PMC3291710_01
A : An axial computed tomography scan without contrast medium on admission, shows a hematoma in the lower pons. B : Right lateral view of vertebral angiogram, shows a fusiform aneurysm of the right vertebral artery, distal to the origin of the posterior inferior cerebellar artery.
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F1
Brain computed tomography (CT) revealed a hematoma in the posterior portion of the lower pons with minimal mass effect (Fig. 1A). On angiography, the fusiform aneurysm was located distal to the origin of the posterior inferior cerebellar artery (Fig. 1B).
A : A short range 3D magnetic resonance angiography (MRA). 7th nerve root exit zone compressed by the VA (arrowhead). Pre- (B) and 20-month post-ligation MRAs (C). The fusiform aneurysm is not visible postoperatively with intact patency of right PICA (arrows). Note enlargement in diameter of left VA after treatment (double arrowheads). VA : vertebral artery, PICA : posterior inferior cerebellar artery.
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F2
The left VA, which was compressing the facial nerve REZ, did not change architecturally but enlarged in diameter (Fig. 2).
Intraoperative microscopic findings. A : The facial nerve REZ and proximal facial nerve are pressed by the VA (arrow). B : Vascular decompression by Teflon-felt insertion. REZ : root exit zone, VA : vertebral artery.
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F3
The facial nerve REZ was subsequently found to be compressed by an elongated VA (Fig. 3).