Quadruple vessel involvement at root entry zone in trigeminal neuralgia

The author describes a rare case of trigeminal neuralgia where four major named vessels of the posterior circulation were detected to be in close approximation to the trigeminal nerve. The quadruple vessel compression included a tortuous dilated basilar trunk, ipsilateral anterior inferior cerebellar artery, a superior cerebellar artery and superior petrosal vein. All vessels were related to the root entry zone of the nerve. Significance of such a multiple vessel neuovascular conflict at the root entry zone is discussed, highlighting technical implications during surgical management and its prognostic relevance.