Pretemp transcav kawase approach for trigeminal neuralgia

Background Trigeminal neuralgia (TN) secondary to vertebrobasilar artery (VBA) compression is extremely rare. Macrovascular decompression is an option to address this condition. However, the unique anatomy surrounding the VBA and trigeminal nerve poses significant surgical challenges. Various approaches and techniques have been discussed in the literature. We describe the pretemporal transcavernous Kawase approach, utilizing the transposition method with Teflon and an artificial dura sling, to achieve effective decompression. Presentation We present a case of a 65-year-old male with left side medically-intractable TN secondary to dissecting basilar artery aneurysm compression. Strategy with pretemporal transcavernous Kawase approach was conducted. The trigeminal nerve was found push superiolaterally by ipsilateral deviation of VBA. The VBA was mobilized inferomedially with care to prevent perforating artery transection. A Teflon prosthesis and an artificial dura sling were interposed in neurovascular conflicting area. The left-sided TN abated immediately after the intervention, and the patient was free from medication upon discharge. Conclusion This case was effectively managed utilizing the pretemporal transcavernous Kawase approach, coupled with a unique transposition technique employing Teflon and an artificial dura sling. This approach offered significant advantages, notably enhanced visualization of the trigeminal root entry zone and improved maneuverability for repositioning the crooked basilar artery inferomedially, away from the trigeminal nerve. The utilization of Teflon and an artificial dura sling as a transposition method ensured a safe distance between the VBA and the trigeminal nerve. Consequently, an outstanding surgical outcome was achieved, characterized by complete resolution of TN resulting from dissecting basilar artery aneurysm compression.