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Background <p>Dolichoectatic vertebrobasilar arteries (DBA)-induced trigeminal neuralgia (TGN) is rare, and both medication and surgical decompression often have a substantial treatment failure rate. Surgical techniques that provide sufficient decompression and long-term pain relief are challenging in cases of large DBA with limited posterior fossa space, and have been scarcely described due to their rarity and technical complexity. We present our novel technique involving mobilization of the trigeminal nerve (CN5) combined with macrovascular transposition of the gigantic DBA for curative treatment of this challenging condition.</p> Methods <p>We described our surgical strategy and maneuvers that safely and effectively achieved long-term pain relief for giant DBA-induced TGN. The DBA measured 11.69&#xa0;mm and compressed both the trigeminal nerve root exit zone (TGN-REZ) and the brainstem. The extremely limited posterior fossa space made conventional microvascular decompression&#xa0;or simple transposition unfeasible. Therefore, we performed a lateral CN5 transposition using a sling-pulling technique in combination with anterior DBA transposition via a combined transpetrosal approach (CTPA). This allowed permanent separation of the DBA from the TGN-REZ, resulting in immediate postoperative symptom relief while preserving critical arteries, veins, and brainstem perforators.</p> Results <p>The CN5 can be untethered and transposed laterally, anchored to the temporal dura, while the DBA was transposed anteriorly following maximal petroclival bone removal, which created sufficient space for mobilization and secured with Teflon felt soaked with fibrin glue. Postoperative complications include mild facial palsy, which completely resolved within 4&#xa0;months. At the 20-month follow-up, the patient remained pain-free without recurrence.</p> Conclusion <p>The gigantic DBA-induced TGN can be safely and effectively treated through CN5 transposition combined with DBA transposition, resulting in a permanent contactless TGN-REZ and favorable long-term pain relief. Preoperative counseling regarding the risk of CTPA-related complications is essential, taking into account the potential risks and benefits of the procedure.</p>

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Trigeminal nerve transposition by sling-pulling technique in combination with macrovascular transposition for giant basilar artery–induced trigeminal neuralgia via a combined transpetrosal approach

  • 期刊论文

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  • 发表日期：

    2026年3月4日

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  • Gahn Duangprasert,
  • Pree Nimmannitya,
  • Vich Yindeedej,
  • Raywat Noiphithak

摘要

Background

Dolichoectatic vertebrobasilar arteries (DBA)-induced trigeminal neuralgia (TGN) is rare, and both medication and surgical decompression often have a substantial treatment failure rate. Surgical techniques that provide sufficient decompression and long-term pain relief are challenging in cases of large DBA with limited posterior fossa space, and have been scarcely described due to their rarity and technical complexity. We present our novel technique involving mobilization of the trigeminal nerve (CN5) combined with macrovascular transposition of the gigantic DBA for curative treatment of this challenging condition.

Methods

We described our surgical strategy and maneuvers that safely and effectively achieved long-term pain relief for giant DBA-induced TGN. The DBA measured 11.69 mm and compressed both the trigeminal nerve root exit zone (TGN-REZ) and the brainstem. The extremely limited posterior fossa space made conventional microvascular decompression or simple transposition unfeasible. Therefore, we performed a lateral CN5 transposition using a sling-pulling technique in combination with anterior DBA transposition via a combined transpetrosal approach (CTPA). This allowed permanent separation of the DBA from the TGN-REZ, resulting in immediate postoperative symptom relief while preserving critical arteries, veins, and brainstem perforators.

Results

The CN5 can be untethered and transposed laterally, anchored to the temporal dura, while the DBA was transposed anteriorly following maximal petroclival bone removal, which created sufficient space for mobilization and secured with Teflon felt soaked with fibrin glue. Postoperative complications include mild facial palsy, which completely resolved within 4 months. At the 20-month follow-up, the patient remained pain-free without recurrence.

Conclusion

The gigantic DBA-induced TGN can be safely and effectively treated through CN5 transposition combined with DBA transposition, resulting in a permanent contactless TGN-REZ and favorable long-term pain relief. Preoperative counseling regarding the risk of CTPA-related complications is essential, taking into account the potential risks and benefits of the procedure.