Anatomy and clinical significance of the trigeminocerebellar artery

Tüccar, Eray; Sen, Tulin; Esmer, Ali Fırat

doi:10.1016/j.jocn.2008.06.025

Cited by 7 publications

(13 citation statements)

References 13 publications

(14 reference statements)

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“…3F). 10,15 In our case, the offending artery clearly branched directly from the distal part of the BA, and the intraoperative findings confirmed that the artery almost encircled the trigeminal nerve and thereafter coursed toward the cerebellum. The exact distribution of the artery in the cerebellum related to the SCA, AICA, and posterior cerebellar artery was not clear because no angiographical evidence was available, but we concluded that the trigeminocerebellar artery was the correct identification for the offending artery.…”

Section: Discussionsupporting

confidence: 69%

“…10,15 The trigeminocerebellar artery can be divided into the pontine, trigeminal, cisternal, and cerebellar segments, and it is thought to be related to the embryonic trigeminal artery. There are insufficient data about the prevalence of the trigeminocerebellar artery, but the etiology of the artery seems to be related to the developmental process.…”

Section: Discussionmentioning

confidence: 99%

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Trigeminal neuralgia caused by a trigeminocerebellar artery

Amagasaki¹,

Abe

Watanabe³

et al. 2014

JNS

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T rigeminal neuralgia is considered to be a type of neurovascular compression syndrome 4,7 typically caused by compression of the trigeminal nerve by the superior cerebellar artery (SCA) or other arteries branching from the vertebral and basilar arteries, and sometimes by veins or tumors. 2,3 We report a case of trigeminal neuralgia caused by an artery that had almost encircled the nerve, which was successfully decompressed surgically, and discuss the anatomy of the offending artery and trigeminal nerve root vasculature. Case ReportHistory and Presentation. This 31-year-old woman visited our hospital because of right facial pain. She first experienced a sharp pain in the right V 2 area of her face at age 16 years. The pain was triggered by brushing her teeth or washing her face. Treatment was initiated with oral medication (carbamazepine 600 mg per day), but the pain aggravated and the affected region enlarged to include the entire right V 1 to V 3 distribution and was even easily triggered by eating and conversation.Imaging. Gradient echo MRI indicated the presence of arteries along the right trigeminal nerve (Fig. 1); MR angiography showed 3 arteries on the right side of the upper part of the basilar artery (BA) (Fig. 2 left), and further gradient echo MRI showed bilateral thin anterior inferior cerebellar arteries (AICAs) branching from the lower portion of the BA (Fig. 2 right). The 3D fusion image from the caudal side revealed an artery arising from the BA and coursing toward the right trigeminal nerve, with neurovascular conflict observed at the proximal part of the nerve root, so this artery was identified as the offending artery (Fig. 3A). On the basis of this image and another 3D image from the posterior direction, it was confirmed that the duplicated SCAs and the offending artery directly branching from the BA were congruent with the 3 arteries identified on MR angiography (Fig. 3B). A surgical view of the 3D image allowed detailed evaluation of the neurovascular complex at the nerve root (Fig. 3C).Operation and Postoperative Course. After providing informed consent, the patient underwent microvascular decompression through a right suboccipital retrosig- This 31-year-old woman presented with typical right trigeminal neuralgia caused by a trigeminocerebellar artery, manifesting as pain uncontrollable with medical treatment. Preoperative neuroimaging studies demonstrated that the offending artery had almost encircled the right trigeminal nerve. This finding was confirmed intraoperatively, and decompression was completed. The neuralgia resolved after the surgery; the patient had slight transient hypesthesia, which fully resolved within the 1st month after surgery. The neuroimaging and intraoperative findings showed that the offending artery directly branched from the upper part of the basilar artery and, after encircling and supplying tiny branches to the nerve root, maintained its diameter and coursed toward the rostral direction of the cerebellum, which indicated that the artery supplied both the trigem...

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Trigeminal neuralgia caused by a trigeminocerebellar artery

Amagasaki¹,

Abe

Watanabe³

et al. 2014

JNS

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“…4 Furthermore, Tuccar et al reported that either the superolateral or inferolateral pontine arteries that travel to and supply the cerebellum must also be identified with the TCA because the superolateral or inferolateral pontine arteries were absent from sites where the TCA was present. 3 Marinković et al found that the TCA was present in 1 of 22 brainstems (2.3%) in their study. 2 In another study by Marinković and Gibo, the TCA was found in 2 of 29 cases (6.89%).…”

Section: Anatomy Of the Tcamentioning

confidence: 69%

“…2 The TCA supplies both the trigeminal nerve root and the cerebellar hemisphere after branching from the basilar artery. 3 Although the TCA is considered a potential cause of trigeminal neuralgia due to its unique course as described in the report just cited, trigeminal neuralgia caused by the TCA has not been reported to date. Here we describe two cases of trigeminal neuralgia caused by the TCA and discuss the anatomy and surgical points of the TCA.…”

Section: Introductionmentioning

confidence: 99%

Two Cases of Trigeminal Neuralgia Caused by the Trigeminocerebellar Artery

Shibao

Ohira

Kano

et al. 2015

J Neurol Surg A Cent Eur Neurosurg

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The trigeminocerebellar artery (TCA) is a unique branch of the basilar artery. We treated two cases of trigeminal neuralgia caused by the TCA. A 72-year-old woman had severe typical trigeminal neuralgia for ∼ 3 years. Thin-slice T2-weighted magnetic resonance imaging revealed an offending TCA. During microvascular decompression (MVD), we found that the TCA was compressing the medial aspect of the trigeminal nerve. We therefore transposed the TCA loop medially and anteriorly away from the nerve and inserted shredded Teflon between the TCA and the trigeminal nerve. Postoperatively, this patient's trigeminal neuralgia resolved, and she remained pain free at her 24-month follow-up. An 80-year-old man had trigeminal neuralgia. Magnetic resonance cisternography revealed that the course of the offending artery was the same as that of the TCA, originating from the superior cerebellar artery. During the MVD, we performed the same procedure as in case 1. Postoperatively, this patient's trigeminal neuralgia resolved, and he remained pain free at his 24-month follow-up. Because the TCA has a unique anatomical course, its decompression may sometimes be difficult.

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“…Considering its course, it can give symptoms of compression of abducens and trigeminal nerves [3]. Tuccar et al [28] showed that analogical situation can also apply to sion of more intracranial nerves. The most often coexisted facial, oculomotor and abducens palsy [4,26,27].…”

Section: Analysis Of the Anatomical Variations Of Neurovascular Conflictmentioning

confidence: 99%