PMC6157039_01
(a) Operative view of the first surgery. The sponge was flexible and the bubbles in the sponge were large. (b) Operative view of the second surgery. The sponge was fragile and the honeycomb structure was not preserved
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F1
We carried out microvascular decompression surgery with a lateral suboccipital approach and placed a sponge (polyurethane) between the PICA and the brainstem, fixing them with fibrin glue [Figure 1a]. The honeycomb structure or bubbles in the sponge were not preserved [Figure 1b].
(a) T2-based cisternography immediately after the first surgery. The PICA was located far from the brainstem. (b) T2-based cisternography at the time of recurrence. The distance from the brainstem of PICA was narrowed when compared with that in Figure 2a
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F2
Postoperative MRI showed a PICA running course without attachment to the brainstem [Figure 2a]. T2-based cisternography showed a closed PICA running course compared with the MRI immediately after her initial surgery [Figure 2b].