Authors
Zhengxing Xie, Chengyang Xie, Yan Zhuang, Jieping Liu
Published in
World neurosurgery. Pages 125494. Nov 10, 2026. Epub Nov 10, 2026.
Abstract
The presence of vascular variations often renders microvascular decompression (MVD) more technically demanding and increases the risk. This study aims to describe a rare variant and report our initial experience in safely MVD via fully endoscopic techniques without drilling the petrous bone.
We retrospectively reviewed 356 patients with trigeminal neuralgia (TN) who underwent fully endoscopic MVD between 2010 and 2025 and identified six patients with intraosseous subarcuate loop (SL). Patient data (age, sex), clinical characteristics (symptoms, visual analog scale [VAS] pain score), radiological images, surgical records, and intraoperative videos were analyzed.
Six patients (1.7%) with SL arising from lateral pontine segment of the anterior inferior cerebellum arterial (AICA) and embedded in the petrous bone were identified. Using a 30° endoscope, MVD was successfully performed without drilling the petrous bone to mobilize the loop. There was no endoscope-related mortality. Transient facial numbness occurred in one patient and resolved spontaneously one month after surgery. No postoperative hematoma, infarction, cerebrospinal fluid (CSF) leak, or intracranial infection occurred. All patients experienced immediate pain relief postoperatively. During follow-up, no recurrence was recorded.
Fully endoscopic techniques without drilling petrous bone are feasible to perform MVD in patients with intraosseous SL. Accurate diagnosis of such variation may favor surgical decision-making to reduce the risk of vascular injury.
PMID:
43009011
Bibliographic data and abstract were imported from PubMed on 11 Nov 2026.
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