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Location of the abducens nerve stretched by a tortuous vertebrobasilar artery in trigeminal neuralgia

  • Original Article - Functional Neurosurgery - Pain
  • Published:
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Abstract

Background

Trigeminal neuralgia (TGN) caused by the vertebrobasilar artery (VBA) is uncommon. The abducens nerve root is frequently dislocated by a tortuous VBA near the trigeminal nerve root. This unusual location of the root is not well known. This study aimed to investigate the location of the stretched abducens nerve root.

Methods

The objective is 26 patients with VBA-related TGN who underwent microvascular decompression (MVD). We retrospectively investigated the course of the abducens nerve root with magnetic resonance imaging (MRI) with three-dimensional (3D) imaging and surgical findings. The displacement of the abducens nerve root on the affected side was compared to the contralateral side.

Results

The abducens nerve root was distorted by a tortuous VBA (46.2%) or the anterior inferior cerebellar artery (53.8%). The average length of the cisternal segment was stretched to 23.4 mm versus 12.4 mm on the contralateral side. The peak point of the elevated abducens nerve root was mostly located rostro-medial (65.4%) or caudo-medial (34.6%) to the neurovascular compression site of the trigeminal nerve with a mean distance of 9.1 mm. Contact with the trigeminal nerve root was observed in 7 patients (26.9%). Three-dimensional imaging was consistent with the surgical findings and useful in predicting the location of the abducens nerve root. No abducens nerve palsy was noted in our series.

Conclusions

The abducens nerve root is located near the trigeminal nerve root in VBA-related TGN. Preoperative understanding of the unusual course of the abducens nerve root contributes to avoiding accidental nerve injury during MVD.

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Acknowledgements

We thank Ms. Lori Radcliffe for her assistance with English language editing.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Subarukai Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan

    Takuro Inoue, Satoshi Shitara & Ayako Shima

  2. Department of Neurosurgery, Saiseikai Shiga Hospital, Ritto, Shiga, Japan

    Yukihiro Goto

  3. Department of Neurosurgery, National Brain Center Hospital, Jakarta, Indonesia

    Mustaqim Prasetya

  4. Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA

    Takanori Fukushima

Authors
  1. Takuro Inoue
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  2. Satoshi Shitara
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  3. Ayako Shima
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  4. Yukihiro Goto
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  5. Mustaqim Prasetya
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  6. Takanori Fukushima
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Correspondence to Takuro Inoue.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Functional Neurosurgery – Pain.

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Inoue, T., Shitara, S., Shima, A. et al. Location of the abducens nerve stretched by a tortuous vertebrobasilar artery in trigeminal neuralgia. Acta Neurochir 163, 1027–1036 (2021). https://doi.org/10.1007/s00701-021-04742-1

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  • DOI: https://doi.org/10.1007/s00701-021-04742-1

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