How I do it: identification and preservation of trigeminocerebellar artery from superior petrosal vein during endoscopic microvascular decompression for trigeminal neuralgia

BACKGROUND: The superior petrosal vein (SPV) frequently impedes surgical access to the trigeminal nerve (TN) during microvascular decompression for trigeminal neuralgia. Distinguishing arterial structures, such as the trigeminocerebellar artery (TCA), from SPV venous tributaries presents a significant challenge. METHOD: In this case, intraoperative indocyanine green (i-ICG) angiography precisely identified the TCA. We then safely transposed it using fibrin glue to establish an optimal surgical field. CONCLUSION: Routine i-ICG application may improve neurovascular differentiation, enabling preservation of critical structures and facilitating effective endoscopic microvascular decompression(e-MVD) of the trigeminal nerve.