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Badary A, Almealawy YF, Florez-Perdomo WA, Sanker V, Andrew Awuah W, Abdul-Rahman T, Salam Alabide A, Alrubaye SN, Saleh A, Ergen A, Chaurasia B, Azab MA, Atallah O. Chiari malformation and its influence on trigeminal neuralgia: a systematic review. Ann Med Surg (Lond) 2024; 86:5999-6011. [PMID: 39359841 PMCID: PMC11444572 DOI: 10.1097/ms9.0000000000002527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/22/2024] [Indexed: 10/04/2024] Open
Abstract
Objective In order to properly understand the correlation between TN and Chiari malformation type I (CMI), it is imperative to delve into the underlying processes and develop efficacious treatment strategies. Methods A comprehensive search was performed regarding trigeminal neuralgia (TN) in individuals diagnosed with CMI. A total of 19 cases were identified in the existing literature. Results The review of 19 studies showed that the most commonly affected division was V2 (31.6%), followed by V3 (10.5%) and V1 (5.3%). Radiological findings were variable. The medulla oblongata was compressed in 6 patients (31.6%), the cervical spinal cord showed abnormalities in 3 patients (15.8%) abnormalities; one cervical myelocele (5.26%), two cervical syringomyelia (10.53%) while 5 patients (26.3%) showed normal findings. The skull bones in 4 patients (21,1%) showed deformity in the form of small posterior fossa or platybasia. The surgical treatment was conducted in 14 patients (73.7%). The study suggested that posterior fossa decompression (PFD) plus microvascular decompression (MVD) dual surgical modality yielded the best results for V2 distribution (P=0.017). Conclusion Chiari malformation type I can directly influence the occurrence and severity of trigeminal neuralgia. Therefore, an effective management of this malformation, like neurovascular decompression, PFD or ventriculoperitoneal shunt, can act as a potential treatment for trigeminal neuralgia. While the PFD alone was effective in the V3 and V1 distribution of trigeminal neuralgia, PFD plus microvascularplus plus microvascular decompression (MVD) as a dual surgical modality yielded the best results for V2 distribution.
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Affiliation(s)
- Amr Badary
- Departemnt of Neurosurgery, Klinikum Dessau, Dessau-Roßlau
| | | | | | - Vivek Sanker
- Department of Neurosurgery, Trivandrum Medical College, Kerala, India
| | | | | | | | | | - Aalaa Saleh
- Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
| | - Anil Ergen
- Department of Neurosurgery, Derince Research Hospital, Derince, Kocaeli, Turkey
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Mohammed A. Azab
- Departemnt of Neurosurgery, Cairo University Hospital, Cairo, Egypt
| | - Oday Atallah
- Departemnt of Neurosurgery, Hannover Medical School, Hannover, Germany
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Anichini G, Iqbal M, Rafiq NM, Ironside JW, Kamel M. Sacrificing the superior petrosal vein during microvascular decompression. Is it safe? Learning the hard way. Case report and review of literature. Surg Neurol Int 2016; 7:S415-20. [PMID: 27313970 PMCID: PMC4901823 DOI: 10.4103/2152-7806.183520] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/08/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Venous infarction as a complication of microvascular decompression (MVD) is a recognized but extremely rare occurrence in an otherwise standard neurosurgical procedure. Sacrificing one or more veins is considered safe by majority of experienced surgeons and authors. However, in the recent years, there has been growing debate about the management of venous trigeminal compression and/or superior petrosal complex (separation vs. coagulation and cutting of the vein), with few papers describing mild to severe complications related to venous sacrifice. CASE DESCRIPTION We report our dramatic experience during re-exploration for MVD on a male who developed massive cerebellar, brainstem, and brain infarction. Extensive analysis of surgical planning and literature debate about this topic is also reported. CONCLUSION Despite rare, venous infarction after venous sacrifice in MVD is possible and can have catastrophic consequences. We would advise: (1) To try preserving the vein anytime this is possible, especially if it is large in size; (2) if it is decided to sacrifice the vein temporary occlusion while observing changed in the neurophysiology might be safer; (3) when planning an MVD for suspected venous compression, possible alternative forms of treatment should also be considered.
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Affiliation(s)
- Giulio Anichini
- Department of Neurosurgery, Charing Cross Hospital, Imperial College of London, London
| | - Mazhar Iqbal
- Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland, UK
| | - Nasir Muhammad Rafiq
- Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland, UK
| | - James W. Ironside
- Department of Pathology, NHS Lothian, Western General Hospital, Edinburgh, Scotland, UK
| | - Mahmoud Kamel
- Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland, UK
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Pereira VM, Geibprasert S, Krings T, Aurboonyawat T, Ozanne A, Toulgoat F, Pongpech S, Lasjaunias PL. Pathomechanisms of Symptomatic Developmental Venous Anomalies. Stroke 2008; 39:3201-15. [PMID: 18988912 DOI: 10.1161/strokeaha.108.521799] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background and Purpose—
Although it is generally accepted that developmental venous anomalies (DVAs) are benign vascular malformations, over the past years, we have seen patients with symptomatic DVAs. Therefore, we performed a retrospective study and a literature study to review how, when, and why DVAs can become clinically significant.
Methods—
Charts and angiographic films of 17 patients with DVAs whose 18 vascular symptoms could be attributed to a DVA were selected from a neurovascular databank of our hospital. MRI had to be available to rule out any other associated disease. In the literature, 51 cases of well-documented symptomatic DVAs were found. Pathomechanisms were divided into mechanical and flow-related causes.
Results—
Mechanical (obstructive or compressive) pathomechanisms accounted for 14 of 69 symptomatic patients resulting in hydrocephalus or nerve compression syndromes. Flow-related pathomechanisms (49 of 69 patients) could be subdivided into complications resulting from an increase of flow into the DVA (owing to an arteriovenous shunt using the DVA as the drainage route; n=19) or a decrease of outflow (n=26) or a remote shunt with increased venous pressure (n=4) leading to symptoms of venous congestion. In 6 cases, no specific pathomechanisms were detected.
Conclusions—
Although DVAs should be considered benign, under rare circumstances, they can be symptomatic. DVAs, as extreme variations of normal venous drainage, may represent a more fragile venous drainage system that can be more easily affected by in- and outflow alterations. The integrity of the DVA needs to be preserved irrespective of the treatment that should be tailored to the specific pathomechanism.
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Affiliation(s)
- Vitor M. Pereira
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Sasikhan Geibprasert
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Timo Krings
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Thaweesak Aurboonyawat
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Augustin Ozanne
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Frederique Toulgoat
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Sirintara Pongpech
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Pierre L. Lasjaunias
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
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Papanastassiou AM, Schwartz RB, Friedlander RM. CHIARI I MALFORMATION AS A CAUSE OF TRIGEMINAL NEURALGIA. Neurosurgery 2008; 63:E614-5; discussion E615. [DOI: 10.1227/01.neu.0000324726.93370.5c] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
OBJECTIVE
Trigeminal neuralgia (TN) is usually associated with vascular compression of the trigeminal nerve, but some cases are associated with central lesions such as tumors, aneurysms, or arteriovenous malformations. In this article, we report the 19th case of TN associated with Chiari I malformation and review clinical outcomes and pathophysiology.
CLINICAL PRESENTATION
A 63-year-old right-handed man initially presented in 1993 with left-sided lancinating facial pain in the V2 distribution of the trigeminal nerve; the pain was triggered by certain movements, tactile stimulation, or a hot shower. Magnetic resonance imaging revealed a Chiari I malformation associated with a syrinx from C1 to C3.
INTERVENTION
The patient underwent uncomplicated suboccipital craniectomy, C1 laminectomy, and duraplasty for Chiari decompression. Postoperatively, his pain resolved over a period of 1 year.
CONCLUSION
Chiari I malformation has been found to be associated with TN in 19 cases in the English-language literature. In patients refractory to medical treatment, suboccipital decompression leads to resolution of pain in about two-thirds of patients. Potential mechanisms for the pathogenesis of TN in the setting of Chiari I malformation are discussed. Chiari I malformation is important to consider as a rare cause of TN that responds to surgical therapy.
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Affiliation(s)
| | | | - Robert M. Friedlander
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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