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. 2024 Nov 22;15:430. doi: 10.25259/SNI_768_2024

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Copyright: © 2024 Surgical Neurology International

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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Figure 2: — Abnormal muscle response (AMR) waves (left panels), intraoperative photographs (mid), and schematic illustrations (right). (a) Intraoperative findings before microscopic manipulation. The anterior inferior cerebellar artery (AICA) (arrow) on the vertebral artery (VA) is in contact with the facial nerve (asterisk). (b) AMR waves (left panels), intraoperative photographs (mid), and schematic illustrations (right). Teflon felt (curved double arrows) is inserted between the brain stem and VA. AMR is amplified after decompression of the root exit zone. (c) AMR waves (left panels), intraoperative photographs (mid), and schematic illustrations (right). Compression of the facial nerve by AICA (arrow) is exacerbated after further decompression of both sides of the facial nerve (asterisk). AMR is further amplified. (d) AMR waves (left panels), intraoperative photographs (mid), and schematic illustrations (right). Compression of the facial nerve by AICA (arrow) is completely resolved by transposition using fibrin glue (asterisk). AMR remains absent after surgery. double arrows: VA, V: Trigeminal nerve, VII: Facial nerve, VIII:Vestibulocochlear nerve.