Trigeminal neuralgia in the presence of ectatic basilar artery and basilar invagination: treatment by foramen magnum decompression.

This 65-year-old woman presented with a 7-year history of classic trigeminal neuralgia. After a conservative therapeutic approach and because the pain had become unbearable, she was subjected to surgical treatment. Examinations revealed an ectatic basilar artery that indented deeply into the region of the root entry zone of cranial nerve V. Additionally, severe basilar invagination, the fusion of multiple cervical vertebrae, and partial agenesis of the clivus were observed. Foramen magnum decompression resulted in lasting relief from the pain. The authors discuss the pathogenesis of trigeminal neuralgia in a relatively rare clinical situation.