PMC7294170_01
Preoperative images. (a) Three-dimensional computed tomography angiogram and (b-d) magnetic resonance imaging showing the collection of abnormal dilated medullary veins in the left cerebellar peduncle and the brainstem merging into a single large vein compressing the facial nerve root exit zone.
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F1
The vein reached the surface of the brainstem at the root of the facial nerve [Figure 1].
Intraoperative images. (a) The Teflon sponge inserted earlier was seen under the cisternal portion of the facial and the vestibulocochlear nerves. The large vein emerged the lateral recess of the IV ventricle run under the facial nerve root exit zone (REZ); (b) the main trunk of the brainstem developmental venous anomaly was clipped near the cerebellar peduncle with temporary clip; (c) the vein was dissected and transposed ventrally to relieve the compression of the facial nerve REZ with insertion of "Surgicel" between the brainstem and the displaced draining vein; (d) transposed large vein was fixed with fibrin glue. (VII - the facial nerve, IX - the glossopharyngeal nerve, AICA - the anterior inferior cerebellar artery).
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F2
The MVD was completed by insertion of Surgicel and fibrin glue between the brainstem and the displaced draining vein, and temporary clip was released [Figure 2]. The postoperative course was uneventful.
Postoperative images. (a) Three-dimensional computed tomography angiogram and (b-d) magnetic resonance imaging showing the thrombosis of the main trunk of the brainstem developmental venous anomaly and decompression of the facial nerve root exit zone.
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F3
CT angiography and MRI showed the thrombosis of the main trunk of the brainstem DVA and decompression of the facial nerve REZ [Figure 3].