Arterial Compression of the Trigeminal Nerve at the Pons in Patients with Trigeminal Neuralgia

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    View of right trigeminal nerve at pons through dissecting microscope. Transtentorial approach to nerve from superolateral direction: (a) pons; (b) motor root; (c) intermediate fibers; (d) “fibrous cone” of major sensory root; (e) tortuous small artery which was compressing nerve before dissection; (f) site of selective transection; (g) right cerebellar hemisphere (retracted). (Reprinted with the permission of the Bulletin of the Los Angeles County Neurological Societies.) ×10.

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    View of right trigeminal nerve at pons through dissecting microscope. Transtentorial approach to nerve from superolateral direction: (a) small tortuous branches of superior cerebellar artery compressing nerve at pons; (b) motor roots; (c) “fibrous cone” region of portio major; (d) another arterial branch; (e) intermediate fibers; (f) cerebellum (retracted); (g) trigeminal nerve entering dural canal. ×16.

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    Same patient as Fig. 52 with identical identifying letters. Tortuous arterial branches supported partly away from nerve by instrument. ×16.

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    Patient three months following operation. First division trigeminal neuralgia with decreased corneal reflex, small artery freed up from nerve at pons and small infero-lateral section of portio major carried out with preservation of intermediate fibers. Pain-free with normal corneal reflex postoperatively. Light touch totally intact. Hypalgesia in area outlined.

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