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Background: Trigeminal neuralgia (TN) is characterized by paroxysmal episodes of severe shocklike orofacial pain typically resulting from arterial compression on the trigeminal root entry zone. However, neurovascular conflict in more proximal parts of the trigeminal pathway within the pons is extremely rare., Methods: The authors present a case of microvascular decompression for TN caused by dual arterial compression on the dorsolateral pons, along with a brief literature review., Results: Our patient was a 74-year-old man with episodic left-sided facial stabbing pain. Brain magnetic resonance imaging revealed a dual arterial compression on dorsolateral pons, the known site of the trigeminal sensory nucleus and descending trigeminal tract. Microvascular decompression was performed via a retrosigmoid approach. Complete pain relief and partial improvement of the facial hypesthesia were achieved immediately after surgery and the Barrow Neurological Institute (BNI) pain intensity score improved from V to I, and the BNI hypesthesia score decreased from III to II within a month following surgery. The literature review identified 1 case of TN secondary to an arteriovenous malformation in root entry zone with lateral pontine extension. One month following partial coagulation of the draining vein, the patient was reportedly able to reduce medication dosage by half to achieve an improvement of BNI pain intensity score from V to IIIa., Conclusions: Neurovascular compression in the trigeminal tract and nucleus is a rare but potential cause of TN. A thorough investigation of the trigeminal pathway should be considered during preoperative evaluation and intraoperative inspection, particularly if no clear offending vessel is identified., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This article describes a rare case of trigeminal neuralgia (TN) caused by compression on the trigeminal sensory nucleus and tract by an aberrant dual anastomotic artery loop. The patient, a 74-year-old male, experienced progressive episodic pain in the left forehead, eyelid, cheek, and jaw. Brain MRI revealed compression on the pons near the fourth ventricle caused by the left posterior inferior cerebellar artery (PICA) and an anastomotic loop connecting the anterior inferior cerebellar artery (AICA) and PICA. The patient underwent endoscopic-assisted microvascular decompression (MVD), which successfully relieved the pain. The article discusses the vulnerability of the trigeminal nerve to vascular forces and the effectiveness of MVD in reversing microstructural changes. It also highlights the need for further research on the mechanism and treatment of TN caused by vascular compression. [Extracted from the article]