Microvascular decompression of aberrantly looped anterior inferior cerebellar artery: illustrative case

BACKGROUND: The anterior inferior cerebellar artery (AICA) is the second most common neurovascular etiology of trigeminal neuralgia. OBSERVATIONS: Here the authors build on a prior reported technique for noncompressive decompression of a curious anatomical AICA variant, where a loop of the main artery nearly completely encircles the trigeminal nerve to circumferentially impact it. LESSONS: Circuitous anatomy of AICA may present particular challenges for microvascular decompression, but it is still possible to achieve a noncompressive configuration to best limit future irritation of the trigeminal nerve. An optimal and durable separation of the AICA loop and trigeminal nerve adhering to noncompressive principles was achieved using two aneurysm clips to fix a Teflon felt to the tentorium and petrous face of the temporal bone. https://thejns.org/doi/10.3171/CASE25388.