PMC9115890_01
Preoperative T2-weighted MRI shows the left anterior inferior cerebellar artery (arrow) coursing perpendicular to and contacting the VII-VIII complex.
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F1
A preoperative MRI confirmed the presence of a vascular conflict on the facial nerve [Figure 1].
At surgery (a), a vascular loop, most likely anterior inferior cerebellar artery (a with white circle), is seen coursing inferior to the VII-VIII complex (VII-VIII) and displacing it rostrally. Several Teflon pledgets (T) are inserted at the site of conflict, separating the artery from the nerves (b).
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F2
The cerebellomedullary cistern was entered and the flocculus elevated, exposing choroid plexus, and the facial root exit zone [Figure 2]. This was carefully dissected away and several Teflon (polytetrafluoroethylene) felt pledgets were placed between the offending vessel and the VII nerve exit zone [Figure 2].
The VII-VIII complex (arrow) is now displaced posteriorly and superiorly by the Teflon pledgets placed beneath the nerve complex.
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F3
An MRI was obtained [Figure 3] that revealed indentation and posterior displacement of the VII-VIII complex due to the pledgets.
The Teflon (T) sponges are found displacing the VII-VIII complex (VII-VIII) posteriorly (a). The Teflon is dissected free of the nerves and the nerves decompressed with the trigeminal nerve (V) seen superiorly (b). A significant amount of Teflon sponge is removed (c).
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F4
Teflon pledgets [Figure 4]. This required the removal of approximately half of the Teflon sponges.