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Esteban Garcia JM, Mato Mañas D, Marco De Lucas E, Garcia Catalan G, Lopez Gomez P, Santos Jimenez C, Laez RM. Invisible compression, anterior fossa tumor causing trigeminal neuralgia. Surg Neurol Int 2021; 12:106. [PMID: 33880211 PMCID: PMC8053474 DOI: 10.25259/sni_371_2020] [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: 06/21/2020] [Accepted: 02/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Trigeminal neuralgia secondary to posterior and middle fossae tumors, whether ipsilateral or contralateral, has been well described. However, this disabling disease has never been reported in the context of anterior fossa neoplasms. Case Description: A 75-year-old female with right hemifacial pain was diagnosed with an anterior clinoid meningioma. Despite neuroimaging did not show any apparent anatomical or neurovascular conflict, a detailed MRI analysis revealed a V3 hyperintensity. Not only symptoms completely resolved after surgical resection but also this radiological sign disappeared. Nowadays, the patient remains asymptomatic and V3 hyperintensity has not reappeared during her follow-up. Conclusion: A surgical definitive treatment can be offered to patients suffering from trigeminal neuralgia secondary to lesions adjacent to Gasserian ganglion or trigeminal branches. In this respect, posterior and middle fossae tumors are well-reported etiologies. Nevertheless, in the absence of evident compression, other neoplasms located in the vicinity of these critical structures and considered as radiological findings may be involved in trigeminal pain. Microvascular and pressure gradient changes could be an underlying cause of these symptoms in anterior skull base lesions. Here, we report the case of a patient with uncontrollable hemifacial pain resolved after anterior clinoid meningioma removal.
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Affiliation(s)
| | - David Mato Mañas
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Enrique Marco De Lucas
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Guillermo Garcia Catalan
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Patricia Lopez Gomez
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Carlos Santos Jimenez
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Ruben Martin Laez
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Yin Z, Liu Y, Bai Y, Zhang H, Yao W, Yu F, Zhang J, Liu R, Yang A. The Epidemiology, Cause, and Prognosis of Painful Tic Convulsif Syndrome: An Individual Patient Data Analysis of 192 Cases. World Neurosurg 2020; 147:e130-e147. [PMID: 33307261 DOI: 10.1016/j.wneu.2020.11.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Characterized by the coexistence of trigeminal neuralgia and ipsilateral hemifacial spasm (HFS), painful tic convulsif (PTC) is a rare entity that has not yet been systematically studied. OBJECTIVE To systematically explore the epidemiology, cause, prognosis, and prognosis predictors of PTC. METHODS We searched PubMed, Web of Science, and the Cochrane Library for relevant studies published between establishment of the library and July 1, 2020. Information on demographics, causes, specific interventions, and intervention outcomes was extracted. We first performed descriptive analysis of demographics, causes, and surgical outcomes of PTC. Univariate and multivariate regression methods were used to explore potential prognosis predictors. Further, a 2-step meta-analysis method was used to validate the identified factors. RESULTS Overall, 57 reports including 192 cases with PTC were included in the analysis. The median age of patients with PTC is 54 years (range, 44-62 years), with more patients being female (P < 0.001), initiated as HFS (P = 0.005), and being affected with left side (P = 0.045). The vertebrobasilar artery contributes to >65% of the causes of single vascular compression for PTC. Anterior inferior cerebellar artery/posterior inferior cerebellar artery involvement (odds ratio, 4.050; 95% confidence interval, 1.091-15.031) and older age (P = 0.008) predict freedom from symptoms and recurrence after microvascular decompression, respectively. CONCLUSIONS PTC occurs more in middle-aged women between 40 and 60 years old, initiates as HFS, and affects the left side. Vertebrobasilar artery compression is the most common single cause of PTC. Microvascular decompression effectively treated PTC, with a cure rate >80%. Anterior inferior cerebellar artery/posterior inferior cerebellar artery involvement predicts successful surgery and older age predicts recurrence.
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Affiliation(s)
- Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuye Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hua Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Yao
- Department of Neurosurgery, Shunping County Hospital, Baoding, Hebei Province, China
| | - Feng Yu
- Department of Neurosurgery, PLA 960th Hospital, Jinan, Shandong Province, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Ruen Liu
- Peking University People's Hospital, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Prakash C, Tanwar N. Trigeminal neuralgia secondary to cerebellopontine angle tumor: A case report and brief overview. Natl J Maxillofac Surg 2019; 10:249-252. [PMID: 31798267 PMCID: PMC6883898 DOI: 10.4103/njms.njms_2_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/17/2019] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Trigeminal neuralgia (TN) is a paroxysmal shock-like pain restricted to innervations of the areas of one or more branches of the trigeminal nerve, often set off by light stimuli in a trigger zone. Pain attacks occur spontaneously and can also be triggered by a nonpainful sensory stimulus to the skin, intraoral mucosa surrounding the teeth, or tongue. The pathogenesis of TN is uncertain and typically is idiopathic, but it may be due to a structural lesion. Some pathologies include traumatic compression of the trigeminal nerve by neoplastic or vascular anomalies and intracranial tumors or demyelinating conditions such as multiple sclerosis. This case report describes an epidermoid cyst at the cerebellopontine angle in a 25-year-old young man with otherwise classical unilateral TN. The case highlights the difficulties of diagnosis and the importance of a multidisciplinary approach in making the correct diagnosis in symptomatic as well as classical TN.
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Affiliation(s)
- Chander Prakash
- Oral and Maxillofacial Surgeon, Polaris Superspeciality Hospital, Rohtak, Haryana, India
| | - Nishi Tanwar
- Department of Periodontology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
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Goel A, Vaja T, Shah A, Dandpat S, Bakale N. Atlantoaxial Fixation as Treatment of Trigeminal Neuralgia in a Patient Having Basilar Invagination. World Neurosurg 2019; 129:437-439. [PMID: 31229744 DOI: 10.1016/j.wneu.2019.06.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Trigeminal neuralgia can rarely be identified in association with basilar invagination. The presented case report observes that the treatment of basilar invagination by atlantoaxial fixation can result in lasting relief from trigeminal neuralgia. CASE DESCRIPTION We report a case of a 36-year-old male patient who presented with the primary symptom of trigeminal neuralgia for a period of 2 years. Investigations revealed the presence of basilar invagination and an ectatic vertebral artery loop in the vicinity of the trigeminal nerve. The patient underwent atlantoaxial fixation on the basis of the concept that atlantoaxial instability is the nodal point of pathogenesis of basilar invagination. Atlantoaxial fixation resulted in complete and lasting relief from symptom of trigeminal neuralgia. CONCLUSIONS The pathogenesis of trigeminal neuralgia and its relationship with atlantoaxial instability is speculated.
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Affiliation(s)
- Atul Goel
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India; Lilavati Hospital and Research Centre, Bandra (E), Mumbai, India.
| | - Tejas Vaja
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India
| | - Abhidha Shah
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India
| | - Saswat Dandpat
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India
| | - Nilesh Bakale
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India
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Muhammad S, Niemelä M. Surgical management of coexisting trigeminal neuralgia and hemifacial spasm. Surg Neurol Int 2018; 9:214. [PMID: 30488012 PMCID: PMC6213807 DOI: 10.4103/sni.sni_188_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/19/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Coexisting hemifacial spasm (HFS) and trigeminal neuralgia (TN) without any mass lesion in the posterior fossa is a rare condition. Hence, the surgical strategy of coexisting HFS and TN has rarely been discussed. Case Description: We present a rare case of coexisting HFS and TN without any mass lesion in posterior fossa having microvascular confliction of trigeminal nerve with superior cerebellar artery (SCA) and facial nerve with anterior inferior cerebellar artery (AICA). Single surgery was performed for both trigeminal nerve and facial nerve. Mobilization of vessels and placement of Teflon between the nerve and vessel relieved the symptoms immediately after the operation. We have reviewed the literature for cases with coexistent HFS and TN. The treatment strategy for such cases has been discussed. The surgical treatment has been demonstrated with a video. Conclusion: A single surgery is a safe and effective option to treat coexistent HFS and TN due to microvascular confliction.
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Affiliation(s)
- Sajjad Muhammad
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Bir SC, Maiti TK, Bollam P, Nanda A. Management of Recurrent Trigeminal Neuralgia Associated with Petroclival Meningioma. J Neurol Surg B Skull Base 2015; 77:47-53. [PMID: 26949588 DOI: 10.1055/s-0035-1558834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/11/2015] [Indexed: 12/26/2022] Open
Abstract
Objective Petroclival meningioma (PM) presents with trigeminal neuralgia (TN) in < 5% of cases. Neurosurgeons often face the dilemma of formulating a treatment protocol when TN recurs. In this study, we sought to set up a protocol in patients with PM who had a recurrent TN. Materials and Methods We performed a retrospective review of 57 patients with PM. Of the 57 patients, only 7 patients presented with TN, and six patients experienced recurrent TN. The study population was evaluated clinically and radiographically after treatment. Results Overall improvement of pain control after various treatments was 67%, and tumor control was 100%. The pain-free period was 2 years for the Gamma Knife radiosurgery (GKRS) group and 4 years for the resection group when treated as a primary treatment (p = 0.034). Of the six patients, four patients had Barrow Neurosurgical Institute (BNI) score I (no TN, no medication), and two patients had BNI score III (some pain controlled with medication). The Karnofsky performance scale score was significantly improved after treatment compared with the pretreated status (78 versus 88; p = 0.044). Conclusion Microsurgical resection is superior to GKRS in achieving and maintaining pain-free status in patients with recurrent trigeminal pain associated with PM.
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Affiliation(s)
- Shyamal C Bir
- Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
| | - Tanmoy Kumar Maiti
- Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
| | - Papireddy Bollam
- Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
| | - Anil Nanda
- Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
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Verghese J, Mahore A, Goel A. Arachnoid cyst associated with painful tic convulsif. J Clin Neurosci 2012; 19:763-4. [DOI: 10.1016/j.jocn.2011.07.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Accepted: 07/12/2011] [Indexed: 11/16/2022]
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Four patients with painful tic convulsive and a brief review of surgical treatment. J Clin Neurosci 2012; 19:740-2. [PMID: 22326497 DOI: 10.1016/j.jocn.2011.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 08/04/2011] [Accepted: 08/08/2011] [Indexed: 11/21/2022]
Abstract
We present four patients with unusual painful tic convulsive: three were due to neurovascular compression; one was secondary to a cerebellopontine angle epidermoid cyst. We discuss these patients and those in the literature to determine the appropriate therapy for this rare disease.
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Shah A, Mahore A, Goel A. Bilateral vasculopexy of anomalous vertebral arteries causing cervicomedullary compression: case report and technical note. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21 Suppl 4:S505-8. [PMID: 22237850 DOI: 10.1007/s00586-011-2136-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/15/2011] [Accepted: 12/25/2011] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The authors report an extremely rare cause of cervicomedullary cord compression by anomalous ectatic vertebral arteries. MATERIAL A 50-year-old male patient presented with a 9 month history of progressive quadriparesis. Investigations revealed that the vertebral arteries on both sides had a mirror-like course and caused a deep indentation into the high cervical cord. Bilateral vasculopexy was done using Teflon slings. The treatment resulted in rapid recovery from symptoms. CONCLUSIONS Anomalous course of the vertebral artery can result in symptoms of high cervical cord compression. Vasculopexy can result in lasting cure from symptoms.
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Affiliation(s)
- Abhidha Shah
- Department of Neurosurgery, Seth G.S. Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, 400012, India
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10
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Trato J, Johnson EG. Differential diagnosis and management of a patient with peripheral vestibular and central nervous system disorders: a case study. J Man Manip Ther 2011; 18:159-65. [PMID: 21886427 DOI: 10.1179/106698110x12640740712491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Clinical examination and management of patients with meningiomas is primarily dependent upon appropriate diagnosis of tumor type and surgical intervention. Physical therapists should be able to identify patients presenting with signs and symptoms suggestive of potential central nervous system (CNS) disorders and refer the patient appropriately. PATIENT CHARACTERISTICS In this case report, a 52-year-old female was referred to physical therapy after 18 months of unresolved dizziness. EXAMINATION Oculomotor examination revealed evidence of peripheral vestibular and potential CNS disorders. The physical therapist referred the patient to a physician who ordered magnetic resonance imaging (MRI). INTERVENTION The patient received five physical therapy sessions while waiting for the MRI which revealed a meningioma. The meningioma was surgically removed and the patient was subsequently relieved of all symptoms. OUTCOMES Despite the presence of the meningioma, the patient reported improved stability during work-related activities and decreased dizziness as a result of physical therapy intervention pre-operatively. DISCUSSION This case report emphasizes the importance of a physical therapists ability to perform and interpret an oculomotor examination in a patient presenting with signs consistent with peripheral vestibular and CNS disorders. It also demonstrates the role of physical therapy in collaboration with physicians in order to provide appropriate patient care management.
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Affiliation(s)
- Jill Trato
- Department of Physical Therapy, Long Beach Memorial Medical Center, USA
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Nagasawa D, Yew A, Safaee M, Fong B, Gopen Q, Parsa AT, Yang I. Clinical characteristics and diagnostic imaging of epidermoid tumors. J Clin Neurosci 2011; 18:1158-62. [PMID: 21742503 DOI: 10.1016/j.jocn.2011.02.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 02/16/2011] [Accepted: 02/22/2011] [Indexed: 11/20/2022]
Abstract
Epidermoid tumors are rare, benign congenital lesions which typically present between the third and fifth decades of life. They are thought to originate from ectodermal cells misplaced during neural tube formation and separation. While epidermoids may present anywhere in the cranial vault, they are characteristically located intradurally and in a paramedian position within the cerebellopontine angle and parasellar regions. Although imaging results may vary depending upon cystic content, CT scanning generally reveals a well-circumscribed, nonenhancing, lobulated, hypodense mass. They are hypointense on T1-weighted MRI, and hyperintense on T2-weighted MRI, diffusion-weighted imaging and fluid-attenuated inversion recovery sequences. The use of appropriate neuroimaging should be utilized to differentiate epidermoids from other intracranial lesions. While gross total resection of these tumors is the definitive treatment to prevent recurrence and aseptic meningitis, a subtotal resection may be necessary to preserve neurological function.
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Affiliation(s)
- Daniel Nagasawa
- Department of Neurological Surgery, University of California Los Angeles, 695 Charles E. Young Drive South, Gonda 3357, Los Angeles, CA 90095-1761, USA
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Zhong J, Zhu J, Li ST, Guan HX. Microvascular Decompressions in Patients With Coexistent Hemifacial Spasm and Trigeminal Neuralgia. Neurosurgery 2011; 68:916-20; discussion 920. [PMID: 21221033 DOI: 10.1227/neu.0b013e318208f5ac] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Although microvascular decompression (MVD) is widely accepted as the effective therapy for hemifacial spasm (HFS) or trigeminal neuralgia (TN), the surgical treatment of coexistent HFS and TN in an individual is seldom addressed.
OBJECTIVE:
To discuss the operative strategy of MVD for both the hemifacial and trigeminal nerves.
METHODS:
Nine consecutive cases of coexistent HFS and TN caused by neurovascular confliction in the same side were studied. Except for one, the patients suffered from HFS followed by ipsilateral TN. All patients underwent MVD and were followed up for 3 to 30 months. Each surgery was analyzed retrospectively.
RESULTS:
Intraoperatively, a looped vertebral artery (VA) shifted to the suffered side was found in 8 patients. The VA was regarded as the direct or indirect offending artery. After MVDs, the spasm ceased immediately in 6 patients; the other 3 patients had delayed relief within 3 months. The pain disappeared immediately in 7 of 9 patients. One patient felt relief after a week, and 1 had pain but improved slightly. No recurrence or complication was found.
CONCLUSION:
A shifted VA loop may account for this tic convulsif syndrome. MVD is a reasonable and effective therapy with a high cure rate for the disease. The key to the surgery is to move the VA proximally. The dissection should be performed rostrally starting from the caudal cranial nerves.
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Affiliation(s)
- Jun Zhong
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai, Shanghai, China
| | - Jin Zhu
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai, Shanghai, China
| | - Shi-Ting Li
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai, Shanghai, China
| | - Hong-Xin Guan
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai, Shanghai, China
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Goel A, Shah A. Trigeminal neuralgia in the presence of ectatic basilar artery and basilar invagination: treatment by foramen magnum decompression. J Neurosurg 2010; 111:1220-2. [PMID: 19558301 DOI: 10.3171/2009.6.jns09469] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This 65-year-old woman presented with a 7-year history of classic trigeminal neuralgia. After a conservative therapeutic approach and because the pain had become unbearable, she was subjected to surgical treatment. Examinations revealed an ectatic basilar artery that indented deeply into the region of the root entry zone of cranial nerve V. Additionally, severe basilar invagination, the fusion of multiple cervical vertebrae, and partial agenesis of the clivus were observed. Foramen magnum decompression resulted in lasting relief from the pain. The authors discuss the pathogenesis of trigeminal neuralgia in a relatively rare clinical situation.
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Affiliation(s)
- Atul Goel
- Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G. S. Medical College, Parel, Mumbai, India.
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Han IB, Chang JH, Chang JW, Huh R, Chung SS. Unusual causes and presentations of hemifacial spasm. Neurosurgery 2009; 65:130-7; discussion 137. [PMID: 19574834 DOI: 10.1227/01.neu.0000348548.62440.42] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate unusual possible causes and clinical presentations of hemifacial spasm (HFS). METHODS The authors reviewed 1642 cases of HFS. Assessments were based on clinical features, 3-dimensional time-of-flight magnetic resonance angiography, and surgical findings. Causes other than neurovascular compression at the root exit zone of the facial nerve were investigated and unusual clinical presentations were noted. RESULTS Nine (0.5%) patients had a secondary causative structural lesion, 7 patients had a tumor, and the remaining 2 had a vascular malformation. Direct compression by dolichoectatic vertebrobasilar artery was noted in 12 (0.7%) patients. In 7 (0.4%) patients, only the distal portion of the facial nerve was compressed, and five (0.3%) had only venous compression. Bilateral HFS and tic convulsif were encountered in 7 (0.4%) and 6 (0.37%) patients, respectively. Fifty-six (3.4%) patients were younger than 30 years old at the time of microvascular decompression. CONCLUSION HFS can result from tumor, vascular malformation, and dolichoectatic artery. Therefore, appropriate preoperative radiological investigations are crucial to achieve a correct diagnosis. The authors emphasize that distal compression or only venous compression can be responsible for persistent or recurrent symptoms postoperatively. In cases of bilateral HFS, a definite differential diagnosis is necessary for appropriate therapy. MVD is recommended as the treatment of choice in patients younger than 30 years old or patients with painful tic convulsif.
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Affiliation(s)
- In-Bo Han
- Department of Neurosurgery, Pochon CHA University College of Medicine, Sungnam, Korea
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Goel A, Muzumdar D, Desai K. Anterior tentorium-based epidermoid tumours: Results of radical surgical treatment in 96 cases. Br J Neurosurg 2009; 20:139-45. [PMID: 16801045 DOI: 10.1080/02688690600776796] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A retrospective analysis of 96 surgically treated tentorium and anterior tentorial hiatus-based epidermoid tumours from 1997 - 2004 is presented. The most prominent symptoms were headache (53.1%) and ataxia (44.8%). The average tumour size was 4.4 cm. Surgical approaches included posterior cranial fossa route (85 cases), basal subtemporal middle fossa route (9 cases) and combined posterior fossa and subtemporal routes in two cases. Total tumour resection was performed in 46 patients. Eight and four patients developed transient and sustained postoperative neurological deficits respectively. There was mortality in two patients. There was non-symptomatic recurrence of the tumour in two cases. Ninety-four patients are leading active functional lives. Radical and safe resection of anterior tentorium-based epidermoid tumours is associated with symptomatic relief and lasting cure. Extensive drilling of the petrous bone can be avoided. Gentle dissection of the tumour and capsule from the critical neurovascular structures can limit post-operative morbidity.
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Affiliation(s)
- A Goel
- Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Parel, Mumbai, India.
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Trigeminal neuralgia secondary to epidermoid cyst at the cerebellopontine angle: case report and brief overview. Odontology 2009; 97:54-6. [PMID: 19184299 DOI: 10.1007/s10266-008-0088-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 06/08/2008] [Indexed: 10/21/2022]
Abstract
Trigeminal neuralgia (TN) is a paroxysmal shock-like pain restricted to the innervations of the areas of one or more trigeminal branches, often set off by light stimuli in a trigger zone. Pain attacks occur spontaneously, and can also be triggered by a nonpainful sensory stimulus to the skin, intraoral mucosa surrounding the teeth, or tongue. The pathogenesis of TN is uncertain and typically is idiopathic, but it may be due to a structural lesion. Various proposed causes include traumatic compression of the trigeminal nerve by neoplastic or vascular anomalies, infectious agents such as human herpes simplex virus, and intracranial tumors or demyelinating conditions such as multiple sclerosis. Here we report a case of a young patient diagnosed with trigeminal neuralgia secondary to epidermoid cyst at the cerebellopontine angle.
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Felicio AC, Godeiro CDO, Borges V, Silva SMDA, Ferraz HB. Bilateral hemifacial spasm and trigeminal neuralgia: A unique form of painful tic convulsif. Mov Disord 2007; 22:285-6. [PMID: 17083101 DOI: 10.1002/mds.21202] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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