Trigeminal Neuralgia Caused by Vascular Compression from the Petrous Carotid Artery with Bony Erosion and Meckel's Cave Encephalocele: Clinical Imaging with Surgical Video.

Trigeminal neuralgia (TN) is most commonly caused by neurovascular compression of the superior cerebellar artery. We present the first reported TN case where nerve compression was caused by the petrous internal carotid artery (ICA) in the vicinity of a Meckel's cave (MC) encephalocele. The patient underwent a pterional craniotomy for decompression of the Gasserian ganglion (GG) and Trigeminal Nerve (TNe) branches. All symptoms were resolved post-surgery. We surmise that the principal cause of the TN was vascular compression from an exposed petrous ICA in the presence of an encephalocele. Causation was irrespective of whether the dehiscence in the petrous apex was a congenital defect, or associated with destruction from the encephalocele. Based on this observation, we recommend that surgeons carefully consider all possible causes of patient symptoms as they prepare a meticulous dissection plan to avoid damage to surrounding neurovascular structures.