artery downward is effective for treating TN caused by VBD.
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Nishimura et al. (2026) studied this question.
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