How I do it: Endoscopic microvascular decompression with vertebral artery transposition for trigeminal neuralgia caused by vertebrobasilar dolichoectasia.

BACKGROUND

Vertebrobasilar dolichoectasia (VBDE) is an uncommon cause of trigeminal neuralgia (TN), in which an ectatic vertebral artery (VA) compresses the root entry zone (REZ), while perforators may limit safe transposition.

METHODS

Fully endoscopic microvascular decompression with VA transposition was performed. Preservation of all arterial branches was achieved and confirmed endoscopically.

CONCLUSION

In VBDE-related TN, VA transposition may be the preferred decompressive strategy because of the characteristics of the ectatic vessel. Endoscopy offers a wide-angle view of the REZ, facilitating safe mobilization under full visualization of branch vessels.