1
|
Tugend M, Washington E, Sekula RF. Outcomes of Trigeminal Ganglion Sparing Surgical Resection of Nonacoustic Cerebellopontine Angle Tumors Causing Trigeminal Neuralgia. World Neurosurg 2024; 187:e54-e62. [PMID: 38583565 DOI: 10.1016/j.wneu.2024.03.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE Tumors may be responsible for up to 5% of trigeminal neuralgia cases. Predictors of long-term pain relief after surgical resection of various cerebellopontine angle tumor types are not well understood. Previous studies found that size and extent of resection predict long-term pain status, although resection of tumor involving the trigeminal ganglion may be associated with high morbidity. This study evaluated predictors of TN pain freedom after resection of a nonacoustic CPA tumor, with avoidance of any portion involving the TG. METHODS In a retrospective cohort study, we evaluated clinical outcomes and complications after surgical resection of nonacoustic CPA tumors with purposeful avoidance of the TG causing trigeminal neuralgia. The primary outcome was pain-freedom. We performed logistic regression analyses to examine the relationship between pain-freedom at last follow-up and age, side of symptoms, preoperative symptom duration, tumor diameter, tumor type, and concurrent neurovascular compression (NVC). RESULTS Of 18 patients with nonacoustic CPA tumors causing TN treated with surgical resection, 83.3% were pain-free at last follow-up (mean 44.6 months). Age (P = 0.12), side (P = 0.41), preoperative symptom duration (P = 0.85), tumor diameter (P = 0.29), tumor type (P = 0.37), and NVC presence (P = 0.075) were not associated with long-term pain freedom. CONCLUSIONS This study provides additional evidence that various tumor types causing TN may safely undergo surgical resection and decompression of the trigeminal nerve to treat TN. This study presents a cohort of patients that underwent resection of a nonacoustic CPA tumor, with purposeful avoidance of the TG to minimize complications, demonstrating high rates of long-term pain freedom.
Collapse
Affiliation(s)
- Margaret Tugend
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Evan Washington
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Raymond F Sekula
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, USA.
| |
Collapse
|
2
|
Revuelta-Gutiérrez R, Contreras-Vázquez OR, Piñón-Jiménez F, Martínez-Anda JJ. Trigeminal neuralgia secondary to epidermoid cyst and neurovascular conflict: An illustrative case with literature review. Surg Neurol Int 2024; 15:36. [PMID: 38468668 PMCID: PMC10927216 DOI: 10.25259/sni_925_2023] [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: 11/19/2023] [Accepted: 01/09/2024] [Indexed: 03/13/2024] Open
Abstract
Background Trigeminal neuralgia (TN) is a highly disabling facial pain syndrome, historically known as the suicide disease, in which most cases can be cured with appropriate surgical treatment. Case Description We present the case of a 43-year-old male farmer with acute, self-limiting episodes of shock-like pain on the left side of the face that started in June of 2021. He was diagnosed with TN and was treated with carbamazepine. Magnetic resonance imaging was performed, which revealed an epidermoid cyst (EC) at the prepontine cistern with an extension to the left cerebellopontine angle. The neurosurgery department at our institution was consulted, which performed surgical tumor resection and Vth cranial nerve decompression. During the resection, a neurovascular conflict (NVC) was identified at the root entry zone. After the resection around the nerve and its whole tract was completed, a microvascular decompression (MVD) was performed. Conclusion TN secondary to EC in association with a NVC is a rare phenomenon, due to the growth pattern of the EC. TN may remit if an appropriate treatment is carried out. In cases of NVC, an MVD is required apart from an appropriate resection to achieve pain relief.
Collapse
|
3
|
Zhang H, Wang J, Liu J, Cao Z, Liu X, Jin H, Liu W, Xue Z, Yang N, Li C, Wang X. Fully neuroendoscopic resection of cerebellopontine angle tumors through a retrosigmoid approach: a retrospective single-center study. Neurosurg Rev 2023; 47:14. [PMID: 38102367 DOI: 10.1007/s10143-023-02244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/01/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
The objective of this study is to preliminarily investigate the surgical safety, efficacy, techniques, and clinical value of fully neuroendoscopic surgery for the resection of cerebellopontine angle (CPA) tumors via a retrosigmoid approach. The clinical data of 47 cerebellopontine angle area (CPA) tumors that were treated by full neuroendoscopic surgery from June 2014 to June 2023 were retrospectively analyzed. The efficacy and advantages of the surgical techniques were evaluated based on indicators such as duration of the surgery, neuroendoscopic techniques, intraoperative integrity of nerves and blood vessels, extent of tumor resection, outcomes or postoperative symptoms, and incidence of complications. The 47 cases of cerebellopontine angle tumors include 34 cases of epidermoid cysts, 7 cases of vestibular schwannomas, and 6 cases of meningiomas. All patients underwent fully neuroendoscopic surgery. Twenty tumors were removed using the one-surgeon two-hands technique, and 27 tumors were removed using the two-surgeons four-hands technique. The anatomical integrity of the affected cranial nerves was preserved in all 47 cases. None of the patients suffered a postoperative hemorrhage, cerebrospinal fluid leak, and aseptic or septic meningitis, or died. The rate of total tumor resection was 72.3% (34/47), and the symptom improvement rate was 89.4% (42/47). All patients were followed up for 2 to 12 months, and none died nor showed any signs of tumor recurrence. By analyzing 47 fully neuroendoscopic resections of CPA tumors using the posterior sigmoid sinus approach in our center, we believe that such method allows complete, safe, and effective resection of CPA tumors and is thereby worthy of clinical promotion.
Collapse
Affiliation(s)
- Hengrui Zhang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Jiwei Wang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Junzhi Liu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Zexin Cao
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Xuchen Liu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Haoyong Jin
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Wenyu Liu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Zhiwei Xue
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Ning Yang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China
| | - Chao Li
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China.
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China.
| | - Xinyu Wang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China.
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, 250117, China.
| |
Collapse
|
4
|
Li MW, Jiang XF, Niu CS. Balloon compression, neuroendoscopy and electrophysiological monitoring-assisted retrosigmoid approach for resection of cholesteatoma in the cerebellopontine angle-Meckel's cave: a technical description. Br J Neurosurg 2023; 37:1395-1397. [PMID: 33377403 DOI: 10.1080/02688697.2020.1864290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
We report a case of cholesteatoma that caused left facial pain with facial numbness. The tumour was located in the left cerebellopontine angle (CPA) and Meckel's cave. A balloon was first placed into Meckel's cave, and then, under electrophysiological monitoring, the tumour within the CPA cistern was resected via the retrosigmoid approach. The balloon was inflated in Meckel's cave to push the tumour out of Meckel's cave, and then, the tumour was completely removed under endoscopy. The symptoms, including pain and numbness, subsided after surgery.
Collapse
Affiliation(s)
- Ming-Wu Li
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Neurosurgery, Hefei City, China
| | - Xiao-Feng Jiang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Neurosurgery, Hefei City, China
| | | |
Collapse
|
5
|
Nugroho SW, Anindya Y, Hafif M, Wicaksana BA, Desbassari F, Sadewo W, Perkasa SAH. Open surgery vs. stereotactic radiosurgery for tumour-related trigeminal neuralgia: A systematic review. Clin Neurol Neurosurg 2023; 228:107683. [PMID: 37001475 DOI: 10.1016/j.clineuro.2023.107683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/25/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Secondary trigeminal neuralgia is a facial pain in trigeminal nerve dermatome caused by an underlying disease, such as cerebellopontine angle tumours. Treatment options to relieve the pains were surgical tumour resection and stereotactic radiosurgery of the tumour or trigeminal nerve. This study aims to review the efficacy of open surgery and stereotactic radiosurgery and recommend the treatment of choice for secondary trigeminal neuralgia due to cerebellopontine angle tumours. METHOD The inclusion criteria were studies covering patients with trigeminal neuralgia associated with cerebellopontine angle tumours that were treated with either open surgery or stereotactic radiosurgery and reported pain outcomes after treatment. Non-English articles or studies with a population of less than five were excluded. We systematically searched studies from PubMed, Ebscohost, and Cochrane Library from inception until December 20, 2021. Several works of literature from manual search were also added. Selected articles were appraised using a critical appraisal tool for prognostic studies. RESULT Included articles were 26 retrospective studies and one prospective study comprising 517 patients. Of 127 schwannomas, 226 epidermoids, 154 meningiomas, and ten other tumours, 320 cases received surgical tumour excision with or without MVD, 196 had tumour-targeted radiosurgery, and 22 underwent nerve-targeted radiosurgery. In surgical series, 92.2 % gained pain improvement, 2.8 % were unchanged, and 4.5 % had recurrence; none of the patients had worsened outcomes. In cases treated with tumour-targeted radiosurgery, the improvement rate was 79.1 %, unchanged at 14.3 %, recurrence at 26.5 %, and worse symptoms rate after the intervention was 6.6 %. Six patients with recurrent pain after tumour-targeted radiosurgery received secondary nerve-targeted radiosurgery with improved outcomes. Only one patient in our review underwent primary nerve-targeted radiosurgery, and the result was satisfactory. One study treated 15 patients with a single session of tumour-targeted and nerve-targeted radiosurgery, with an improvement rate of 93.3 % and a recurrence rate of 21.4 %. CONCLUSION Open surgery releasing the nerve root from compressive lesions is advocated to be the first-line treatment to gain satisfactory outcomes. Total removal surgery is recommended if possible. Nerve-targeted radiosurgery should be reserved as a secondary treatment for recurrent cases.
Collapse
|
6
|
Wang L, Zhang X, Zhao M, Wang Q. Assessment of epidermoid cyst with trigeminal neuralgia before neuroendoscopy: A high-resolution MR study based on 3D-FIESTA and MR angiography. Clin Imaging 2022; 91:9-13. [PMID: 35973272 DOI: 10.1016/j.clinimag.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/29/2022] [Accepted: 08/07/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the value of preoperative 3D-FIESTA and MR angiography (MRA) in endoscopic resection of epidermoid cysts presenting with trigeminal neuralgia (TN). METHODS 3D-FIESTA and MRA were performed before neuroendoscopy in 32 cases of epidermoid cysts with TN, and the tumors were grouped into types A, B, C, and D according to the relationship between the tumor and adjacent nerves and arteries (Hitoshi Kobata's classification). Evaluation of the neuroendoscopic resectability of different types of tumors, included gross total tumor removal (GTR), subtotal tumor removal (STR), and partial tumor removal (PTR). During the 5-year follow-up, symptoms were assessed based on facial pain relief using the Barrow Neurological Institute (BNI) score. RESULTS The coincidence rate between MRI classification of the tumor and the operation was 100%. Type B tumors were the most common (18/32, 56.3%). Type A tumors showed the highest resectability (9/9, 100%), followed by type B tumors (14/18, 77.8%). Moreover, microvascular decompression was performed in all 4 cases of type C and 1 case of type D tumors. During follow-up, 23 patients showed marked improvement in symptoms (15, 8 of BNI I or II), 8 cases showed partial improvement (BNI III), and only 1 case of type C tumor was associated with poor facial pain relief, which recurred 5 years later (BNI IV). CONCLUSIONS Preoperative high-resolution MR can accurately analyze the relationship between epidermoid cysts and adjacent nerves and arteries. It could act as a powerful tool in the evaluation of tumor resectability and the prognosis of surgery.
Collapse
Affiliation(s)
- Long Wang
- Department of Radiology, Jining No. 1 People's Hospital, Six Jiankang Road, Jining, China
| | - Xiaoming Zhang
- Department of Radiology, Qilu Hospital of Shandong University, No.107 Wenhuaxi Road, Jinan, China
| | - Meng Zhao
- Department of Radiology, Qilu Hospital of Shandong University, No.107 Wenhuaxi Road, Jinan, China
| | - Qian Wang
- Department of Radiology, Qilu Hospital of Shandong University, No.107 Wenhuaxi Road, Jinan, China.
| |
Collapse
|
7
|
Singh S, Das KK, Kumar K, Rangari K, Dikshit P, Bhaisora KS, Sardhara J, Mehrotra A, Srivastava AK, Jaiswal AK, Behari S. Cerebellopontine Angle Epidermoids: Comparative Results of Microscopic and Endoscopic Excision Using the Retromastoid Approach”. Skull Base Surg 2022; 83:e60-e68. [DOI: 10.1055/s-0040-1722713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Background Densely packed neurovascular structures, often times inseparable capsular adhesions and sometimes a multicompartmental tumor extension, make surgical excision of cerebellopontine angle epidermoids (CPEs) a challenging task. A simultaneous or an exclusive endoscopic visualization has added a new dimension to the classical microscopic approaches to these tumors recently.
Methods Eighty-six patients (age: 31.6 ± 11.7 years, M:F = 1:1) were included. Nineteen patients (22.1%) had a multicompartmental tumor. Tumor extension was classified into five subtypes. Sixty-two patients underwent a pure microscopic approach (72%) out of which 10 patients (16%) underwent an endoscope-assisted surgery (11.6%) and 24 patients (28%) underwent an endoscope-controlled excision. Surgical outcomes were retrospectively analyzed.
Results Headache (53.4%), hearing loss (46.5%), and trigeminal neuralgia (41.8%) were the leading symptoms. Interestingly, 21% of the patients had at least one preexisting cranial nerve deficit. Endoscopic assistance helped in removing an unseen tumor lobule in 3 of 10 patients (30%). Pure endoscopic approach significantly reduced the hospital stay from 9.2 to 7.3 days (p = 0.012), and had a statistically insignificant yet a clearly noticeable lesser incidence of subtotal tumor excision (0 vs. 10%, p = 0.18) with comparable cranial nerve deficits but with a higher postoperative cerebrospinal fluid (CSF) leak rate (29% vs. 4.8%, p = 0.004).
Conclusion Endoscope assistance in CPE surgery is a useful addition to conventional microscopic retromastoid approach. Pure endoscopic excision in CPE is feasible, associated with a lesser duration of hospital stay, better extent of excision in selected cases, and it has a comparable cranial nerve morbidity profile albeit with a higher rate of CSF leak.
Collapse
Affiliation(s)
- Suyash Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Krishna Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Rangari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyadarshi Dikshit
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
8
|
Freddi TDAL, Ottaiano AC, Lucio LL, Corrêa DG, Hygino da Cruz LC. The Trigemius Nerve: Anatomy and Pathology. Semin Ultrasound CT MR 2022; 43:403-413. [DOI: 10.1053/j.sult.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
9
|
Curnes JM. A Pilot With Electrical Pain in the Face. Fed Pract 2021; 38:337-339. [PMID: 34733085 DOI: 10.12788/fp.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An intracranial epidermoid cyst is an unusual but treatable cause of trigeminal neuralgia.
Collapse
Affiliation(s)
- John M Curnes
- is the Senior Naval Flight Surgeon at Training Air Wing Four at Naval Air Station Corpus Christi in Texas
| |
Collapse
|
10
|
Berra LV, Armocida D, Mastino L, Rita AD, Norcia VD, Santoro A, Piccirilli M. Trigeminal Neuralgia Secondary to Intracranial Neoplastic Lesions: a Case Series and Comprehensive Review. J Neurol Surg A Cent Eur Neurosurg 2020; 82:118-124. [PMID: 33291153 DOI: 10.1055/s-0040-1718708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
It is known that intracranial tumors may trigger trigeminal neuralgia (TN) in some patients although the exact prevalence and occurrence is not completely defined yet. In the present study, we present a case series of patients with brain tumor and a clinical diagnosis of TN as the first and main manifestation of the disease. A retrospective analysis was performed involving patients diagnosed with brain tumor whose exclusive clinical feature our department focused on was TN. In addition, a review of all published cases was performed. From January 2017 to November 2018, 718 patients with brain tumor were admitted to our department, 17 of which suffered of TN, of which 8 patients presented with at least another neurologic symptom and 9 patients presented with TN alone, with typical symptoms of stubbing electric pain in 6 cases. In our series, we found that 2.3% of patients admitted for brain tumors had TN. In 0.8% of cases, TN was the main clinical symptom. The prevalence of tumor lesion in patients with facial neuropathic pain is not defined, but it is a well-known recognized initial symptom; however, early cerebral magnetic resonance imaging (MRI) is not yet strongly recommended in patients with newly diagnosed trigeminal neuralgia. The purpose of this article is, especially in unusual cases, to show that the application of such MR techniques and preoperative evaluation may contribute to diagnosis, indication, and surgery planning.
Collapse
Affiliation(s)
- Luigi Valentino Berra
- Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Daniele Armocida
- Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Lara Mastino
- Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Andrea Di Rita
- Department of Neurosurgery, San Carlo Borromeo Hospital, Milan, Italy
| | - Valerio Di Norcia
- Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Manolo Piccirilli
- Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
11
|
Zhang YQ, Yu F, Zhao ZY, Men XZ, Shi W. Surgical Treatment of Secondary Trigeminal Neuralgia Induced by Cerebellopontine Angle Tumors: A Single-Center Experience. World Neurosurg 2020; 141:e508-e513. [PMID: 32492542 DOI: 10.1016/j.wneu.2020.05.226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Secondary trigeminal neuralgia (TN) caused by cerebellopontine angle (CPA) tumors are rare, although TN may be a primary manifestation in the neurosurgery department. In this study, we aimed to retrospectively assess patients with CPA tumor-induced TN from a single center. METHODS Of 819 consecutive patients with TN treated at our center between 2007 and 2017, 36 with CPA tumor-induced TN were enrolled, and their medical and surgical records were analyzed. RESULTS The 36 patients accounted for 4.4% of all patients with TN. A comparison of patients with classic and tumor-induced TN indicated significant intergroup differences in the mean age at surgery (58.94 vs. 49.33 years, P = 0.000), the mean age at onset of TN (52.01 vs. 38.04 years), and affected side (298/485 vs. 22/14 in left/right, P = 0.006); no such difference was noted in the sex ratio (0.598 vs. 0.385, P = 0.214). The rates of excellent, good, and fair clinical outcomes were 80.56%, 13.89%, and 2.78%, respectively. The offending vessels found during surgery included the superior and anterior inferior cerebellar arteries in 3 and 4 cases, respectively. Postoperative complications included aseptic meningitis (1 case), facial numbness (2 cases), hearing disturbance (3 cases), facial palsy (4 cases), hemorrhage (1 case), and diplopia (2 cases). CONCLUSIONS Secondary TN caused by CPA tumors is not as frequent as classic TN. Compared with classic TN, tumor-induced TN is characterized by symptom onset and surgery at a younger age. Direct compression rather than chemical irritation is the cause of secondary TN.
Collapse
Affiliation(s)
| | - Feng Yu
- Department of Neurosurgery, PLA 960th Hospital, Jinan, China.
| | - Zhen-Yu Zhao
- Department of Neurosurgery, PLA 960th Hospital, Jinan, China
| | - Xue-Zhong Men
- Department of Neurosurgery, PLA 960th Hospital, Jinan, China
| | - Wei Shi
- Department of Neurosurgery, PLA 960th Hospital, Jinan, China
| |
Collapse
|
12
|
Nova CV, Zakrzewska JM, Baker SR, Riordain RN. Treatment Outcomes in Trigeminal Neuralgia-A Systematic Review of Domains, Dimensions and Measures. World Neurosurg X 2020; 6:100070. [PMID: 32123867 PMCID: PMC7036566 DOI: 10.1016/j.wnsx.2020.100070] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/16/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a painful disorder characterized by sudden electric shock-like pain. It is a rare condition for which multiple treatments are available, including medical and surgical. The best treatment option is yet to be defined, and this is related to the lack of definition in the treatment outcomes and outcome measures. The aim of this systematic review was to summarize all the outcomes and outcomes measures that have been published to date and highlight variability in their use. METHODS We have conducted a literature search using a wide range of databases (1946-2019 for medical and 2008-2019 for surgical treatment), for all intervention studies in TN. Four hundred and sixty-seven studies were selected for data extraction on TN classification, data collection method, intervention, and treatment outcomes mapped to the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT guidelines). RESULTS Most studies collected data on pain (n = 459) and side effects (n = 386) domains; however, very few collected data on the impact of treatment on physical (n = 46) and emotional functioning (n = 17) and on patient satisfaction (n = 35). There was high variability on outcome measures used for pain relief (n = 10), pain intensity (n = 9), and frequency of pain episodes (n = 3). CONCLUSIONS A clear definition of what are the important outcomes for patients with TN is essential. The choice of standardized outcome measures allowing for consistent reporting in TN treatment will allow for comparison of studies and facilitate treatment choice for patients and clinicians thus, improving health outcomes and reducing health care cost.
Collapse
Affiliation(s)
| | | | - Sarah R. Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Richeal Ni Riordain
- UCL Eastman Dental Institute, London, United Kingdom
- Department of Oral Medicine, Cork University Dental School and Hospital, Cork, Ireland
| |
Collapse
|
13
|
Grigoryan GY, Dreval' ON, Sitnikov AR, Grigoryan YA. [Anatomical rationale for surgical treatment of trigeminal neuralgia combined with cerebellopontine angle tumors]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2019; 83:53-66. [PMID: 30900688 DOI: 10.17116/neiro20198301153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
UNLABELLED Trigeminal neuralgia (TN) can be combined with tumors of the cerebellopontine angle (CPA). The optimal surgical management in these cases depends on the anatomical relationship of the trigeminal nerve root (TNR) with tumors and vessels. The purpose of this study is to evaluate variants of the anatomical relationship between the TNR and the surrounding structures as well as to analyze the results of using various surgical techniques for treatment of TN in CPA tumors. MATERIAL AND METHODS We performed a retrospective analysis of 51 patients (38 females and 13 males aged 22 to 77 years) with TN and ipsilateral CPA tumors. Space-occupying lesions were represented by 29 meningiomas of the petrous apex, 11 epidermoids, 9 vestibular schwannomas, 1 hemangioma, and 1 cavernoma. RESULTS Intraoperatively, we identified 6 types of the anatomical relationships among the TNR, tumors, and CPA vessels: type I - the TNR is completely surrounded by the tumor (4 epidermoids); type II - the tumor compresses and displaces the TNR (21 meningiomas, 4 schwannomas, and 6 epidermoids); type III - the tumor occurs inside the TNR (1 cavernoma); type IV - the tumor together with the vessel compresses the TNR (3 meningiomas and 1 epidermoid); type V - the tumor displaces the TNR towards the vessel (5 meningiomas and 5 schwannomas); type VI - the tumor does not contact the TNR that is compressed by the vessel (1 hemangioma). Preoperative MRI and intraoperative findings revealed compression and deformity of the brain stem at the TNR entry level in all but two patients. Vascular compression of the TNR (usually by the superior cerebellar artery) was found in 15 of 51 patients. Microvascular decompression (MVD) was performed using various techniques: interposition of implants between vessels and the TNR, transposition of the compressing vessels from the TNR, or transposition of the nerve root. In all patients, except 1, pain syndrome regressed immediately after tumor removal and MVD. In 1 case, the pain syndrome did not regress after total removal of epidermoid and MVD, and TN was resolved by percutaneous radiofrequency rhizotomy. Long-term postoperative follow-up results showed complete elimination of TN in all cases; there were no persistent neurological complications and postoperative mortality. CONCLUSION TN may result from direct compression and deformation of the TNR and brain stem by CPA tumors. In some cases, the cause of TN is combined compression of the TNR by the tumor and vessels. Assessment of the neurovascular relationships requires detailed examination of the entire TNR after tumor removal. In the case of vascular compression of the TNR, various MVD techniques can be used for treatment of TN.
Collapse
Affiliation(s)
- G Yu Grigoryan
- Medical Rehabilitation Center of the Ministry of Health of Russia, Moscow, Russia; Russian Medical Academy of Continuous Postgraduate Education, Moscow, Russia
| | - O N Dreval'
- Russian Medical Academy of Continuous Postgraduate Education, Moscow, Russia
| | - A R Sitnikov
- Medical Rehabilitation Center of the Ministry of Health of Russia, Moscow, Russia
| | - Yu A Grigoryan
- Medical Rehabilitation Center of the Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
14
|
Khan KA, Kataria R, Grover M, Sinha VD. Cerebellopontine angle epidermoid with ipsilateral external ear atresia: an embryological association or a coincidence? Br J Neurosurg 2018:1-3. [PMID: 30451009 DOI: 10.1080/02688697.2018.1533106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The cerebellopontine angle (CPA) is the most common site for intracranial epidermoids. They may have varied presentations viz facial pain, hemifacial spasms, headache and uncommonly features of raised intracranial pressure. Their association with external ear atresia has not been reported in literature to date. We present a very rare case of CPA epidermoid with ipsilateral external ear atresia.
Collapse
Affiliation(s)
- Khursheed Alam Khan
- a Department of Neurosurgery , Sawai Maan Singh Medical College , Jaipur , India
| | - Rashim Kataria
- a Department of Neurosurgery , Sawai Maan Singh Medical College , Jaipur , India
| | - Mohnish Grover
- b ENT , Sawai Maan Singh Medical College , Jaipur , India
| | - Virendra Deo Sinha
- a Department of Neurosurgery , Sawai Maan Singh Medical College , Jaipur , India
| |
Collapse
|
15
|
Mangraviti A, Mazzucchi E, Izzo A, Sturdà C, Albanese A, Marchese E, Olivi A, Puca A, Sturiale CL. Surgical Management of Intracranial Giant Epidermoid Cysts in Adult: A Case-Based Update. Asian J Neurosurg 2018; 13:1288-1291. [PMID: 30459920 PMCID: PMC6208223 DOI: 10.4103/ajns.ajns_91_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Epidermoid cysts (ECs) are benign and slow-growing lesions that account for about 0.2%-2% of all intracranial tumors. Symptoms appear slowly and tumors may have already grown to giant proportions when patients receive their first diagnosis. The optimal treatment for ECs is surgical removal, which includes the total resection of the entire capsule of the lesion in order to minimize the risk of malignant transformation associated with partial removal. However, considering the giant size that the ECs can reach at the time of the diagnosis, and their adherence to the surrounding structures, the risks and benefits of total versus subtotal resections in the short- and long-term patients' outcome are still under debate. Here, we report a case of an extensive giant EC and offer a discussion of its characteristics, surgical management, and postoperative outcome, taking a cue to argue about the recent literature based in the latest case studies.
Collapse
Affiliation(s)
- Antonella Mangraviti
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edoardo Mazzucchi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Izzo
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cosimo Sturdà
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Albanese
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico Marchese
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Puca
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmelo Lucio Sturiale
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
| |
Collapse
|
16
|
Dalvandi M, Rafie AN, Kamali A, Jamshidifard A. Evaluation of the prognostic value of multimodal intraoperative monitoring in posterior fossa surgery patients with cerebellopontine angle tumors. Eur J Transl Myol 2018; 28:7260. [PMID: 29686816 PMCID: PMC5895985 DOI: 10.4081/ejtm.2018.7260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/05/2018] [Accepted: 02/07/2018] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to compare the outcomes of four intraoperative monitoring approaches in order to compare their prognostic value in surgical complications of the facial nerve. This quasi-experimental study was conducted on 25 patients with Cerebellopontine Angle (CPA) tumors, who were hospitalized in the Valiasr Hospital, affiliated to the Arak University of Medical Sciences, Arak, Iran. The degree of the facial nerve paralysis was assessed based on the House-Brackmann (HB) facial nerve grading system. The Orbicularis oris and Oculi muscles were evaluated by electromyography (EMG) before and after the surgery. Monitoring the facial nerve was performed by the EMG, Facial Nerve Antidromic Potentials (FNAPs), Transcranial Electrical Stimulation (TES), and Brainstem Auditory Evoked Potentials (BAEPs) methods. The mean HB score was 0.36.6±5.83, indicating that the function of the facial muscle was abnormal in all the patients pre-surgery. The comparison of the four monitoring approaches six months after surgery showed that the predictive value of facial nerve TES was higher than the other approaches (P<0.005). Furthemroe, 4% of the patients showed normal function in the facial muscle after the surgery. In addition, 8%, 56%, and 32% of the patients had mild abnormalities, moderate to severe paralysis in the facial muscles, and severe facial nerve dysfunction, respectively. In summary, 36% of the patients showed a mild abnormalities in the follow-up period, and full recovery was observed in 28% of the cases. In conclusion, the transcranial motor evoked potential (TCMEP) is a useful method for monitoring the facial nerve during the surgery along with the continuous EMG recordings.
Collapse
Affiliation(s)
- Mohsen Dalvandi
- Department of Neurosurgery, Arak University of Medical Sciences, Arak
| | - Ali Nazemi Rafie
- Department of Neurosurgery, Arak University of Medical Sciences, Arak
| | - Alireza Kamali
- Department of Anesthesiology, Arak University of Medical Sciences, Arak
| | | |
Collapse
|
17
|
Abstract
OBJECTIVE To analyze disease presentation, treatment, and clinical course of a consecutive series of patients with primary cerebellopontine angle (CPA) epidermoids. PATIENTS Forty-seven consecutive patients with previously untreated CPA epidermoids. INTERVENTION(S) Observation and microsurgery. MAIN OUTCOME MEASURES Disease- and treatment-associated morbidity, recurrence. RESULTS Forty-seven patients (mean age 39 years; 53% women) were analyzed and the average duration of follow-up was 42 months. The most common presenting symptom was headache (27; 57%); 13 (28%) exhibited preoperative asymmetric sensorineural hearing loss, 3 (6%) facial nerve paresis, and 3 (6%) hemifacial spasm. Thirteen patients (28%) were initially observed over a mean interval of 56 months; however, five experienced disease progression requiring operation. Thirty-nine patients (83%) underwent surgical resection; 18 (46%) received gross total, 5 (13%) near total, and 16 (41%) aggressive subtotal resection. Three patients (8%) recurred at a median of 53 months; two after subtotal and one after gross total resection. Ninety-three percent of patients with useful hearing maintained serviceable hearing following treatment and one patient (3%) experienced mild long-term postoperative facial nerve paresis (HB II/VI). All patients with preoperative facial nerve paresis recovered normal function postoperatively. There were no episodes of stroke or death. CONCLUSIONS Surgical intervention is effective in alleviating symptoms of cranial neuropathy and brainstem compression from CPA epidermoids. Gross total resection is preferred; however, aggressive subtotal removal should be considered with adherent or extensive disease as reoperation rates are low, even in the setting of aggressive subtotal resection. Conservative observation with serial imaging is a viable initial strategy in asymptomatic or minimally symptomatic patients.
Collapse
|
18
|
Park SC, Lee DH, Lee JK. Two-Session Tumor and Retrogasserian Trigeminal Nerve-Targeted Gamma Knife Radiosurgery for Secondary Trigeminal Neuralgia Associated with Benign Tumors. World Neurosurg 2016; 96:136-147. [DOI: 10.1016/j.wneu.2016.08.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/16/2022]
|
19
|
Abstract
Epidermoid tumors are benign tumors which contain keratin, cellular debris, and cholesterol, and are lined with stratified squamous epithelium. They grow in discreet silence sustained over a multitude of years. The tumors most commonly present with headache and seizures. We report the case of a 24-year-old male with a large sylvian fissure epidermoid tumor who presented with intention tremor. The patient was operated, and a near-total excision of the tumor was performed with a resolution of the tremor.
Collapse
Affiliation(s)
- Abhidha Shah
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
| | - Feda Makkiyah
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
| | - Atul Goel
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
| |
Collapse
|
20
|
Kim MS, Ryu YJ, Park SY, Kim HY, An S, Kim SW. Secondary trigeminal neuralgia caused by pharyngeal squamous cell carcinoma - a case report -. Korean J Pain 2013; 26:177-80. [PMID: 23614082 PMCID: PMC3629347 DOI: 10.3344/kjp.2013.26.2.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/23/2012] [Accepted: 12/05/2012] [Indexed: 11/05/2022] Open
Abstract
Trigeminal neuralgia (TN) is characterized by recurrent paroxysms of unilateral facial pain that typically is severe, lancinating, and activated with cutaneous stimulation. There are two types of TN, classical TN and atypical TN. The pain nature of classical TN are the same as those described above, whereas atypical TN is characterized by constant, burning pain. We describe the case of a 49-year-old male presenting with right-sided facial pain. The patient was diagnosed with temporomandibular joint disorder at a dental clinic and was on medical treatment, but his symptoms worsened gradually. He was referred to our pain clinic for further evaluation. Radiologic evaluation, including MRI, showed a parapharyngeal tumor. For the relief of TN, a right mandibular nerve (V3) root block was performed at our pain clinic, and then he was scheduled for radiation and chemotherapy.
Collapse
Affiliation(s)
- Min Seok Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
21
|
Chowdhury FH, Haque MR. Endoscopic assisted microsurgical removal of cerebello-pontine angle and prepontine epidermoid. J Neurosci Rural Pract 2012. [PMID: 23189019 PMCID: PMC3505358 DOI: 10.4103/0976-3147.102647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Cerebello-pontine(CP) angle and prepontine epidermoid tumors are challenging lesions because they grow along the subarachnoid spaces around the very important neurovascular structures and often extend into the supratentorial compartment. They have typically been removed through a variety of anterolateral, lateral, and posterolateral cranial base microsurgical approaches. Sometime they were removed by the endoscope-assisted microneurosurgical (EAM) techniques. Here we report a CP angle and preontine epidermoid tumor extended to supratentorial compartment presented with trigeminal neuralgia that was removed by pure endoscopic visualization through retrosigmoid retromastoid lateral suboccipital approach. (The method of using endoscope along with surgical instruments passing along the sides of endoscope is termed as Endoscope-Controlled Microsurgery–ECM.) So far our knowledge, in the literature this type of report is probably very rare.
Collapse
Affiliation(s)
- Forhad H Chowdhury
- Department of Neurosurgery, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | | |
Collapse
|