PMC9560044_01
Preoperative imaging showing the vertebrobasilar dolichoectasia with a nerve-vessel conflict on the left side. A: Time-of-flight MRI scan; B: T2 weighted MRI scans; C: T1 contrast enhanced MRI scans.
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fig1
Preoperative radiological imaging of the brain is demonstrated in Fig. 1 and is showing a VBD with a nerve-vessel conflict on the left side.
Intraoperative transposition of the VA. A-C: Chronological sequential view on the process of sling placement around the VA; D: In-situ situation clip assisted tethering in the area of the clival dura; E: Intraoperative metric measurement of the VA.
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fig2
Transposition of the VA is summarized in Fig. 2.
Insertion of Teflon between VA and root entry zone of trigeminal nerve. A: In-situ situation after intraoperative transposition of the VA. Trigeminal nerve (N. V) is visible; B + C: Insertion of Teflon; D: Final intraoperative view.
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Teflon sponge was inserted between the root entry zone of the trigeminal nerve and the ventro-lateral displaced VA to relieve any further vessel-nerval conflict. This is shown in Fig. 3.
Postoperative CT and CT-angiographic imaging.
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CT scans of the first postoperative day are demonstrated in Fig. 4 and show a satisfactory postoperative result.