Our surgical experiences showed that venous compression could cause trigeminal neuralgia by itself and that the transverse pontine vein should be carefully observed because it is most frequently the offending vein.

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Our anatomic findings demonstrate anatomic variation of the OA in terms of its region of origin. Several anatomic points that were noteworthy during surgical exploration of this region are discussed.

Since 3D-CTA demonstrates the surgical anatomy of VA-PICA aneurysms in detail, it is very useful for helping surgeons to select the optimal approach.