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BACKGROUND AND PURPOSE: Diffusion tensor imaging (DTI) was introduced as a good technique to evaluate structural abnormalities in the white matter. In this study, we used DTI to examine anisotropic changes of the pyramidal tracts displaced by chronic subdural hematoma (CSDH).

A 66-year-old man presented with typical right trigeminal neuralgia. Neuroimaging showed a small arteriovenous malformation (AVM) in the right cerebellopontine angle. Suboccipital craniotomy verified that the AVM was almost completely embedded in the root entry zone of the trigeminal nerve and the nerve axis was tilted infero-posteriorly. The patient obtained complete pain relief without sequelae after surgery by transposition of the superior cerebellar artery and correction of the tilted nerve axis. The nidus of the unresected AVM was obliterated by gamma knife radiosurgery.

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