1
|
Altamirano JM, Jimenez-Olvera M, Moreno-Jimenez S, Gutierrez-Aceves GA, Velasco-Campos F, Navarro-Olvera JL, Carrillo-Ruiz JD. Comparison of microvascular decompression, percutaneous radiofrequency rhizotomy, and stereotactic radiosurgery in the treatment of trigeminal neuralgia: A long term quasi-experimental study. Pain Pract 2024; 24:514-524. [PMID: 38071446 DOI: 10.1111/papr.13327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Microvascular decompression (MVD), radiofrequency rhizotomy (RFR), and stereotactic radiosurgery (SRS) are surgical techniques frequently used in the treatment of idiopathic trigeminal neuralgia (TN), although the results reported for each of these are diverse. OBJECTIVE This study aimed to compare long-term pain control obtained by MVD, SRS, and RFR in patients with idiopathic TN. METHODS To compare the results obtained by MVD, SRS, and RFR we chose a quasi-experimental, ambispective design with control groups but no pretest. A total of 52 participants (MVD n = 33, RFR n = 10, SRS n = 9) were included. Using standardized outcome measures, pain intensity, pain relief, quality of life, and satisfaction with treatment were assessed by an independent investigator. The TREND statement for reporting non-randomized evaluations was applied. Clinical outcomes were evaluated at the initial postoperative period and at 6 months, 1, 2, 3, 4, and 5 years postoperatively. RESULTS MVD has shown better results in pain scales compared to ablative procedures. Significant differences between groups were found regarding pain intensity and pain relief at the initial postoperative period (p < 0.001) and 6 months (p = 0.022), 1 year (p < 0.001), 2 years (p = 0.002), and 3 years (p = 0.004) after the intervention. Those differences exceeded the thresholds of the minimal clinically important difference. A higher percentage of patients free of pain was observed in the group of patients treated by MVD, with significant differences at the initial postoperative period (p < 0.001) and 6 months (p = 0.02), 1 year (p = 0.001), and 2 years (p = 0.04) after the procedure. Also, a higher risk of pain recurrence was observed in the RFR and SRS groups (HR 3.15, 95% CI 1.33-7.46; p = 0.009; and HR 4.26, 95% CI 1.77-10.2; p = 0.001, respectively) compared to the MVD group. No significant differences were found in terms of quality of life and satisfaction with treatment. A higher incidence of complications was observed in the MVD group. CONCLUSION Concerning pain control and risk of pain recurrence, MVD is superior to RFR and SRS, but not in terms of quality of life, satisfaction with treatment, and safety profile.
Collapse
Affiliation(s)
- Juan M Altamirano
- Research Direction, Mexico General Hospital "Dr. Eduardo Liceaga", Mexico City, Mexico
- Neurosurgery Department, Hospital Angeles Clínica Londres, Mexico City, Mexico
| | - Miguel Jimenez-Olvera
- Pain management Unit, Mexico General Hospital "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Sergio Moreno-Jimenez
- Radiosurgery Unit, Department of Neurosurgery, Neurological Center, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suarez", Mexico City, Mexico
| | - Guillermo A Gutierrez-Aceves
- Radiosurgery Unit, Department of Neurosurgery, Neurological Center, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suarez", Mexico City, Mexico
| | - Francisco Velasco-Campos
- Unit for Stereotactic and Functional Neurosurgery, Mexico General Hospital "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - José L Navarro-Olvera
- Unit for Stereotactic and Functional Neurosurgery, Mexico General Hospital "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - José D Carrillo-Ruiz
- Research Direction, Mexico General Hospital "Dr. Eduardo Liceaga", Mexico City, Mexico
- Unit for Stereotactic and Functional Neurosurgery, Mexico General Hospital "Dr. Eduardo Liceaga", Mexico City, Mexico
- Neuroscience Coordination, Psychology Faculty, Mexico Anahuac University, México City, Mexico
| |
Collapse
|
2
|
Kim S, Kong SK, Lee JM, Oh SJ. Drop Attack Treated by Microvascular Decompression of the Superior Vestibular Nerve. Ear Nose Throat J 2024; 103:NP179-NP182. [PMID: 34565213 DOI: 10.1177/01455613211043672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a case of cochleovestibular neurovascular compressive syndrome (CVCS)-induced drop attack treated with microvascular decompression (MVD) of the superior vestibular nerve. This report discusses the merits of surgical intervention through a review of related literature. A 58-year-old woman was referred to our clinic with a chief complaint of intermittent, strong, right-sided tinnitus lasting for a few seconds immediately prior to drop attack. Magnetic resonance imaging (MRI) showed bilateral neurovascular contact between the anterior inferior cerebellar artery (AICA) and the vestibulocochlear nerve. Based on MRI findings, history of present illness, and response to anticonvulsants, CVCS was suspected, and surgical decompression on the right side was subsequently performed. The patient became asymptomatic immediately after the surgery, and the vestibular-evoked myogenic potentials were normalized. No recurrence was reported during a 1-year follow-up period.
Collapse
Affiliation(s)
- Sanghoon Kim
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Busan, Republic of Korea
| | - Jae Meen Lee
- Department of Neurosurgery, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Busan, Republic of Korea
| |
Collapse
|
3
|
Jeon C, Jung NY, Kim M, Park K. Intraoperative Monitoring of the Facial Nerve during Microvascular Decompression for Hemifacial Spasm. Life (Basel) 2023; 13:1616. [PMID: 37511991 PMCID: PMC10381659 DOI: 10.3390/life13071616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
This review article discusses the clinical significance of intraoperative neurophysiological monitoring (IONM), provides recommendations for monitoring protocols, and considers the interpretation of results in microvascular decompression (MVD) for hemifacial spasm (HFS). The lateral spread response (LSR) is an important monitoring parameter during MVD. It helps to identify the responsible blood vessel and confirms its thorough decompression from the facial nerve. The disappearance of the LSR during surgery is associated with favorable clinical outcomes. Standard and revised monitoring protocols and the confirmation of LSR persistence and disappearance are also discussed. The blink reflex and other facial nerve monitoring modalities, such as free-running electromyography, facial motor evoked potentials, F-waves, and the Z-L response, are further considered.
Collapse
Affiliation(s)
- Chiman Jeon
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
| | - Na Young Jung
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea
| | - Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, Gangneung 25440, Republic of Korea
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| |
Collapse
|
4
|
Alencar TN, Botelho MM, Carasek N, Bahmad F. Surgical Treatment Outcome for Familial Melkersson-Rosenthal Syndrome. Am J Case Rep 2023; 24:e938670. [PMID: 36755481 PMCID: PMC9923774 DOI: 10.12659/ajcr.938670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Recurrent facial nerve palsy, orofacial edema, and fissured tongue are a triad of manifestations that characterize a rare disorder named Melkersson-Rosenthal syndrome. It is important to consider this syndrome when diagnosing atypical, unilateral, or bilateral facial palsies with characteristics of familial prevalence. There is no established outcome prediction for this disease and the syndrome does not have a specific duration or prospective timeline. Recurrent facial paralysis can require surgery and a multidisciplinary approach with regular follow-up. CASE REPORT We describe a 38-year-old woman presenting with a third episode of facial paralysis and discuss her pedigree chart and the treatment course chosen. After conservative treatment with oral corticosteroids, antiviral therapy, and motor physical therapy with no significant improvements, the patient underwent facial nerve decompression surgery with outstanding results. Eight months after surgery and intense postoperative physical therapy, the patient improved from grade VI to grade II palsy on the House-Brackmann Scale. The patient's older brother also presented a fissured tongue and had a history of 2 episodes of facial paralysis. The patient's son, mother, and sister also presented tongue fissuring but did not have any other clinical signs of the syndrome. CONCLUSIONS Despite being rare, Melkersson-Rosenthal syndrome is associated with a family inheritance and its diagnosis has prognostic implications. Therefore, it is of the utmost importance to have suspicion of this disorder in order to improve quality of care and target the treatment accordingly. Surgical treatment in these cases seems to be an excellent choice to treat current facial paralysis and prevent further episodes.
Collapse
Affiliation(s)
- Tannara Nobile Alencar
- Post-Graduate Program of the School of Health Science, Superior School of Health Science (ESCS), Brasilia, DF, Brazil
| | - Marcela Machado Botelho
- Post-Graduation Program at Health Science Faculty, University of Brasilia, Brasilia, DF, Brazil
| | - Natália Carasek
- Post-Graduation Program at Health Science Faculty, University of Brasilia, Brasilia, DF, Brazil
| | - Fayez Bahmad
- Post-Graduation Program at Health Science Faculty, University of Brasilia, Brasilia, DF, Brazil,Corresponding Author: Fayez Bahmad Jr., e-mail:
| |
Collapse
|
5
|
Thirumalai Vasu S, Retnathankom A. Trigeminal neuralgia in patients with cerebellopontine angle tumors: should we always blame the tumor? A case report and review of literature. Scand J Pain 2023; 23:213-216. [PMID: 36030402 DOI: 10.1515/sjpain-2021-0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/31/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This report seeks to highlight a pitfall that may be encountered in the management of patients with trigeminal neuralgia with imaging showing both neurovascular conflict as well as tumors. CASE PRESENTATION A case of a 53 year old male with simultaneous neurovascular conflict and a vestibular schwannoma with trigeminal neuralgia is presented and the management is discussed with reference to managing this particular subset. Pain was noted to be likely generated by neurovascular conflict and not by the tumor, which is usually not the case. CONCLUSIONS It is suggested that in such cases, microvascular decompression should always be performed in addition to removal of the tumor.
Collapse
Affiliation(s)
| | - Ayyadurai Retnathankom
- Neurosurgery, Amrita Institute of Medical Sciences and Research Centre: Amrita Institute of Medical Sciences, Kochi, India
| |
Collapse
|
6
|
Luna AL, González JA, Guardo LL, Pájaro Castro N. CyberKnife Radiosurgery for refractory bilateral trigeminal neuralgia. Case report. Colomb Med (Cali) 2022; 53:e5005283. [PMID: 37287585 PMCID: PMC10243136 DOI: 10.25100/cm.v53i4.5283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/02/2022] [Accepted: 11/27/2022] [Indexed: 06/09/2023] Open
Abstract
Case description: A case of a 37-year-old female patient suffering from refractory bilateral trigeminal neuralgia is presented, who underwent various interventions such as acupuncture, block therapies and even microvascular decompression without effective pain relief. Clinical findings Paresthesias and shooting-like twinges of pain intensity 10/10 in bilateral maxillary and mandibular branches of the trigeminal nerve, with nasal and intraoral triggers that made eating impossible, becoming increasingly severe since refractoriness to microvascular decompression and carbamazepines, triggering the twinges even during sleep, generating somnolence, depressive mood and social isolation. Treatment and results The patient was evaluated by an interdisciplinary neuro-oncology team, where, in accordance with the analysis of the brain magnetic resonance imaging and the patient's history, it was indicated to perform Cyberknife® radiosurgery in monofraction on the left trigeminal and subsequently treat the contralateral trigeminal. When treated with Cyberknife® radiosurgery, the patient reported absolute improvement in her pain for 2 years. Clinical relevance Radiosurgery by CyberKnife is not yet the first line of management in trigeminal neuralgia, however, it should be considered since several studies have managed to demonstrate an increase in the quality of life of patients and pain relief in refractory or severe cases. of said pathology.
Collapse
Affiliation(s)
- Alma Luz Luna
- Universidad de Sucre, Facultad Ciencias de la Salud, Grupo de Ciencias Médicas y Farmacéuticas. Sincelejo, Colombia
- Clínica Las Peñitas, Sincelejo, Colombia
| | - Jaime Andrés González
- Universidad de Sucre, Facultad Ciencias de la Salud, Grupo de Ciencias Médicas y Farmacéuticas. Sincelejo, Colombia
- Clínica Santa María, Sincelejo, Colombia
| | - Linda Lucía Guardo
- Universidad de Sucre, Facultad Ciencias de la Salud, Grupo de Ciencias Médicas y Farmacéuticas. Sincelejo, Colombia
- Clínica FOSCAL Internacional, Floridablanca, Colombia
| | - Nerlis Pájaro Castro
- Universidad de Sucre, Facultad Ciencias de la Salud, Grupo de Ciencias Médicas y Farmacéuticas. Sincelejo, Colombia
| |
Collapse
|
7
|
Nomura K, Ryu H, Ohno K, Sato K. Wide distribution of central myelin segment along the facial nerve might explain hemifacial spasm with distal nerve compression. Clin Anat 2020; 34:405-410. [PMID: 32713009 DOI: 10.1002/ca.23664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/21/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Many researchers have assumed that neurovascular compression of the facial nerve at the site covered by central myelin sheath causes hemifacial spasm. However, some cases do not correspond to this hypothesis. The aim of this study was to clarify the myelin histology in the facial nerve. MATERIALS AND METHODS Histological analyses were conducted on 134 facial nerves from 67 cadavers. Three dimensions were measured in these sections: the length from the upper border of the medullopontine sulcus to the boundary between the central and peripheral myelin sheath along the anterior side; the length from the detachment point of the brain stem to the boundary along the posterior side; and the length of the transitional zone (TZ), known as the Obersteiner-Redlich zone. RESULTS Of the 134 facial nerves, 41 were available for study. The length of the central myelin segment ranged from 4.62 to 12.6 mm (mean 8.06 mm; median 7.98 mm) along the anterior side and from 0.00 to 4.58 mm (mean 1.68 mm; median 1.42 mm) along the posterior side of the facial nerve, and the length of the TZ ranged from 0.00 to 2.76 mm (mean 1.51 mm; median 1.42 mm). CONCLUSIONS In this study, the length of the central myelin segment in the facial nerve was found to be longer than that previously reported.
Collapse
Affiliation(s)
- Kei Nomura
- Center for Brain and Spine Surgery, Aoyama General Hospital, Toyokawa, Aichi, Japan
| | - Hiroshi Ryu
- Center for Brain and Spine Surgery, Aoyama General Hospital, Toyokawa, Aichi, Japan
| | | | - Kohji Sato
- Department of Organ and Tissue Anatomy, Hamamatsu University School of Medicine, Shizuoka, Japan
| |
Collapse
|
8
|
Toda H, Iwasaki K, Yoshimoto N, Miki Y, Hashikata H, Goto M, Nishida N. Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm. Neurosurg Focus 2019; 45:E2. [PMID: 29961378 DOI: 10.3171/2018.4.focus18122] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm, the bridging veins are dissected to provide the surgical corridors, and the veins of the brainstem may be mobilized in cases of venous compression. Strategy and technique in dissecting these veins may affect the surgical outcome. The authors investigated solutions for minimizing venous complications and reviewed the outcome for venous decompression. METHODS The authors retrospectively reviewed their surgical series of microvascular decompression for trigeminal neuralgia and hemifacial spasm in patients treated between 2005 and 2017. Surgical strategies included preservation of the superior petrosal vein and its tributaries, thorough dissection of the arachnoid sleeve that enveloped these veins, cutting of the inferior petrosal vein over the lower cranial nerves, and mobilization or cutting of the veins of the brainstem that compressed the nerve roots. The authors summarized the patient characteristics, operative findings, and postoperative outcomes according to the vascular compression types as follows: artery alone, artery and vein, and vein alone. They analyzed the data using chi-square and 1-way ANOVA tests. RESULTS The cohort was composed of 121 patients with trigeminal neuralgia and 205 patients with hemifacial spasm. The superior petrosal vein and its tributaries were preserved with no serious complications in all patients with trigeminal neuralgia. Venous compression alone and arterial and venous compressions were observed in 4% and 22%, respectively, of the patients with trigeminal neuralgia, and in 1% and 2%, respectively, of those with hemifacial spasm (p < 0.0001). In patients with trigeminal neuralgia, 35% of those with artery and venous compressions and 80% of those with venous compression alone had atypical neuralgia (p = 0.015). The surgical cure and recurrence rates of trigeminal neuralgias with venous compression were 60% and 20%, respectively, and with arterial and venous compressions the rates were 92% and 12%, respectively (p < 0.0001, p = 0.04). In patients with hemifacial spasm who had arterial and venous compressions, their recurrence rate was 60%, and that was significantly higher compared to other compression types (p = 0.0008). CONCLUSIONS Dissection of the arachnoid sleeve that envelops the superior petrosal vein may help to reduce venous complications in surgery for trigeminal neuralgia. Venous compression may correlate with worse prognosis even with thorough decompression, in both trigeminal neuralgia and hemifacial spasm.
Collapse
Affiliation(s)
- Hiroki Toda
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and.,2Department of Neurosurgery, Fukui Red Cross Hospital, Fukui, Japan
| | - Koichi Iwasaki
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and
| | - Naoya Yoshimoto
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and
| | - Yoshihito Miki
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and
| | - Hirokuni Hashikata
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and
| | - Masanori Goto
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and
| | - Namiko Nishida
- 1Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka; and
| |
Collapse
|
9
|
Venkatraghavan L, Li L, Bailey T, Manninen PH, Tymianski M. Sumatriptan improves postoperative quality of recovery and reduces postcraniotomy headache after cranial nerve decompression. Br J Anaesth 2018; 117:73-9. [PMID: 27317706 DOI: 10.1093/bja/aew152] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Microvascular decompression (MVD) is a surgical treatment for cranial nerve disorders via a small craniotomy. The postoperative pain of this procedure can be classified as surgical site somatic pain and postcraniotomy headache similar in nature to a migraine, including its association with photophobia, nausea, and vomiting. This headache can be difficult to treat and can impact on postoperative recovery. Sumatriptan is used to treat migraine-like headaches in various settings. This single-centre randomized controlled trial investigated whether postoperative administration of sumatriptan after MVD surgery impacts the quality of postoperative recovery. METHODS Fifty patients who complained of postoperative headache after MVD were randomized to receive an s.c. injection of sumatriptan (6 mg) or saline. The primary outcome was quality of recovery as measured by the Quality of Recovery-40 (QoR-40) score at 24 h. RESULTS The QoR-40 scores were significantly higher in the sumatriptan group (median 184; interquartile range 169-196) than in the placebo group (133; 119-155; P<0.01), suggesting higher quality of recovery. The sumatriptan group also had significantly lower headache scores at 4, 12, and 24 h. There were no significant differences in other secondary outcomes. CONCLUSIONS Use of sumatriptan improved the quality of recovery as measured by the QoR-40 and reduction of headache at 24 h after surgery. Sumatriptan is a useful alternative treatment for postcraniotomy headache. The mechanism remains unknown but could be related to reduction in headache, mood modulation, or both, mediated by a serotonin effect. CLINICAL TRIAL REGISTRATION NCT01632657.
Collapse
Affiliation(s)
| | - L Li
- Department of Anesthesia Present address: Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee, UK
| | - T Bailey
- Department of Anesthesia Present address: Department of Anaesthesia, Waikato Hospital, Hamilton 3204, New Zealand
| | | | - M Tymianski
- Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Schroeder HK, Neville IS, de Andrade DC, Lepski GA, Teixeira MJ, Duarte KP. Microvascular decompression of the posterior inferior cerebellar artery for intermediate nerve neuralgia. Surg Neurol Int 2015; 6:52. [PMID: 25883844 PMCID: PMC4395987 DOI: 10.4103/2152-7806.154452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Intermediate nerve neuralgia (INN) is an extremely rare craniofacial pain disorder mainly caused by neurovascular compression. CASE DESCRIPTION We present the case of a 48-year-old female with a 20-month history of intractable paroxysmal INN on the right side. The patient described feeling paroxysmal pain in her auditory canal, pinna, deep in the jaw, and adjacent retromastoid area on the right side. She described the pain as being like a burning sensation. Magnetic resonance imaging showed the right posterior cerebellar artery crossing the cerebellopontine cistern in close contact with the right VII and VIII nerves. Surgical exploration via retromastoid craniotomy revealed vascular compression of the intermediate nerve by the posterior cerebellar artery. We therefore performed microvascular nerve decompression to relieve pain, and the patient remained pain-free at the 6-month follow-up visit. CONCLUSION INN should be considered as a differential diagnosis in cases with atypical facial neuralgia, and microvascular decompression is an effective treatment option that can provide optimal pain relief.
Collapse
Affiliation(s)
- Humberto Kluge Schroeder
- Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Iuri Santana Neville
- Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Guilherme Alves Lepski
- Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Kleber Paiva Duarte
- Division of Functional Neurosurgery, Department of Neurology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| |
Collapse
|
11
|
Abstract
Brachial plexus injuries, in all their severity and complexity, have been extensively studied. Although brachial plexus injuries are associated with serious and often definitive sequelae, many concepts have changed since the 1950s, when this pathological condition began to be treated more aggressively. Looking back over the last 20 years, it can be seen that the entire approach, from diagnosis to treatment, has changed significantly. Some concepts have become better established, while others have been introduced; thus, it can be said that currently, something can always be offered in terms of functional recovery, regardless of the degree of injury. Advances in microsurgical techniques have enabled improved results after neurolysis and have made it possible to perform neurotization, which has undoubtedly become the greatest differential in treating brachial plexus injuries. Improvements in imaging devices and electrical studies have allowed quick decisions that are reflected in better surgical outcomes. In this review, we intend to show the many developments in brachial plexus surgery that have significantly changed the results and have provided hope to the victims of this serious injury.
Collapse
Affiliation(s)
- Marcelo Rosa de Rezende
- Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | | | | |
Collapse
|