PMC7468242_01
Preoperative magnetic resonance imaging. Preoperative axial T2-weighted imaging driven equilibrium radiofrequency reset pulse (T2WI-DRIVE) (a) and sagittal T2WI-DRIVE (b) demonstrate sandwich-type neurovascular compression of the abducens nerve by the vertebral artery (VA) and anterior inferior cerebellar artery (AICA). A three-dimensional (3D) MR fusion image (c) shows pinching of the abducens nerve between the elongated VA and AICA. Arrows indicate the abducens nerve. Large arrowheads indicate the VA. Small arrowheads indicate the AICA.
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F1
MRI with high-resolution T2-weighted imaging driven equilibrium radiofrequency reset pulse (T2WI-DRIVE) sequence showed pinching of the left abducens nerve between the elongated left VA and left AICA [Figure 1a-c].
Intraoperative photograph. (a) An intraoperative photograph reveals that the abducens nerve was pinched between the VA and AICA. (b) An intraoperative photograph shows a severe indentation of the abducens nerve. (c) An intraoperative photograph demonstrates penetration of the abducens nerve by the AICA. (d) An intraoperative photograph shows that the abducens nerve was released from neurovascular compression by the VA and AICA. Black arrows indicate the main trunk of the abducens nerve. White arrowheads indicate the VA. White arrows indicate the AICA. The white curved arrow indicates the indentation of the abducens nerve. Black arrowheads indicate the small nerve fiber of the abducens nerve.
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F2
The abducens nerve was found to be severely compressed from both sides by the VA and AICA [Figure 2a]. Severe indentation of the abducens nerve was observed after moving the VA away from the abducens nerve [Figure 2b]. Next, when we tried to mobilize the AICA toward the petrous bone, the AICA was found to penetrate the abducens nerve [Figure 2c]. Teflon felt and fibrin glue to move it away from the main trunk of the abducens nerve. The neurovascular compression of the abducens nerve was resolved after these procedures [Figure 2d].
Postoperative magnetic resonance imaging. Postoperative axial T2-weighted imaging driven equilibrium radiofrequency reset pulse (T2WI-DRIVE) (a) and sagittal T2WI-DRIVE (b) show disappearance of neurovascular compression of the abducens nerve by the VA and AICA. Arrows indicate the abducens nerve. Large arrowheads indicate the VA. Small arrowhead indicates the AICA.
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F3
MRI demonstrated the disappearance of the neurovascular conflict of the abducens nerve with the VA and AICA [Figure 3].