PMC8326083_01
AP cerebral angiogram showing a right vertebral artery injection. Indicated by the arrows are the right SCA and the right PCA, both occluded postembolization. SCA: Superior cerebellar artery, PCA: Posterior cerebellar artery.
SNI-12-318-g001.jpg
PMC8326083_01_SNI-12-318-g001.jpg
F1
She underwent a diagnostic cerebral angiography which showed total occlusion of the previously embolized AVM along with distal occlusion of the right posterior cerebellar artery and SCA [Figure 1].
Axial sections of T1-weighted brain MRI with and without contrast showing the embolized right occipital intracranial arteriovenous malformation (red arrows) with the embolization material appearing as hyperintense.
SNI-12-318-g002.jpg
PMC8326083_01_SNI-12-318-g002.jpg
F2
Subsequent brain MRI showed the previously embolized AVM in the right occipital lobe [Figure 2], along with no evidence of a vascular loop impinging on the right trigeminal nerve that may explain her trigeminal neuralgia [Figure 3].
Axial section of T1-weighted brain MRI showing the right trigeminal nerve (red arrow) with no impinging vascular loop.
SNI-12-318-g003.jpg
PMC8326083_01_SNI-12-318-g003.jpg
F3
Subsequent brain MRI showed the previously embolized AVM in the right occipital lobe [Figure 2], along with no evidence of a vascular loop impinging on the right trigeminal nerve that may explain her trigeminal neuralgia [Figure 3].
Operative view showing the right trigeminal nerve (v) with the embolized superior cerebellar artery (black arrow) under the instrument. Note the seventh-eighth cranial nerve complex on the right (*).
SNI-12-318-g004.jpg
PMC8326083_01_SNI-12-318-g004.jpg
F4
A whitish tubular structure that resembled an empty vessel was noticed crossing and abutting the trigeminal nerve root entry zone [Figure 4].
Operative view showing the insertion of a Teflon sponge (red arrow) between the trigeminal nerve (v) and the embolized superior cerebellar artery (black arrow).
SNI-12-318-g005.jpg
PMC8326083_01_SNI-12-318-g005.jpg
F5
Teflon sponges which were inserted to separate the vessel from the mentioned structures it was compressing [Figure 5]. The dura and the muscle fascia were thereafter closed tightly and the procedure was completed.