PMC4123266_01
Anteroinferior cerebellar artery (AICA) - IX, Xand XI c.n. at the intracisternal tract. (a) Axial 3D T2 drive image (b) axial 3D TOF image, and (c-e) 3D T2 axial bidimensional image fusion. (a) AICA (blue arrow) impacts IX, X and XI cranial nerve at the intracisternal tract (red arrow) (b) Only the tortuous AICA is visible (red arrows) (c and d) Simultaneous display of artery (red color) and nerves (blue color). (e) Contact between AICA (red color) and XI cranial nerve (blue color)
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F1
To visualize the neurovascular conflict between AICA and lower cranial nerves [Figure 1], the nervous structures were displayed in blue color and the arterial vessels in red. To visualize the neurovascular conflict between AICA distal branch and facial nerve [Figure 2], the nervous structures and distal arteries were displayed in red color and the main arterial vessels in yellow.
AICA distal branch - VII cranial nerve (c.n.) conflict. (a) Magnetic resonance angiogram (MRA) with maximum intensity projection (MIP), (b) 3D T2 axial bidimensional image fusion, and (c) 3D T2 coronal bidimensional image fusion. (a) Moderate scoliosis of the basilar trunk with a long cisternal route of a "dominant" left AICA (arrow) (b) AICA distal branch (white arrow) and VII c.n. at the intracisternal tract (yellow arrow) (c) The VII c.n. (yellow arrow) is slightly raised by the offending vessel (white arrow). (d) Schematic representation of the compression modality in case of "transfixing artery"
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F2
To visualize the neurovascular conflict between AICA and lower cranial nerves [Figure 1], the nervous structures were displayed in blue color and the arterial vessels in red. To visualize the neurovascular conflict between AICA distal branch and facial nerve [Figure 2], the nervous structures and distal arteries were displayed in red color and the main arterial vessels in yellow.
Intraoperative findings (a) A left dominant AICA turns in the cerebello-pontine cistern, conflicting with the lower cranial nerves (c.n.) and the anterior surface of the pons. A small branch of AICA penetrates the VII c.n., under the V c. n. (b) The V c.n. is gently pushed on a side to better evaluate the artery transfixing the VII c.n. (c) A small piece of autologous muscle is interposed between the proximal AICA, the XI c.n and pons. (d) MVD for VII c.n.: A small piece of muscle is interposed around the transfixing artery in the area where the nerve is penetrated. No rhyzotomy is performed
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F3
Microvascular decompression was performed with small pieces of autologous muscle at the point in which the transfixing artery penetrated the nerve, and between AICA, lower cranial nerve and brain stem, allowing the shifting of the vessel from the above-mentioned structures [Figure 3].