Kawase Approach for Dolichoectactic Basilar Artery Macrovascular Decompression in a Patient With Trigeminal Neuralgia: Case Report.

BACKGROUND AND IMPORTANCE: Trigeminal neuralgia (TN) secondary to a dolichoectatic basilar artery (DBA) is an extremely rare phenomenon. The Kawase approach for macrovascular decompression of this rare pathology been used rarely. CLINICAL PRESENTATION: This report describes macrovascular decompression and basilar artery transposition in a 69-yr-old male presenting with progressively worsening left-sided typical TN secondary to a DBA compression. The DBA was successfully decompressed off of the trigeminal nerve via a pterional craniotomy and anterior petrosectomy. The patient had immediate improvement in TN symptoms postoperatively. The patient remained symptom free with nonbothersome facial numbness in the V3 segment at 8-mo postoperative follow-up in clinic. The patient suffered a sixth nerve palsy following surgery, which was later corrected by strabismus surgery. The natural history and epidemiology of TN, results of macrovascular decompression secondary to DBA compression via a traditional suboccipital retrosigmoid approach, and potential advantages of the Kawase approach are also discussed. CONCLUSION: The macrovascular decompression strategy succeeded because the compressive force was applied by the DBA to the nerve in a superolateral direction, and the decompressive sling pulled the DBA away from the nerve in an inferomedial direction. The working space and access to the clival dura through the Kawase approach allowed proper corrective pull with a sling