• Kenshi Sano, Atsushi Kuge, Rei Kondo, Tetsu Yamaki, Yu Shimokawa, Shinjiro Saito, and Yukihiko Sonoda.
• Department of Neurosurgery, Yamagata City Hospital Saiseikan, Yamagata, Japan.
• World Neurosurg. 2020 Jun 1; 138: 257-260.

BackgroundTrigeminal neuralgia (TN) is one of the neuropathic pain syndromes, most commonly caused by vascular compression in the root entry zone of the trigeminal nerve in the cerebellopontine angle. It was rare as offending artery that primitive trigeminal artery and primitive trigeminal artery variant (PTAv) as an anomaly that occurs carotid-basilar anastomosis. We report a case of TN caused by the PTAv, and usefulness of fusion images of magnetic resonance imaging (MRI) and computed tomography angiography (CTA).Case DescriptionA 65-year-old man presented with a 2-year history of left paroxysmal facial pain in the second division of the trigeminal nerve. We diagnosed left TN due to PTAv using constructive interference in steady state magnetic resonance imaging (CISS MRI) and CTA. Microvascular decompression surgery disclosed trigeminal nerve compressed by PTAv consisted with findings from preoperative neuroimaging. We report a case of TN caused by PTAv, and usefulness of fusion images of CISS MRI and CTA to understand the neurovascular and bony structure during the perioperative period.ConclusionsThe fusion image created by CISS MRI and 3-dimensional CTA was useful to identify the offending vessel and to clearly understand the neurovascular structure preoperatively.Copyright © 2020 Elsevier Inc. All rights reserved.

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