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Publication Detail
Aberrant Abducent Nerve during Microvascular Decompression for Trigeminal Neuralgia.
BACKGROUND: Microvascular decompression (MVD) is a commonly performed procedure to treat trigeminal neuralgia and hemifacial spasm. Knowledge of the variable anatomy of the cerebellopontine angle is crucial to avoid injury to cranial nerves. OBJECTIVE: Here, we highlight a case of aberrant anatomy of the abducent nerve encountered during MVD, emphasising the importance of visualising the surrounding cranial nerves. METHODS: Case report of a 76-year-old lady with right V1 and V2 trigeminal neuralgia, refractory to medical treatment, undergoing elective MVD. RESULTS: Intraoperatively, a distorted course of the cisternal component of the abducent nerve was noticed, caused by an ectatic anterior inferior cerebellar artery (AICA). Careful mobilisation of the offending vessel to decompress the trigeminal nerve was carried out; however, abducent nerve decompression was not attempted since its function was not compromised. Facial pain resolved post operatively without new diplopia. CONCLUSION: Careful review of imaging prior to surgery is recommended in order to pre-empt such unusual anatomical variations.
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