Two Cases of Trigeminal Neuralgia Caused by the Trigeminocerebellar Artery.

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.