Fig 1. During microvascular decompression for trigeminal neuralgia, the blood vessel is separated from the trigeminal nerve with padding (shredded Teflon felt represented on this drawing as a white oval).
Fig 2. Crossing the trigeminal nerve in this patient with trigeminal neuralgia is a large blood vessel, which is a white structure (lower white arrow) on the MRI (after intravenous contrast). Although most patients with trigeminal neuralgia have a blood vessel in contact with the trigeminal nerve, it is not always as prominent as in this case. Many patients without trigeminal neuralgia will also have a blood vessel in contact with the trigeminal nerve.
Fig 3. Shredded Teflon felt (black vertical arrow) separates the blood vessel (on top) from the trigeminal nerve (below). This is seen through the operating microscope at the time of the microvascular decompression surgery.