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Background <p>The superior petrosal vein (SPV) frequently impedes surgical access to the trigeminal nerve (TN) during microvascular decompression for trigeminal neuralgia. Distinguishing arterial structures, such as the trigeminocerebellar artery (TCA), from SPV venous tributaries presents a significant challenge.</p> Method <p>In this case, intraoperative indocyanine green (i-ICG) angiography precisely identified the TCA. We then safely transposed it using fibrin glue to establish an optimal surgical field.</p> Conclusion <p>Routine i-ICG application may improve neurovascular differentiation, enabling preservation of critical structures and facilitating effective endoscopic microvascular decompression(e-MVD) of the trigeminal nerve.</p>

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How I do it: identification and preservation of trigeminocerebellar artery from superior petrosal vein during endoscopic microvascular decompression for trigeminal neuralgia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月20日

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  • Raj Kumar Pannem,
  • Fuminari Komatsu,
  • Abhishek Kumar,
  • Yoko Kato

摘要

Background

The superior petrosal vein (SPV) frequently impedes surgical access to the trigeminal nerve (TN) during microvascular decompression for trigeminal neuralgia. Distinguishing arterial structures, such as the trigeminocerebellar artery (TCA), from SPV venous tributaries presents a significant challenge.

Method

In this case, intraoperative indocyanine green (i-ICG) angiography precisely identified the TCA. We then safely transposed it using fibrin glue to establish an optimal surgical field.

Conclusion

Routine i-ICG application may improve neurovascular differentiation, enabling preservation of critical structures and facilitating effective endoscopic microvascular decompression(e-MVD) of the trigeminal nerve.