1
|
Niryana IW, Tombeng MA, Lauren C, Maliawan S, Golden N, Mahadewa TGB, Maliawan MGD. Secondary Trigeminal Neuralgia Caused by Cerebellopontine Angle Arachnoid Cyst in A 27-Year-Old Female: A Case Report. Acta Neurol Taiwan 2024; 33(2):76-80. [PMID: 37968093] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
PURPOSE Secondary (TN) caused by an arachnoid cyst in the (CPA) region is a rare finding. Based on the reported literature, there are only 5 cases of secondary trigeminal neuralgia caused by an arachnoid cyst in the cerebellopontine angle region. CASE REPORT A 27-year-old female presented to our neurosurgery clinic with a 2-year history of brief episodes of paroxysm pain in the left cheek. The pain was described as an electric shock-like pain triggered by simple stimuli. The magnetic resonance imaging (MRI) showed a well-confined cystic lesion in the left CPA, which compresses the left pons and the cisternal segment of the left trigeminal nerve. The patient was managed operatively to fenestrate the cyst and decompress the trigeminal nerve. The histopathological result of the cyst wall was consistent with an arachnoid cyst. Six months after surgery, the patient is in good health condition and symptom-free without medication. CONCLUSION Arachnoid cyst in the CPA region is one of the rare causes of secondary TN. Preoperative imaging with MRI is important to provide better results to differentiate the pathology. Surgical treatment to fenestrate the arachnoid cyst and decompress the trigeminal nerve have a good result and can improve the patient's quality of life.
Collapse
Affiliation(s)
- I Wayan Niryana
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Marthinson Andrew Tombeng
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Christopher Lauren
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Sri Maliawan
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Nyoman Golden
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Tjokorda Gde Bagus Mahadewa
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Made Gemma Daniswara Maliawan
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| |
Collapse
|
2
|
Han Z, Du Y, Zheng S, Wu G. Teaching Video NeuroImage: Bilateral Hemifacial Spasm and Left Glossopharyngeal Neuralgia Caused by Bilateral Vertebral Artery Displacement. Neurology 2024; 102:e209422. [PMID: 38593396 DOI: 10.1212/wnl.0000000000209422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Affiliation(s)
- Zongli Han
- From the Department of Neurosurgery (Z.H., S.Z., G.W.), Peking University Shenzhen Hospital, Futian District; and School of Medical Technology and Nursing (Y.D.), Shenzhen Polytechnic University, Xili Lake, Nanshan District, Shenzhen, Guangdong Province, P.R. China
| | - Yanli Du
- From the Department of Neurosurgery (Z.H., S.Z., G.W.), Peking University Shenzhen Hospital, Futian District; and School of Medical Technology and Nursing (Y.D.), Shenzhen Polytechnic University, Xili Lake, Nanshan District, Shenzhen, Guangdong Province, P.R. China
| | - Siyang Zheng
- From the Department of Neurosurgery (Z.H., S.Z., G.W.), Peking University Shenzhen Hospital, Futian District; and School of Medical Technology and Nursing (Y.D.), Shenzhen Polytechnic University, Xili Lake, Nanshan District, Shenzhen, Guangdong Province, P.R. China
| | - Guangyuan Wu
- From the Department of Neurosurgery (Z.H., S.Z., G.W.), Peking University Shenzhen Hospital, Futian District; and School of Medical Technology and Nursing (Y.D.), Shenzhen Polytechnic University, Xili Lake, Nanshan District, Shenzhen, Guangdong Province, P.R. China
| |
Collapse
|
3
|
Khaleghi M, Carlstrom LP, Prevedello DM. Unusual Atrophic Nervus Intermedius in a Patient with Refractory Nervus Intermedius Neuralgia and History of Ipsilateral Sudden-Onset Central Facial Palsy and Sensorineural Hearing Loss: Cadaveric-Clinical Images with Surgical Video. World Neurosurg 2024; 185:91-94. [PMID: 38340797 DOI: 10.1016/j.wneu.2024.02.026] [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: 11/15/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
Nervus intermedius (NI) arises from the superior salivary nucleus, solitary nucleus, and trigeminal tract. It leaves the pons as 1 to 5 roots and travels between the facial and vestibulocochlear nerves before merging with the facial nerve within the internal auditory canal. The mastoid segment of the facial nerve then gives rise to a sensory branch that supplies the posteroinferior wall of the external auditory meatus and inferior pina. This complex pathway renders the nerve susceptible to various pathologies, leading to NI neuralgia. Here, the authors present an unusual intraoperative finding of an atrophic NI in a patient with refractory NI neuralgia and a history of ipsilateral sudden-onset central facial palsy and microvascular decompression for trigeminal neuralgia. The patient underwent NI sectioning via the previous retrosigmoid window and achieved partial ear pain improvement. The gross size of the NI is compared with a cadaveric specimen through stepwise dissection. This case highlights the potential significance of subtle central ischemic events and subsequent atrophy of NI in the pathogenesis of NI neuralgia, as well as the ongoing need to investigate the therapeutic efficacy of nerve sectioning.
Collapse
Affiliation(s)
- Mehdi Khaleghi
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Lucas P Carlstrom
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
| |
Collapse
|
4
|
Sun J, Wang J, Jia J, Cao Z, Li Z, Zhang C, Guo X, Wu Q, Li W, Ma X. Fully Endoscopic Microvascular Decompression for Trigeminal Neuralgia Caused by Vertebrobasilar Artery: A Case Series Review: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:433-441. [PMID: 37976445 DOI: 10.1227/ons.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Microvascular decompression (MVD) is the most definitive and preferred surgical treatment for trigeminal neuralgia (TN). Treatment of TN caused by the vertebrobasilar artery (VBA) has been reported to be challenging and less satisfactory in complications and recurrence. Endoscopy has been implemented to provide a comprehensive view of neurovascular conflicts and minimize brain tissue stretch injury while exploring the trigeminal nerve. However, there are few retrospective studies on the treatment of TN caused by VBA by fully endoscopic microvascular decompression (E-MVD). This article aimed to illustrate the safety and efficacy of E-MVD for TN caused by the VBA. METHODS Clinical data for 26 patients with TN caused by the VBA who underwent E-MVD from 2019 to 2022 were retrospectively analyzed. The characteristics of vertebrobasilar-associated TN were summarized. The safety and efficacy of E-MVD for vertebrobasilar-associated TN were estimated based on the analysis of intraoperative manipulation, postoperative symptom relief, and complications. RESULTS Intraoperatively, the vertebrobasilar artery was regarded as a direct offending vessel in all 26 patients with TN, the vertebral artery in 18 (69.23%) and the basilar artery in 10 (38.46%). In addition to the vertebrobasilar artery, other vessels involved included the superior cerebellar artery in 12 patients, anterior inferior cerebellar artery in 9, posterior inferior cerebellar artery in 1, and veins in 4. All patients underwent E-MVD, and TN was entirely resolved in 26 (100%) patients immediately postoperatively. During the follow-up period of 12-45 months, no recurrence or serious complications were found. There were no serious postoperative complications, such as cerebellar swelling, intracranial hemorrhage, or death. CONCLUSION E-MVD for vertebrobasilar-associated TN is effective and safe.
Collapse
Affiliation(s)
- Jinxing Sun
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan , China
- Jinan Microecological Biomedicine Shandong Laboratory and the Shandong Key Laboratory of Brain Function Remodeling, Jinan , China
| | - Jiwei Wang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan , China
- Jinan Microecological Biomedicine Shandong Laboratory and the Shandong Key Laboratory of Brain Function Remodeling, Jinan , China
| | - Junheng Jia
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan , China
- Jinan Microecological Biomedicine Shandong Laboratory and the Shandong Key Laboratory of Brain Function Remodeling, Jinan , China
| | - Zexin Cao
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan , China
- Jinan Microecological Biomedicine Shandong Laboratory and the Shandong Key Laboratory of Brain Function Remodeling, Jinan , China
| | - Zhenke Li
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan , China
- Jinan Microecological Biomedicine Shandong Laboratory and the Shandong Key Laboratory of Brain Function Remodeling, Jinan , China
| | - Chao Zhang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan , China
- Jinan Microecological Biomedicine Shandong Laboratory and the Shandong Key Laboratory of Brain Function Remodeling, Jinan , China
| | - Xing Guo
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan , China
- Jinan Microecological Biomedicine Shandong Laboratory and the Shandong Key Laboratory of Brain Function Remodeling, Jinan , China
| | - Qianqian Wu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan , China
- Jinan Microecological Biomedicine Shandong Laboratory and the Shandong Key Laboratory of Brain Function Remodeling, Jinan , China
| | - Weiguo Li
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan , China
- Jinan Microecological Biomedicine Shandong Laboratory and the Shandong Key Laboratory of Brain Function Remodeling, Jinan , China
| | - Xiangyu Ma
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan , China
- Jinan Microecological Biomedicine Shandong Laboratory and the Shandong Key Laboratory of Brain Function Remodeling, Jinan , China
| |
Collapse
|
5
|
Oliveira LM, Peres CMA, Figueiredo EG. Facial nerve inflammation after trigeminal microvascular decompression. Br J Neurosurg 2024; 38:542-543. [PMID: 33491500 DOI: 10.1080/02688697.2021.1876212] [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: 08/12/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
In this article, we will discuss a rare complication after microvascular decompression for trigeminal neuralgia: peripheral facial palsy.
Collapse
|
6
|
Nair SK, Xie ME, Kalluri A, Ran K, Kilgore C, Halbert-Elliott K, Huang J, Lim M, Bettegowda C, Xu R. The influence of prior percutaneous rhizotomy on outcomes following microvascular decompression for trigeminal neuralgia. J Neurosurg 2024; 140:1155-1159. [PMID: 37862713 DOI: 10.3171/2023.8.jns231345] [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: 06/11/2023] [Accepted: 08/10/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Microvascular decompression (MVD) is an effective intervention in patients with trigeminal neuralgia (TN). How prior rhizotomy can impact long-term pain outcomes following MVD is not well understood. In this study, the authors sought to compare pain outcomes in patients who had undergone primary MVD versus those who had undergone secondary MVD after a single or multiple rhizotomies. METHODS The authors retrospectively reviewed the data on all patients who had undergone MVD at their institution from 2007 to 2020. Patients were included in the study if they had undergone primary MVD or if their surgical history was notable for past rhizotomy. Barrow Neurological Institute (BNI) pain scores were assigned at preoperative and final follow-up appointments. Perioperative complications were noted for each patient, and evidence of pain recurrence was recorded as well. A history of rhizotomy as well as other variables that might influence TN pain recurrence were evaluated using a Cox proportional hazards model. The impact of prior rhizotomy on TN pain recurrence following MVD was further assessed using Kaplan-Meier survival analysis. RESULTS Of 1044 patients reviewed, 947 met the study inclusion criteria. Of these, 796 patients had undergone primary MVD, 84 had a history of a single rhizotomy before MVD, and 67 had a history of ≥ 2 rhizotomies prior to MVD. Patients in the single rhizotomy and multiple rhizotomies cohorts exhibited a greater frequency of preoperative numbness (p < 0.001), higher preoperative BNI pain scores (p < 0.005), and higher rates of postoperative numbness (p = 0.04). However, final follow-up BNI pain scores were not significantly different between the primary MVD and prior rhizotomy groups (p = 0.34). Cox proportional hazards analysis revealed that younger age, multiple sclerosis, and female sex independently predicted an increased risk of pain recurrence following MVD. Neither a history of a single prior rhizotomy nor a history of multiple prior rhizotomies independently increased the risk of pain recurrence. Furthermore, Kaplan-Meier analysis of pain-free survival among the 3 groups revealed no relationship between a history of prior rhizotomy and pain recurrence following MVD (p = 0.57). CONCLUSIONS Percutaneous rhizotomy does not complicate outcomes following subsequent MVD for TN pain. However, patients undergoing rhizotomy before MVD may have an increased risk of postoperative facial numbness compared to that in patients undergoing primary MVD.
Collapse
Affiliation(s)
- Sumil K Nair
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Michael E Xie
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Anita Kalluri
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Kathleen Ran
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Collin Kilgore
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Kyra Halbert-Elliott
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Judy Huang
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Michael Lim
- 2Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California
| | - Chetan Bettegowda
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Risheng Xu
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| |
Collapse
|
7
|
Nakaya A, Kaneko K, Miyazawa K, Matsumoto A, Hisanaga K, Matsumori Y, Nagano I. Neuralgia in the occipital region associated with ipsilateral trigeminal herpes zoster: Three case reports. Headache 2024; 64:464-468. [PMID: 38525807 DOI: 10.1111/head.14698] [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: 11/17/2023] [Revised: 02/06/2024] [Accepted: 02/28/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Nerve fibers related to pain and temperature sensation in the trigeminal nerve territory converge with the upper cervical spinal nerves from the level of the lower medulla oblongata to the upper cervical cord. This structure is called the trigemino-cervical complex and may cause referred pain in the territory of the trigeminal or upper cervical spinal nerves. CASE SERIES Here, we report three cases of paroxysmal neuralgia in the occipital region with mild conjunctivitis or a few reddish spots in the ipsilateral trigeminal nerve territory. The patients exhibited gradual progression of these reddish spots evolving into vesicles over the course of several days, despite the absence of a rash in the occipital region. The patients were diagnosed with trigeminal herpes zoster and subsequently received antiherpetic therapy. Remarkably, the neuralgia in the occipital region showed gradual amelioration or complete resolution before the treatment, with no sequelae reported in the occipital region. DISCUSSION The trigemino-cervical complex has the potential to cause neuralgia in the occipital region, as referred pain, caused by trigeminal herpes zoster. These cases suggest that, even if conjunctivitis or reddish spots appear to be trivial in the trigeminal nerve territory, trigeminal herpes zoster should be considered when neuralgia occurs in the ipsilateral occipital region.
Collapse
Affiliation(s)
- Akihiko Nakaya
- Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan
| | - Kimihiko Kaneko
- Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan
| | - Koichi Miyazawa
- Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan
- Department of Neurology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
| | - Arifumi Matsumoto
- Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan
| | - Kinya Hisanaga
- Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan
| | | | - Isao Nagano
- Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan
| |
Collapse
|
8
|
Finsterer J. SARS-CoV-2 Vaccination- or Infection-related Trigeminal Neuralgia/Radiculitis. Intern Med 2024; 63:761. [PMID: 38104985 PMCID: PMC10982005 DOI: 10.2169/internalmedicine.3152-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
|
9
|
Branstetter BF, Sekula RF. The Sagittal Angle of the Trigeminal Nerve at the Porus Trigeminus is a Radiologic Predictor of Surgical Outcome in Microvascular Decompression for Classical Trigeminal Neuralgia. Neurosurgery 2024; 94:524-528. [PMID: 37706752 DOI: 10.1227/neu.0000000000002671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/11/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Classical trigeminal neuralgia (cTN) is a painful disease. Microvascular decompression (MVD) provides immediate and durable relief in many patients. A variety of positive and negative prognostic biomarkers for MVD have been identified. The sagittal angle of the trigeminal nerve at the porus trigeminus (SATNaPT) is an MRI biomarker that can identify a subset of patients with cTN whose trigeminal nerve anatomy is different from normal controls. The purpose of this case-control study was to determine whether an abnormally hyperacute SATNaPT is a negative prognostic biomarker in patients with cTN undergoing MVD. METHODS Preoperative MRIs from 300 patients with cTN who underwent MVD were analyzed to identify patients with a hyperacute SATNaPT (defined as less than 3 SDs below the mean). The rate of surgical success (pain-free after at least 12 months) was compared between patients with a hyperacute SATNaPT and all other patients. RESULTS Patients without a hyperacute SATNaPT had an 82% likelihood of surgical success, whereas patients with a hyperacute SATNaPT had a 58% likelihood of surgical success ( P < .05). Patients with a hyperacute SATNaPT who also had no evidence of vascular compression on preoperative MRI had an even lower likelihood of success (29%, P < .05). CONCLUSION In patients with cTN being considered for MVD, a hyperacute SATNaPT is a negative prognostic biomarker that predicts a higher likelihood of surgical failure. Patients with a hyperacute SATNaPT, particularly those without MRI evidence of vascular compression, may benefit from other surgical treatments or a modification of MVD to adequately address the underlying cause of cTN.
Collapse
Affiliation(s)
- Barton F Branstetter
- Departments of Radiology, Otolaryngology, and Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Raymond F Sekula
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York , New York , USA
| |
Collapse
|
10
|
Khaleghi M, Carlstrom LP, Weber MD, Biswas C, Dalm B, Prevedello D. Microvascular Decompression for Trigeminal Neuralgia Caused by Vascular Compression on the Trigeminal Sensory Nucleus and Descending Trigeminal Tract. World Neurosurg 2024; 183:106-112. [PMID: 38143032 DOI: 10.1016/j.wneu.2023.12.087] [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: 10/19/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is characterized by paroxysmal episodes of severe shocklike orofacial pain typically resulting from arterial compression on the trigeminal root entry zone. However, neurovascular conflict in more proximal parts of the trigeminal pathway within the pons is extremely rare. METHODS The authors present a case of microvascular decompression for TN caused by dual arterial compression on the dorsolateral pons, along with a brief literature review. RESULTS Our patient was a 74-year-old man with episodic left-sided facial stabbing pain. Brain magnetic resonance imaging revealed a dual arterial compression on dorsolateral pons, the known site of the trigeminal sensory nucleus and descending trigeminal tract. Microvascular decompression was performed via a retrosigmoid approach. Complete pain relief and partial improvement of the facial hypesthesia were achieved immediately after surgery and the Barrow Neurological Institute (BNI) pain intensity score improved from V to I, and the BNI hypesthesia score decreased from III to II within a month following surgery. The literature review identified 1 case of TN secondary to an arteriovenous malformation in root entry zone with lateral pontine extension. One month following partial coagulation of the draining vein, the patient was reportedly able to reduce medication dosage by half to achieve an improvement of BNI pain intensity score from V to IIIa. CONCLUSIONS Neurovascular compression in the trigeminal tract and nucleus is a rare but potential cause of TN. A thorough investigation of the trigeminal pathway should be considered during preoperative evaluation and intraoperative inspection, particularly if no clear offending vessel is identified.
Collapse
Affiliation(s)
- Mehdi Khaleghi
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lucas P Carlstrom
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthieu D Weber
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Chandrima Biswas
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian Dalm
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| |
Collapse
|
11
|
Samanci Y, Mürdün E, Çil M, Düzkalir AH, Askeroglu MO, Peker S. Long-term outcomes of Gamma Knife radiosurgery in treating glossopharyngeal neuralgia. Headache 2024; 64:323-328. [PMID: 38385643 DOI: 10.1111/head.14687] [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: 09/24/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 02/23/2024]
Abstract
Glossopharyngeal neuralgia (GPN) is an unusual disorder causing severe, brief pain episodes in the areas supplied by the glossopharyngeal nerve. Initial treatment involves medications like carbamazepine, but if these are ineffective or cause side effects, interventional pain management techniques or surgery may be considered. Gamma Knife radiosurgery is becoming popular in managing GPN due to its lower risk of complications than surgical interventions like microvascular decompression or rhizotomy. In this retrospective case series, we examined the outcomes of Gamma Knife radiosurgery in eight patients with GPN. The decision to utilize Gamma Knife radiosurgery was made following specific criteria, including failed surgical interventions, patient preference against surgery, or contraindications to surgical procedures. Patients were administered radiation doses within the range of 80 to 90 Gy, targeting either the cisternal glossopharyngeal nerve or glossopharyngeal meatus of the jugular foramen. Evaluations were conducted before the Gamma Knife radiosurgery; at 3, 6, and 12 months after Gamma Knife radiosurgery; and annually thereafter. Pain severity was assessed using the modified Barrow Neurological Institute scale grades, with patients achieving grade I-IIIa considered to have a good treatment outcome and grade IV-V to have a poor treatment outcome. Pain control and absence of radiosurgery-related complications were primary endpoints. The median age of the patients was 46.5 years, varying from 8 to 72 years. The median duration of pain was 32 months (range, 12-120 months). All patients, except one, were on polydrug therapy. All cases exhibited preoperative grade V pain. The median follow-up duration after Gamma Knife radiosurgery was 54.5 months, varying from 14 to 90 months. The overall clinical assessments revealed a gradual neurological improvement, particularly within the first 8.5 weeks (range, 1-12 weeks). The immediate outcomes at 3 months revealed that all patients (8/8, 100%) experienced pain relief, with 25% (2/8) achieving a medication-free status (Grade I). Three patients (37%) experienced a recurrence during the follow-up and were managed with repeat Gamma Knife radiosurgery (n = 2) and radiofrequency rhizotomy (n = 1). At the last follow-up, 88% (7/8) of patients had pain relief (Grades I-IIIa), with three (37%) achieving a medication-free status (Grade I). No adverse events or neurological complications occurred. The patient who underwent radiofrequency rhizotomy continued to experience inadequately controlled pain despite medication (Grade IV). Gamma Knife radiosurgery is a non-invasive, efficacious treatment option for idiopathic GPN, offering short- and long-term relief without permanent complications.
Collapse
Affiliation(s)
- Yavuz Samanci
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Elif Mürdün
- Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mahmut Çil
- Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | | | - Selcuk Peker
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| |
Collapse
|
12
|
Cui B, Wang N, Meng DW, Guo YP, Sun JD, Wang XS, Chen GQ, Wang L. Surgical management of nervus intermedius neuralgia: A report of 4 cases and literature review. J Clin Neurosci 2024; 121:11-17. [PMID: 38308978 DOI: 10.1016/j.jocn.2024.01.024] [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: 10/31/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Nervus intermedius neuralgia (NIN) is characterized by paroxysmal episodes of sharp, lancinating pain in the deep ear. Unfortunately, only a few studies exist in the literature on this pain syndrome, its pathology and postoperative outcomes. METHOD We conducted a retrospective review of four cases diagnosed with NIN who underwent a neurosurgical intervention at our center from January 2015 to January 2023. Detailed information on their MRI examinations, intraoperative findings and other clinical presentations were obtained, and the glossopharyngeal and vagus nerves were isolated for immunohistochemistry examination. RESULTS A total of 4 NIN patients who underwent a microsurgical intervention at our institution were included in this report. The NI was sectioned in all patients and 3 of them underwent a microvascular decompression. Of these 4 patients, 1 had a concomitant trigeminal neuralgia (TN), and 1 a concomitant glossopharyngeal neuralgia (GPN). Three patients underwent treatment for TN and 2 for GPN. Follow-up assessments ranged from 8 to 99 months. Three patients reported complete pain relief immediately after the surgery until last follow-up, while in the remaining patient the preoperative pain gradually resolved over the 3 month period. Immunohistochemistry revealed that a greater amount of CD4+ and CD8+ T cells had infiltrated the glossopharyngeal versus vagus nerve. CONCLUSIONS NIN is an extremely rare condition showing a high degree of overlap with TN/GPN. An in depth neurosurgical intervention is effective to completely relieve NIN pain, without any serious complications. It appears that T cells may play regulatory role in the pathophysiology of CN neuralgia.
Collapse
Affiliation(s)
- Bin Cui
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Ning Wang
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Da-Wei Meng
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Yu-Peng Guo
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Ji-Dong Sun
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Xiao-Song Wang
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Guo-Qiang Chen
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China
| | - Lin Wang
- Department of Neurosurgery, Aviation General Hospital, Beijing 100012, China.
| |
Collapse
|
13
|
Tang Q, Gao S, Wang C, Zheng K, Zhang J, Huang H, Li Y, Ma Y. A prospective cohort study on perioperative percutaneous balloon compression for trigeminal neuralgia: safety and efficacy analysis. Neurosurg Rev 2024; 47:86. [PMID: 38366200 DOI: 10.1007/s10143-024-02323-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
With the recent emergence of percutaneous balloon compression (PBC) as a promising treatment for trigeminal neuralgia (TN), there is a growing need for research on its safety and efficacy. This study was designed to evaluate the safety and efficacy of PBC in the treatment of TN patients during the perioperative period. This study involved a total of 400 TN patients who were selected and treated with PBC at our institution. The clinical data and short-term outcomes were analyzed based on sex, initial PBC treatment for TN, and subsequent PBC treatment for recurrent TN after previous PBC or microvascular decompression (MVD) or radiofrequency thermocoagulation (RFT). No statistically significant difference was found when comparing postoperative pain relief between male and female patients with TN. Nevertheless, female patients were found to be more vulnerable than male patients to abnormal facial sensations (P = 0.001), diplopia (P = 0.015), postoperative headache (P = 0.012), and hyposmia (P = 0.029). Additionally, it was observed that there was no substantial difference in the postoperative pain relief rate between the first-time PBC group and PBC for recurrent TN patients postoperatively following procedures such as PBC, MVD, and RFT. In conclusion, this study has shown that PBC treatment is effective in managing TN in both males and females, regardless of whether the treatment was administered as a primary intervention or following prior surgical procedures such as PBC, MVD, or RFT. Nonetheless, it is noted that the risk of postoperative complications appears to be higher in female patients compared to male patients.
Collapse
Affiliation(s)
- Qianqian Tang
- Dalian Medical University, Dalian, Liaoning Province, China
- Department of Anesthesiology, People's Hospital of China Medical University (People's Hospital of Liaoning Province), Shenyang, China
| | - Shihui Gao
- Dalian Medical University, Dalian, Liaoning Province, China
- Department of Anesthesiology, People's Hospital of China Medical University (People's Hospital of Liaoning Province), Shenyang, China
| | - Changming Wang
- Department of Anesthesiology, People's Hospital of China Medical University (People's Hospital of Liaoning Province), Shenyang, China.
| | - Kai Zheng
- Department of Anesthesiology, Jinan Eighth Hospital, Shandong, China.
| | - Jing Zhang
- Department of Anesthesiology, People's Hospital of China Medical University (People's Hospital of Liaoning Province), Shenyang, China
| | - Haitao Huang
- Department of Neurosurgery II, People's Hospital of China Medical University (People's Hospital of Liaoning Province), Shenyang, China
| | - Yanfeng Li
- Department of Neurosurgery II, People's Hospital of China Medical University (People's Hospital of Liaoning Province), Shenyang, China
| | - Yi Ma
- Department of Neurosurgery II, People's Hospital of China Medical University (People's Hospital of Liaoning Province), Shenyang, China
| |
Collapse
|
14
|
Ananthan S, Kumar U, Johnson S. A rare case of vestibular schwannoma manifesting as trigeminal neuralgia. J Am Dent Assoc 2024; 155:177-183. [PMID: 38032593 DOI: 10.1016/j.adaj.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND In this case report, the authors reviewed a rare case of a vestibular schwannoma manifesting as trigeminal neuralgia (TN). Intracranial tumors can have a variety of orofacial pain symptoms. Among benign cerebellopontine angle tumors, vestibular schwannoma is the most common cause of a TN-like manifestation. Although the most common symptoms of a vestibular schwannoma are hearing loss and vestibulopathy, the unique feature of this case was the manifestation of symptoms consistent with TN. CASE DESCRIPTION The patient had right-sided episodic facial pain that was short in duration and severe in intensity. The initial differential diagnoses included short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing and TN. As part of the routine evaluation, the patient was referred for brain magnetic resonance imaging, which revealed a right-sided vestibular schwannoma. The patient was prescribed 200 mg of gabapentin 3 times daily and was referred to neurosurgery for excision of the schwannoma. Surgical excision resulted in complete resolution of pain. PRACTICAL IMPLICATIONS This case illustrates the importance of interdisciplinary treatment and how it can lead to an optimal outcome for a patient with complex orofacial pain symptoms.
Collapse
|
15
|
Zhang F, Ni Y, Luo G, Zhang Y, Lin J. Independent association of the Meckel's cave with trigeminal neuralgia and development of a screening tool. Eur J Radiol 2024; 171:111272. [PMID: 38154423 DOI: 10.1016/j.ejrad.2023.111272] [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: 02/13/2023] [Revised: 11/13/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE To 1) investigate the association of the properties of the Meckel's cave (MC) with TN occurrence (i.e., affected vs. unaffected nerves) and whether such association was independent of neurovascular contact (NVC); and 2) develop an objective screening tool for TN. MATERIALS AND METHODS Two hundred and nineteen trigeminal nerves were included. (The severity of) NVC was identified for individual nerve, and a set of 107 radiomic features were extracted to characterize various properties of each MC. Both procedures were primarily based on magnetic resonance imaging sequences. A radiomic score (Rad-score) was constructed for each MC to integrate the features associated with TN occurrence. Independent t-test and logistic regression were conducted to assess the association and develop the screening tool mentioned above. RESULTS Twelve features were selected to build the Rad-score, with the Inverse Difference Moment Normalized (IDMN) having the greatest weight. The Rad-score was significantly (p ≤ 0.05) higher in the affected compared to the unaffected nerves, irrespective of NVC. The Rad-score and NVC were incorporated in the regression model/screening tool, which demonstrated an acceptable discriminating ability (C-statistic = 0.84). CONCLUSION This study has identified a potential association of the properties/features of the MC with TN occurrence, probably involving the demyelination and axonal injury of the trigeminal ganglion within the MC as suggested by the IDMN. Such association may be independent of NVC. This finding may provide new insight into the etiology and/or pathophysiology of TN. The screening tool, which demonstrated an acceptable discriminating ability, may contribute to an improvement in its diagnosis.
Collapse
Affiliation(s)
- Fang Zhang
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yang Ni
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guoxuan Luo
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yong Zhang
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Jinzhi Lin
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China.
| |
Collapse
|
16
|
Yang W, Sattari SA, Feghali J, Hung A, Chen Y, Xu R, Bettegowda C, Lim M, Huang J. Management outcomes of peripontine arteriovenous malformation patients presenting with trigeminal neuralgia. J Neurosurg 2024; 140:515-521. [PMID: 37486910 DOI: 10.3171/2023.5.jns23771] [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: 04/06/2023] [Accepted: 05/22/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Trigeminal neuralgia as the presenting symptom of brain arteriovenous malformation (bAVM) has been rarely reported. Treatment of reported cases has been skewed toward surgery for these scarce, deeply located bAVMs. Here, the authors report their management and outcomes of bAVM patients presenting with ipsilateral trigeminal neuralgia (TN) at their institution. METHODS This is a retrospective cohort study. The authors' institutional bAVM database was queried for non-hereditary hemorrhagic telangiectasia bAVMs in pontine, cistern, brainstem, trigeminal nerve, or tentorial locations. Patients with complete data were included in a search for trigeminal neuralgia or "facial pain" as the presenting symptom with TN being on the same side as the bAVM. Demographics, TN and bAVM characteristics, management strategies, and outcomes of bAVM and TN management were analyzed. RESULTS Fifty-seven peripontine bAVMs were identified; 8 (14.0%) of these bAVMs were discovered because of ipsilateral TN, including 4 patients (50%) with facial pain in the V2 distribution. Five patients (62.5%) were treated with carbamazepine as the initial medical therapy, 2 (25%) underwent multiple rhizotomies, and 1 (12.5%) underwent microvascular decompression. None of the patients with TN-associated bAVMs presented with hemorrhage, compared with 25 patients (51%) with bAVMs that were not associated with TN (p < 0.01). TN-associated bAVMs were overall smaller than non-TN-associated bAVMs, but the difference was not statistically significant (1.71 cm vs 2.22 cm, p = 0.117), and the Spetzler-Martin grades were similar. Six patients (75%) underwent radiosurgery to the bAVM (mean dose 1800 cGy, mean target volume 0.563 cm3) and had complete resolution of TN symptoms (100%). The mean time from radiosurgery to TN resolution was 193 (range 21-360) days, and 83.3% of treated TN-associated bAVMs were obliterated via radiosurgery. Two patients (12.5%) were recommended for conservative management, with one undergoing subsequent rhizotomies and another patient died of hemorrhage during follow-up. CONCLUSIONS TN-associated bAVM is a rare condition with limited evidence for management guidance. Radiosurgery can be safe and effective in achieving durable TN control in patients with TN-associated bAVMs. Despite their deep location and unruptured presentation, obliteration can reach 83.3% with radiosurgery.
Collapse
Affiliation(s)
- Wuyang Yang
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Shahab Aldin Sattari
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - James Feghali
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Alice Hung
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Yuxi Chen
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Risheng Xu
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Chetan Bettegowda
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Michael Lim
- 2Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Judy Huang
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| |
Collapse
|
17
|
Mousavi SH, Lindsey JW, Westlund KN, Alles SRA. Trigeminal Neuralgia as a Primary Demyelinating Disease: Potential Multimodal Evidence and Remaining Controversies. J Pain 2024; 25:302-311. [PMID: 37643657 DOI: 10.1016/j.jpain.2023.08.012] [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] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
Trigeminal neuralgia is a heterogeneous disorder with likely multifactorial and complex etiology; however, trigeminal nerve demyelination and injury are observed in almost all patients with trigeminal neuralgia. The current management strategies for trigeminal neuralgia primarily involve anticonvulsants and surgical interventions, neither of which directly address demyelination, the pathological hallmark of trigeminal neuralgia, and treatments targeting demyelination are not available. Demyelination of the trigeminal nerve has been historically considered a secondary effect of vascular compression, and as a result, trigeminal neuralgia is not recognized nor treated as a primary demyelinating disorder. In this article, we review the evolution of our understanding of trigeminal neuralgia and provide evidence to propose its potential categorization, at least in some cases, as a primary demyelinating disease by discussing its course and similarities to multiple sclerosis, the most prevalent central nervous system demyelinating disorder. This proposed categorization may provide a basis in investigating novel treatment modalities beyond the current medical and surgical interventions, emphasizing the need for further research into demyelination of the trigeminal sensory pathway in trigeminal neuralgia. PERSPECTIVE: This article proposes trigeminal neuralgia as a demyelinating disease, supported by histological, clinical, and radiological evidence. Such categorization offers a plausible explanation for controversies surrounding trigeminal neuralgia. This perspective holds potential for future research and developing therapeutics targeting demyelination in the condition.
Collapse
Affiliation(s)
- Seyed H Mousavi
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - John W Lindsey
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Karin N Westlund
- Department of Anesthesiology & Critical Care Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Sascha R A Alles
- Department of Anesthesiology & Critical Care Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| |
Collapse
|
18
|
Fu S, Yang Z. Motor cortex stimulation for the treatment of trigeminal neuralgia after brainstem infarction: A case report. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2024; 49:54-57. [PMID: 38615166 PMCID: PMC11017023 DOI: 10.11817/j.issn.1672-7347.2024.230233] [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] [Grants] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Indexed: 04/15/2024]
Abstract
Secondary trigeminal neuralgia after brainstem infarction is rare and rarely reported. A patient with secondary trigeminal neuralgia after brainstem infarction was admitted to the Department of Neurosurgery, Xiangya Hospital, Central South University. The patient was a 44 years old male who underwent motor cortex stimulation treatment after admission. The effect was satisfactory in the first week after surgery, but the effect was not satisfactory after one week. This disease is relatively rare and the choice of clinical treatment still requires long-term observation.
Collapse
Affiliation(s)
- Shiyu Fu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China.
| |
Collapse
|
19
|
Lv SS, Lv XJ, Cai YQ, Hou XY, Zhang ZZ, Wang GH, Chen LQ, Lv N, Zhang YQ. Corticotropin-releasing hormone neurons control trigeminal neuralgia-induced anxiodepression via a hippocampus-to-prefrontal circuit. Sci Adv 2024; 10:eadj4196. [PMID: 38241377 PMCID: PMC10798562 DOI: 10.1126/sciadv.adj4196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
Anxiety and depression are frequently observed in patients suffering from trigeminal neuralgia (TN), but neural circuits and mechanisms underlying this association are poorly understood. Here, we identified a dedicated neural circuit from the ventral hippocampus (vHPC) to the medial prefrontal cortex (mPFC) that mediates TN-related anxiodepression. We found that TN caused an increase in excitatory synaptic transmission from vHPCCaMK2A neurons to mPFC inhibitory neurons marked by the expression of corticotropin-releasing hormone (CRH). Activation of CRH+ neurons subsequently led to feed-forward inhibition of layer V pyramidal neurons in the mPFC via activation of the CRH receptor 1 (CRHR1). Inhibition of the vHPCCaMK2A-mPFCCRH circuit ameliorated TN-induced anxiodepression, whereas activating this pathway sufficiently produced anxiodepressive-like behaviors. Thus, our studies identified a neural pathway driving pain-related anxiodepression and a molecular target for treating pain-related psychiatric disorders.
Collapse
Affiliation(s)
- Su-Su Lv
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Xue-Jing Lv
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Ya-Qi Cai
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Xin-Yu Hou
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Zhi-Zhe Zhang
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Guo-Hong Wang
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Li-Qiang Chen
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Ning Lv
- Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | | |
Collapse
|
20
|
Ortega A, Damodaran O, Tan IYL, Silsby M. Bilateral trigeminal neuralgia due to bilaterally duplicated superior cerebellar arteries. BMJ Case Rep 2024; 17:e258818. [PMID: 38238165 PMCID: PMC10806915 DOI: 10.1136/bcr-2023-258818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Affiliation(s)
- Alexandra Ortega
- Westmead Clinical School, The University of Sydney Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Omprakash Damodaran
- Neurosurgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Irene Yew Lan Tan
- Radiology Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Matthew Silsby
- Westmead Clinical School, The University of Sydney Faculty of Medicine and Health, Camperdown, New South Wales, Australia
- Neurology Department, Westmead Hospital, Westmead, New South Wales, Australia
- Neurology Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| |
Collapse
|
21
|
Park DJ, Kumar KK, Marianayagam NJ, Yener U, Rahimy E, Hancock S, Meola A, Chang SD. Treatment of Trigeminal Neuralgia Secondary to Petroclival Meningioma Using Microsurgical Resection, Microvascular Decompression, and Stereotactic Radiosurgery: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:107-108. [PMID: 38099694 DOI: 10.1227/ons.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/12/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- David J Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin K Kumar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Neelan J Marianayagam
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ulas Yener
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Elham Rahimy
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Steven Hancock
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
22
|
Tirupathi S, Afnan L. Is trigeminal neuralgia the tip of cancer iceberg: An insight. J Cancer Res Ther 2024; 20:500-501. [PMID: 38554376 DOI: 10.4103/jcrt.jcrt_2488_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/06/2023] [Indexed: 04/01/2024]
Affiliation(s)
- Sunnypriytham Tirupathi
- Department of Pediatric and Preventive Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Lamea Afnan
- Department of Public Health Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| |
Collapse
|
23
|
Shimano H. [Microvascular Decompression for Trigeminal Neuralgia Caused by Trigeminocerebellar Artery]. No Shinkei Geka 2024; 52:96-101. [PMID: 38246675 DOI: 10.11477/mf.1436204884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The trigeminocerebellar artery(TCA)is a unique branch of the basilar artery. The TCA was first described in detail by Markovic et al. in 1996. The incidence of TCA was 6.9%-13.3% in previous cadaveric studies. The TCA branches from the distal part of the basilar artery, courses very close to the trigeminal nerve root entry zone, and occasionally twists or encircles the nerve root. A close relationship between the TCA and trigeminal nerve can cause trigeminal neuralgia(TN). This characteristic course of TCA requires adjuvant decompression techniques performed by the operators. In the microvascular decompression for TN caused by the TCA, operators should pay attention to the following: 1)sufficient arachnoid dissection around the TCA, 2)combined transposition and interposition technique, 3)decompression of perforators and vessels penetrating the nerve, and 4)recognition of the existence of the TCA.
Collapse
|
24
|
Toda H, Ishibashi R, Hashikata H. [Microvascular Decompression for Trigeminal Neuralgia Due to Venous Compression]. No Shinkei Geka 2024; 52:88-95. [PMID: 38246674 DOI: 10.11477/mf.1436204883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
In microvascular decompression surgery for trigeminal neuralgia, the veins are essential as an anatomical frame for the microsurgical approach and as an offending vessel to compress the trigeminal nerve. Thorough arachnoid dissection of the superior petrosal vein and its tributaries provides surgical corridors to the trigeminal nerve root and enables the mobilization of the bridging, brainstem, and deep cerebellar veins. It is necessary to protect the trigeminal nerve by coagulating and cutting the offending vein. We reviewed the clinical features of trigeminal neuralgia caused by venous decompression and its outcomes after microvascular decompression. Among patients with trigeminal neuralgia, 4%-14% have sole venous compression. Atypical or type 2 trigeminal neuralgia may occur in 60%-80% of cases of sole venous compression. Three-dimensional MR cisternography and CT venography can help in detecting the offending vein. The transverse pontine vein is the common offending vein. The surgical cure and recurrence rates of trigeminal neuralgia with venous compression are 64%-75% and 23%, respectively. Sole venous compression is a unique form of trigeminal neuralgia. Its clinical characteristics differ from those of trigeminal neuralgia caused by arterial compression. Surgical procedures to resolve venous compression include nuances in safely handling venous structures.
Collapse
Affiliation(s)
- Hiroki Toda
- Department of Neurosurgery, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai
| | | | | |
Collapse
|
25
|
Coburn RP, Truitt KA, DeLone DR. Dolichoectatic Basilar Artery Causing Trigeminal Neuralgia. Mayo Clin Proc 2024; 99:172-173. [PMID: 38176826 DOI: 10.1016/j.mayocp.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Ryan P Coburn
- Department of Neurology, Mayo Clinic, Rochester, MN.
| | | | | |
Collapse
|
26
|
Zhu Z, Zhang Z, Liang R. Trigeminal neuralgia caused by a persistent primitive trigeminal artery variant passing through Meckel's cavity: a case report. BMC Neurol 2023; 23:432. [PMID: 38062385 PMCID: PMC10702054 DOI: 10.1186/s12883-023-03483-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Persistent primitive trigeminal artery variant (PPTAv) is a rare remnant of the primitive intracranial embryonic anastomotic arteries, and its persistence has an unknown etiology. Trigeminal neuralgia attributed to a PPTAv passing through Meckel's cavity is extremely uncommon. CASE PRESENTATION A 73-year-old woman presented with right-sided facial pain for 10 years that had failed to respond to medication. Magnetic resonance angiography suggested the presence of a PPTAv compressing the trigeminal nerve, as the abnormal artery originated from the right internal carotid artery. During microvascular decompression (MVD), the offending vessel was inferred to be a PPTAv, as it continued to become the anterior inferior cerebellar artery after passing through Meckel's cavity. Postoperative computed tomography angiography showed the PPTAv continuing posteriorly as the anterior inferior cerebellar artery and supplying the cerebellar hemisphere, which confirmed the intraoperative judgment. The pain resolved after MVD and has not recurred in 12 months of follow-up. CONCLUSION MVD is the best surgical choice for trigeminal neuralgia combined with a PPTAv. For patients with neurovascular conflicts, particularly those with suspected vascular variations, preoperative imaging examinations play a critical role in meticulously evaluating the anatomical locations of the nerves and blood vessels. Semilunar puncture (for radiofrequency ablation or percutaneous balloon compression) is contraindicated in patients with a PPTAv.
Collapse
Affiliation(s)
- Zhengyan Zhu
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Zhenpan Zhang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Risheng Liang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
| |
Collapse
|
27
|
Sudhakar V, Sekula RF. Retrosigmoid microvascular decompression as a treatment for trigeminal neuralgia in a patient with osteogenesis imperfecta. Br J Neurosurg 2023; 37:1667-1669. [PMID: 34057868 DOI: 10.1080/02688697.2021.1931811] [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: 04/26/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Individuals with osteogenesis imperfecta develop pathologic bone due to genetic defects in collagen synthesis. These patients are prone to skull base abnormalities with resultant lower cranial nerve deficits, most common of which is trigeminal neuralgia. Typically, such patients are managed medically, and surgical options are not well explored for those patients, who become refractory to medication management. While microvascular decompression is often recommended for patients with classical trigeminal neuralgia, neurovascular compression by MRI, and normal skull base anatomy, ablative procedures have been described for patients with trigeminal neuralgia and osteogenesis imperfecta. MVD via a retrosigmoid approach has not been described in a patient with trigeminal neuralgia and skull base abnormalities secondary to osteogenesis imperfecta. A 23-year-old man with osteogenesis imperfecta was referred with right-sided classical trigeminal neuralgia. His trigeminal pain had become refractory to a number of medications. High-resolution MRI demonstrated compression of the trigeminal nerve by the superior cerebellar artery. Microvascular decompression of the trigeminal nerve via a retrosigmoid craniectomy was performed, and he remains pain-free 6 months after surgery. Microvascular decompression of the trigeminal nerve through a retrosigmoid approach can be an effective surgical treatment for young patients with trigeminal neuralgia secondary to osteogenesis imperfecta.
Collapse
Affiliation(s)
- Vivek Sudhakar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
28
|
Deng S, Luo J, Lai M, Yang W, Feng W, Ouyang J, Kuang J. Percutaneous balloon compression for trigeminal neuralgia: experience and surgical techniques from a single institution. Acta Neurol Belg 2023; 123:2295-2302. [PMID: 37353706 PMCID: PMC10682111 DOI: 10.1007/s13760-023-02310-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE The treatment experience and the technical skill with percutaneous balloon compression (PBC) for treatment of primary trigeminal neuralgia (TN) were summarised in a single institution. METHODS This is a retrospective review including consecutive patients with typical symptoms of uni-lateral primary TN who underwent PBC from June 2020 to September 2021 in our institution. We excluded secondary aetiologies of TN. Patient demographics, surgical techniques and outcomes were reviewed. All included patients were initially managed with carbamazepine before PBC. RESULTS A total of 70 patients were included. The mean length of follow-up was 10.6 months. Sixty-nine (98.6%) were successfully treated, and only one patient failed due to particularly narrow foramen ovale. Amongst successfully treated patients, 68 (97.1%) had immediate pain relief, with one having delayed relief. Sixty-eight patients (97.1%) had immediate facial numbness post-operatively and one (1.4%) presented delayed numbness 7 days after surgery. In the last follow-up, regarding facial numbness, 22 (31.9%) patients had complete resolution, whilst 46 (67.6%) had different degrees of benefit. Forty-nine (71.0%) patients developed masseter muscle weakness with recovery at 3-month follow-up. No anaesthesia dolorosa, keratitis, intracranial infection or death occurred in this study. CONCLUSION PBC for treatment of TN has quick and effective result, and could be safely performed under general anaesthesia without discomfort to the patient. The common postoperative complications are facial numbness and masseter muscle weakness, with most being improved or recovered at follow-up.
Collapse
Affiliation(s)
- Shengze Deng
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi Province, China.
| | - Jilai Luo
- Department of Neurosurgery, The Affiliated Hospital of Jinggangshan University, Jinggangshan University, Jian, Jiangxi Province, China
| | - Minfang Lai
- Department of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi Province, China
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, USA
| | - Wenping Feng
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi Province, China
| | - Jinyou Ouyang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi Province, China
| | - Jianguo Kuang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi Province, China.
| |
Collapse
|
29
|
Abstract
BACKGROUND Percutaneous balloon compression is a safe and effective treatment for trigeminal neuralgia. Current technique consists of penetrating the foramen ovale using a sharp 14G needle with a stylet. Difficulty of cannulation of the foramen ovale, failures of cannulation and major neurovascular complications of the procedure, although rare, may be due to the relatively large caliber of this needle and its sharp tip. OBJECTIVE To present a novel technique to facilitate and make the cannulation of the foramen ovale with a 14G cannula safer. METHODS A rigid blunt-tip guide of 1.2 or 1.5 mm is used to penetrate the foramen ovale under lateral fluoroscopic control. Once the guide enters the foramen it is advanced further to the clival line, and a 14G cannula is then advanced over the guide to engage the foramen, at which point the guide is withdrawn and replaced with the balloon catheter. RESULTS The technique was employed to deliver a 4F balloon catheter to Meckel's cave successfully in 500 consecutive procedures performed on 416 trigeminal neuralgia patients. None of the patients had neurovascular complications like facial hematoma, arterial injury, carotid-cavernous fistula or cranial nerve palsies. CONCLUSION A novel technique for cannulation of the foramen ovale is described. The use of blunt tip guides of smaller diameters instead of sharp 14 G needles considerably facilitated cannulation of the foramen ovale and enabled cannulation in all cases. Absence of complications of cannulation such as facial hematoma, carotid-cavernous fistula or intracranial hemorrhage in this series of patients suggests that the technique may be safer than the use of conventional sharp tipped 14G needles in terms of avoiding neurovascular complications.
Collapse
Affiliation(s)
- Orhan Barlas
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugrul Cem Unal
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
30
|
Eghlimi RA, Meyer JH, Bendok BR, Zimmerman RS. Commentary: Microvascular Decompression for Treatment of Simultaneous Arterial and Venous Conflict Causing Trigeminal Neuralgia: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e380-e381. [PMID: 37831982 DOI: 10.1227/ons.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 10/15/2023] Open
Affiliation(s)
- Ryan A Eghlimi
- Mayo Clinic Alix School of Medicine, Scottsdale , Arizona , USA
| | - Jenna H Meyer
- Department of Neurosurgery, Mayo Clinic Arizona, Phoenix , Arizona , USA
| | - Bernard R Bendok
- Department of Neurosurgery, Mayo Clinic Arizona, Phoenix , Arizona , USA
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix , Arizona , USA
- Department of Radiology, Mayo Clinic Arizona, Phoenix , Arizona , USA
| | | |
Collapse
|
31
|
Hatipoglu Majernik G, Wolff Fernandes F, Al-Afif S, Heissler HE, Krauss JK. Microsurgical posterior fossa re-exploration for recurrent trigeminal neuralgia after previous microvascular decompression: common grounds-scarring, deformation, and the "piston effect". Acta Neurochir (Wien) 2023; 165:3877-3885. [PMID: 37955684 PMCID: PMC10739219 DOI: 10.1007/s00701-023-05877-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Microvascular decompression (MVD) is a well-accepted treatment modality for trigeminal neuralgia (TN) with high initial success rates. The causes for recurrence of TN after previously successful MVD have not been fully clarified, and its treatment is still a matter of debate. Here, we present the surgical findings and the clinical outcome of patients with recurrent TN after MVD who underwent posterior fossa re-exploration. METHODS Microsurgical posterior fossa re-exploration was performed in 26 patients with recurrent TN (mean age 59.1 years) who underwent MVD over a period of 10 years. The trigeminal nerve was exposed, and possible factors for recurrent TN were identified. Arachnoid scars and Teflon granulomas were dissected meticulously without manipulating the trigeminal nerve. Outcome of posterior fossa re-exploration was graded according to the Barrow Neurological Institute (BNI) pain intensity score. Follow-up was analyzed postoperatively at 3, 12, and 24 months and at the latest available time point for long-term outcome. RESULTS The mean duration of recurrent TN after the first MVD was 20 months. Pain relief was achieved in all patients with recurrent TN on the first postoperative day. Intraoperative findings were as follows: arachnoid scar tissue in 22/26 (84.6%) patients, arterial compression in 1/26 (3.8%), venous contact in 8/26 (30.8%), Teflon granuloma in 14/26 (53.8%), compression by an electrode in Meckel's cave used for treatment of neuropathic pain in 1/26 (3.8%), evidence of pulsations transmitted to the trigeminal nerve through the Teflon inserted previously/scar tissue ("piston effect") in 15/26 (57.7%), and combination of findings in 18/26 (69.2%). At long-term follow-up (mean 79.5 months; range, 29-184 months), 21/26 (80.8%) patients had favorable outcome (BNI I-IIIa). New hypaesthesia secondary to microsurgical posterior fossa re-exploration occurred in 5/26 (19.2%) patients. CONCLUSIONS Posterior fossa re-exploration avoiding manipulation to the trigeminal nerve, such as pinching or combing, may be a useful treatment option for recurrent TN after previously successful MVD providing pain relief in the majority of patients with a low rate of new hypaesthesia.
Collapse
Affiliation(s)
- Gökce Hatipoglu Majernik
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Lower Saxony, Germany
| | - Filipe Wolff Fernandes
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Lower Saxony, Germany.
| | - Shadi Al-Afif
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Lower Saxony, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Lower Saxony, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Lower Saxony, Germany
| |
Collapse
|
32
|
Mori K, Otani N, Toyooka T, Morita S, Numazawa S, Wada K, Watanabe S. Validation of Efficacy and Safety of TachoSil ® Tissue Sealant for Vessel Transposition in Microvascular Decompression. Oper Neurosurg (Hagerstown) 2023; 25:417-425. [PMID: 37820076 DOI: 10.1227/ons.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Use of TachoSil ® as the transposition material of microvascular decompression (MVD) for hemifacial spasm (HFS) and trigeminal neuralgia (TN) is easy and safe to perform, but the efficacy and safety of this technique are unknown. This study attempted to validate the efficacy and safety of TachoSil ® as a transposition material of MVD. METHODS A retrospective study of the surgical results and complications of 63 patients (35 HFS and 28 TN) treated by the TachoSil ® technique between January 2011 and December 2021 was conducted. The efficacy of the treatment was evaluated by Kaplan-Meier survival analysis. Magnetic resonance imaging follow-up study was performed to detect any adverse events including a mass formation. RESULTS The rate of complete disappearance of HFS was 91.4% at 1 year and estimated to be 85.7% after a 10-year follow-up. The rate of no pain without medication for TN was 85.4% at 1 year and estimated to be 69.0% after a 9-year follow-up. These surgical results are comparable with those previously reported. Flaking of TachoSil ® releasing the offending artery was only recognized in one case (1.6%). Therefore, TachoSil ® can be considered as an effective transposition material for MVD. TachoSil ® did not increase the rate of acute and subacute adverse events such as inflammation and delayed facial palsy. Magnetic resonance imaging follow-up identified no abnormalities including mass that suggested granuloma formation. CONCLUSION The efficacy of the TachoSil ® technique for HFS and TN and the reliability of TachoSil ® as an adhesive material in MVD were verified. No adverse events associated with TachoSil ® use in MVD were found. We conclude that the TachoSil ® technique has relatively long efficacy and safety for MVD.
Collapse
Affiliation(s)
- Kentaro Mori
- Department of Neurosurgery, Tokyo General Hospital, Tokyo , Japan
- Department of Neurosurgery, National Defense Medical College, Tokorozawa , Saitama , Japan
| | - Naoki Otani
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo , Japan
| | - Terushige Toyooka
- Department of Neurosurgery, National Defense Medical College, Tokorozawa , Saitama , Japan
| | - Shuhei Morita
- Department of Neurosurgery, Tokyo General Hospital, Tokyo , Japan
| | | | - Kojiro Wada
- Department of Neurosurgery, National Defense Medical College, Tokorozawa , Saitama , Japan
| | | |
Collapse
|
33
|
Amaya Pascasio L, De La Casa-Fages B, Esteban de Antonio E, Grandas F, García-Leal R, Ruiz Juretschke F. Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factors. Neurologia 2023; 38:625-634. [PMID: 37996213 DOI: 10.1016/j.nrleng.2021.03.010] [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: 08/25/2020] [Accepted: 03/02/2021] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Microvascular decompression is considered to be the most effective and only etiological surgical treatment for classical trigeminal neuralgia, relieving the neurovascular compression found in up to 95% of cases. This study aims to report the long-term outcomes and to identify prognostic factors in a series of patients with trigeminal neuralgia treated by microvascular decompression. METHODS A retrospective observational study of 152 consecutive patients operated by microvascular decompression with at least six months of follow-up. The surgical results, including pain relief according to the Barrow Neurological Institute pain scale, complications and the medical treatment during the follow-up period were reviewed. Binary regression analysis was performed to identify factors associated with a good long-term outcome. RESULTS A total of 152 patients with a mean age of 60 years and a mean follow-up of 43 months were included. At the final follow-up visit, 83% of the patients had achieved significant relief of the pain and 63% could reduce the absolute drug doses by 50% or more. The most frequent complications were wound infection (4.5%) and CSF fistula (7%). Being over 70 years of age and having paroxysmal pain were associated with a long-term pain relief. CONCLUSIONS Our results support the notion that microvascular decompression is an effective and safe therapy in patients with trigeminal neuralgia. A multidisciplinary approach with an early referral to a neurosurgical unit many be beneficial in patients who are refractory to pharmacological treatment.
Collapse
Affiliation(s)
- L Amaya Pascasio
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
| | - B De La Casa-Fages
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Neurosciences Area, Instituto Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - E Esteban de Antonio
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - F Grandas
- Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Neurosciences Area, Instituto Investigacion Sanitaria Gregorio Marañon, Madrid, Spain
| | - R García-Leal
- Neurosurgery Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - F Ruiz Juretschke
- Neurosurgery Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| |
Collapse
|
34
|
Zamarud A, Park DJ, Ung TH, McCleary TL, Yoo KH, Soltys SG, Lim M, Chang SD, Meola A. Stereotactic Radiosurgery for Medically Refractory Trigeminal Neuralgia Secondary to Stroke: A Systematic Review and Clinical Case Presentation. World Neurosurg 2023; 179:e366-e373. [PMID: 37640262 DOI: 10.1016/j.wneu.2023.08.092] [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: 04/05/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a paroxysmal, unilateral, brief, shock-like pain in ≥1 divisions of the trigeminal nerve. It can result from multiple causes; however, TN secondary to stroke is very rare. METHODS We present the case of TN secondary to pontine infarction treated with incremental doses of neuropathic pain medication for >5 years before conservative management failed. He was then treated with stereotactic radiosurgery (SRS). Additionally, we conducted a systematic review using standard PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines for all the cases of TN with brainstem stroke from 1976 to 2022. RESULTS Our patient was an 82-year-old man. Magnetic resonance imaging demonstrated a pontine lesion consistent with stroke. The Barrow Neurological Institute (BNI) score at presentation was 5. He received a marginal dose of 60 Gy to the 80% isodose line in a single fraction to a volume of 0.05 cm3. The immediate post-treatment BNI score was 0 and remained at 0 for 3 months, when he experienced recurrence. The recurrence was treated with oxcarbazepine. His pain remained well controlled with a lower dose of oxcarbazepine, and he had no adverse effects at 1 year of follow-up with a BNI score of 3. The systemic review identified 21 case reports with a combined cohort of 25 patients with TN secondary to stroke. Only 3 patients were treated with SRS, 2 of whom reported symptom improvement at 6 months and 8 months of follow-up with no adverse events. CONCLUSIONS Our case and literature review demonstrate durable and effective treatment with SRS, which can be considered a safe and effective treatment option for patients with stroke-associated TN.
Collapse
Affiliation(s)
- Aroosa Zamarud
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - David J Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Timothy H Ung
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Tamra-Lee McCleary
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kelly H Yoo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
| |
Collapse
|
35
|
Khandelwal A, Seshan JR, Rath GP, Chaturvedi A. Local Ulceration following Peripheral Neurolysis with Absolute Alcohol in Patients with Drug-Refractory Trigeminal Neuralgia: A Series of Four Cases. Neurol India 2023; 71:1244-1246. [PMID: 38174467 DOI: 10.4103/0028-3886.391396] [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: 01/05/2024]
Abstract
A significant number of patients with trigeminal neuralgia (TGN) are refractory to first-line drugs and require interruption of the pain pathway by various percutaneous procedures. One such percutaneous technique involves an injection of absolute alcohol (AA) into the peripheral branches of the trigeminal nerve. This procedure is useful in elderly and medically compromised drug-refractory cases of TGN who are not interested in undergoing open neurosurgery. Peripheral neurolysis with AA is easy, quick, and safe. It may be carried out in the outpatient department; however, its use is not free from complications. Here, we report four such patients who were complicated with local necrosis and ulceration following administration of AA. The most probable attributable etiologies are sympathetic nerve involvement, intravascular injection of alcohol, vascular spasm of the terminal arteries, distal micro-emboli effect, and faulty technique, including repeated injections.
Collapse
Affiliation(s)
- Ankur Khandelwal
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Jayanth Ranganathan Seshan
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Girija Prasad Rath
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Arvind Chaturvedi
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| |
Collapse
|
36
|
Guan H, Li S, Wang X. Fully endoscopic microvascular decompression for trigeminal neuralgia: technical note and early outcomes. Neurosurg Rev 2023; 46:292. [PMID: 37910277 DOI: 10.1007/s10143-023-02188-w] [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: 08/01/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
Microscopic microvascular decompression (MVD) has been considered a curative and reliable method for treating classical trigeminal neuralgia (TN) for decades. Endoscopy can provide bright illumination and a panoramic view, which enhances the visualization of the posterior fossa. In view of the above advantages of endoscopy, it gradually became an option for MVD for treating TN. This study was performed to evaluate the advantages of fully endoscopic MVD for treating TN and is presented with a description of our operative technique. From January 2020 to January 2022, 95 classical TN patients underwent fully endoscopic MVD performed by the same surgeon and assistant in our department. The assistant held the endoscope, and the surgeon operated. Brain stem auditory evoked potentials (BEMPs) were routinely monitored. For every patient, the neurovascular conflict was identified, and complete decompression was achieved. The Barrow Neurological Institute (BNI) pain intensity score was used to evaluate the degree of facial pain. The intraoperative findings, postoperative outcomes, and complications were analyzed. Immediately after the operation, 93 patients (97.9%) achieved complete pain relief (BNI score of I). Two patients (2.1%) still had some pain, but it could be adequately controlled with medicine (BNI score of III). During the 12-36 months of follow-up, recurrence was found in 3 patients (3.2%), including one patient (1.1%) with a BNI score of II and 2 patients (2.1%) with a BNI score of III. Complications were found in 5 patients (5.3%), including facial numbness in 3 patients (3.2%), vertigo in one patient (1.1%), and headache in one patient (1.1%). There were no cases of mortality, stroke, hearing impairment, facial paralysis, or other complications. Fully endoscopic MVD is a safe and effective method for treating TN. It provides bright illumination and a panoramic view for surgeons to better observe neurovascular conflicts in deep areas of the cerebellopontine angle (CPA).
Collapse
Affiliation(s)
- Hongpeng Guan
- Department of Neurosurgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Kongjiang Road & No.1665, Shanghai, 200092, China
| | - Shiting Li
- Department of Neurosurgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Kongjiang Road & No.1665, Shanghai, 200092, China
| | - Xuhui Wang
- Department of Neurosurgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Kongjiang Road & No.1665, Shanghai, 200092, China.
- Department of Neurosurgery, Chongming Hospital Affiliated with Shanghai University of Medicine and Health Sciences, Nanmen Road & No. 25, Shanghai, 202150, China.
| |
Collapse
|
37
|
Morales-Valero SF, Tabor JK, Moliterno J. Microvascular Decompression for Treatment of Simultaneous Arterial and Venous Conflict Causing Trigeminal Neuralgia: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e291. [PMID: 37499238 DOI: 10.1227/ons.0000000000000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/31/2023] [Indexed: 07/29/2023] Open
Affiliation(s)
- Saul F Morales-Valero
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Joanna K Tabor
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| |
Collapse
|
38
|
Flores-Pina B, Paré-Curell M, Menéndez-Osorio B, Dorado-Bouix L. [Concomitant, asynchronous and refractory trigeminal and glossopharyngeal neuralgia. Good response to surgical approach in one time]. Rev Neurol 2023; 77:223-225. [PMID: 37889130 PMCID: PMC10831735 DOI: 10.33588/rn.7709.2023182] [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: 10/18/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Microvascular decompression (MVD) surgery is the first choice treatment for refractory cranial neuralgia secondary to vascular compression. Simultaneous neuralgia of two cranial nerves is extremely rare. We describe a case of concomitant refractory trigeminal (TN) and glossopharyngeal (GN) neuralgia secondary to neurovascular crossover, treated surgically at the same time. CASE REPORT 65-year-old woman with right TN (initially V2-V3) since 2004 with regular control with carboxamides. Seventeen years later, paroxysms worsened in V2-V3, also appearing in V1 and in the territory of the right glossopharyngeal nerve (right ear and tonsillar fossa when speaking and swallowing). Cerebral MRI showed significant arterial contact between the superior cerebellar artery (SCA) with the origin of the right V cranial nerve and the antero-inferior cerebellar artery (AICA) with the origin of the right lower CCNN. MVD of both cranial nerves was performed at the same surgical time by means of retrosigmoid craniectomy, releasing the V cranial nerve, in intimate contact with the SCA, and the IX cranial nerve in contact with the right AICA, interposing teflon between them. The patient had an immediate resolution of the trigeminal paroxysms and a dramatic improvement in intensity and frequency of glossopharyngeal paroxysms. Two years after the intervention, de-escalation of neuromodulator treatment continues with good response. CONCLUSION MVD in simultaneous TN and GN is feasible and can offer a good post-surgical outcome.
Collapse
Affiliation(s)
- B Flores-Pina
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, España
| | - M Paré-Curell
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, España
| | | | - L Dorado-Bouix
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, España
| |
Collapse
|
39
|
Sampathkumar M, Krishnan SS, Dhawali V. Encephalitis following Radiofrequency Lesion for Trigeminal Neuralgia. Neurol India 2023; 71:1311-1312. [PMID: 38174497 DOI: 10.4103/0028-3886.391378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
|
40
|
Zhang M, Phung D, Gupta R, Wykes J, Wu R, Lee J, Elliott M, Palme CE, Clark J, Low THH. Persisting facial nerve palsy or trigeminal neuralgia - red flags for perineural spread of head and neck cutaneous squamous cell carcinoma (HNcSCC). ANZ J Surg 2023; 93:2394-2401. [PMID: 37485776 DOI: 10.1111/ans.18625] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Perineural spread (PNS) of head and neck cutaneous squamous cell carcinoma (HNcSCC) is a unique diagnostic challenge, presenting with insidious trigeminal (CN V) or facial nerve (CN VII) neuropathies without clinically discernible primary masses. These patients are often sub-optimally investigated and misdiagnosed as Bell's palsy or trigeminal neuralgia. This case series highlights the red flags in history and pitfalls that lead to delays to diagnosis and treatment. METHODS A retrospective case series of 19 consecutive patients with complete clinical histories with HNcSCC PNS without an obvious cutaneous primary lesion at time of presentation to a quaternary head and neck centre in Australia were identified and included for analysis. RESULTS Fifteen had CN VII PNS, 17 had CN V PNS, and 13 had both. The overall median symptom-to-diagnosis time was 12-months (IQR-15 months). Eight patients had CN VII PNS and described progressive segmental facial nerve palsy with a median symptom-to-diagnosis time of 9-months (IQR-11.75 months). Eleven patients had primary CN V PNS and described well localized parathesia, formication or neuralgia with a median symptom-to-diagnosis time of 19-months (IQR 27.5 months). CONCLUSION PNS is often mistaken for benign cranial nerve dysfunction with delays in diagnosis worsening prognosis. Red flags such as progressive CN VII palsy or persistent CN V paraesthesia, numbness, formication or pain, particularly in the presence of immuno-compromise and/or a history of facial actinopathy should raise suspicion for PNS. Gadolinium-enhanced MR Neurography should be obtained expediently in patients with persistent/progressive CN V/CN VII palsies in patients with red flags, with low threshold for referral to a Head and Neck Surgeon.
Collapse
Affiliation(s)
- Michael Zhang
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Daniel Phung
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Ruta Gupta
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Raymond Wu
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jenny Lee
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Elliott
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Otolaryngology, Head and Neck Surgery, Macquarie Medical School, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
41
|
Mulcahy T, Ma N, Mitchell K. Endovascular treatment of trigeminal neuralgia with cranial autonomic symptoms due to a right-sided petrous ridge dAVF. Br J Neurosurg 2023; 37:1339-1345. [PMID: 33467937 DOI: 10.1080/02688697.2021.1874295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/05/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
Dural arteriovenous fistula represents a rare cause of secondary Trigeminal Neuralgia. To date, there have been 18 reported cases of successful treatment of trigeminal neuralgia with endovascular embolization. Here we describe a unique case of a 51-year-old man with right-sided petrous ridge dural arteriovenous fistula causing ipsilateral V1 pain and cranial autonomic dysfunction. Cerebral angiography confirmed a Cognard type 3 right-sided tentorial dAVF supplied by an enlarged meningo-hypophpyseal vessel from the extradural ICA and by the middle meningeal artery. The fistula drains towards the midline via deep cerebral veins, the internal cerebral vein and the straight sinus with likely variceal compression of the right trigeminal nerve root entry zone. Transarterial Onyx embolization resulted in complete obliteration of the dural arteriovenous fistula with immediate resolution of facial pain and autonomic symptoms. After 24 months, the patient remains symptom-free and has no radiographic or clinical evidence of fistula recurrence. To date, there have been no other cases reported of trigeminal neuralgia with cranial autonomic symptoms or SUNCT syndrome due to a dural arteriovenous fistula. The presence of cranial autonomic symptoms with trigeminal neuralgia or a diagnosis of SUNCT should not deter endovascular treatments of dural arteriovenous fistulas or treatment of other compressive vascular lesions.
Collapse
Affiliation(s)
- Thomas Mulcahy
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Norman Ma
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Kenneth Mitchell
- Department of Interventional Radiology, Royal Brisbane and Women's Hospital, Herston, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
42
|
Hirata S, Kobayashi M, Ujihara M, Takabatake K, Fujimaki T. Preoperative findings in relation to the usefulness of endoscopic assistance for microvascular decompression. Acta Neurochir (Wien) 2023; 165:3011-3017. [PMID: 37656306 DOI: 10.1007/s00701-023-05762-9] [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: 06/20/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Endoscopy is known to be a useful adjunct for microvascular decompression (MVD) surgery, assisting observation in blind spots such as Meckel's cave in cases of trigeminal neuralgia (TN) and the root exit zone (REZ) in hemifacial spasm (HFS). However, few reports have discussed the usefulness of endoscopy in relation to individual patient characteristics or preoperative magnetic resonance imaging (MRI). METHODS We retrospectively reviewed the medical records of 109 patients (98 with HFS and 11 with TN, 85 women, median age 55 years) who had undergone endoscopically assisted MVD at our institution between 2017 and 2021. The usefulness of endoscopy in individual cases was scored by three neurosurgeons using a grading scale: 2, essential and indispensable; 1, useful and helpful; 0, not necessary. The mean value of the assigned scores was taken as an indicator of "usefulness," and endoscopy was considered to have been "useful" in cases with a score of > 1.0. RESULTS Endoscopic assistance was judged to have been useful in 69% of the patients. The proportion of patients evaluated as useful was significantly lower for TN (18.2%) than for HFS (74.5%). Patients with superior cerebellar artery compression had significantly lower scores than patients with other vessels. Endoscopy was considered useful in a significantly higher proportion of patients with anatomically complicated offending vessels (bifurcation or strong meandering) in the REZ detected by preoperative MRI (P < 0.005). CONCLUSION Endoscopy for MVD is useful for patients with HFS, especially when preoperative MRI shows bifurcation or strongly meandering vessels in the REZ.
Collapse
Affiliation(s)
- Sachiko Hirata
- Department of Neurosurgery, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan.
| | - Masahito Kobayashi
- Department of Neurosurgery, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan
| | - Masaki Ujihara
- Department of Neurosurgery, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan
| | - Kazuhiko Takabatake
- Department of Neurosurgery, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan
| | - Takamitsu Fujimaki
- Department of Neurosurgery, Saitama Medical University Hospital, 38 Morohongo, Moroyama-Machi, Iruma-Gun, Saitama, 350-0495, Japan
| |
Collapse
|
43
|
Hu S, Huang Z, Wang H, Chen K, Xia L, Dou N, Zhong J. The Value of a Headless Pear Shape in Percutaneous Balloon Compression for Trigeminal Neuralgia. Oper Neurosurg (Hagerstown) 2023; 25:372-378. [PMID: 37499245 DOI: 10.1227/ons.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Percutaneous balloon compression (PBC) has been regarded as a simple and effective remedy for trigeminal neuralgia. This study aims to retrospectively analyze the correlation between intraoperative balloon shapes and postoperative outcomes. METHOD Those consecutive PBC cases performed in our department between 2019 and 2022 were reviewed. According to the intraoperative balloon figures, they were cataloged as headless pear, slim pear, bottle gourd, and winter melon groups. The degree of pain or numbness was quantified using the visual analog scale. Those pain-free or pain score <3 and satisfied by the patient were called effective, and those numb score >3 were taken into account of numbness incidence. RESULTS Except for missing cases, 160 were finally recruited in this study with a mean follow-up for 23.6 ± 12.8 months. Postoperatively, the pain score plunged from 8.8 ± 1.0 to 0.8 ± 2.0 immediately, which rose slightly over time and maintained at 2.4 ± 3.1. The maximal pain score drop occurred in the headless pear group ( P < .001) and the minimal in the winter melon group ( P < .001). The early efficacy of PBC was 100%, 84.1%, 91.4%, and 50.0%, respectively. However, the long-term efficacy was 88.2%, 75.0%, 82.1% and 25.0%. The ipsilateral numbness occurred in most of the cases immediately after PBC with a score of 3.5 ± 2.3, which decreased significantly within 3 months to 2.3 ± 2.0 and turned to 1.7 ± 1.8 finally ( P < .05). The highest and lowest numb score appeared in bottle gourd and winter melon groups, respectively ( P < .05). CONCLUSION A headless pear shape emerged in lateral fluoroscopy as the balloon was fully inflated indicates that the entire Meckel cave is suffused, and hence, the anterior semilunar ganglion has been solidly compressed, which may lead to a successful outcome.
Collapse
Affiliation(s)
- Shaozhen Hu
- Department of Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | | | | | | | | | | | | |
Collapse
|
44
|
Grossen AA, Iser CR, Leming AB, Desai VR, Chrusciel DG. Treatment of pediatric trigeminal neuralgia with microvascular decompression: a case series and systematic review. J Neurosurg Pediatr 2023; 32:384-393. [PMID: 37347654 DOI: 10.3171/2023.4.peds22494] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is a rare disorder, affecting 4-13 per 100,000 people annually. Only 1%-1.5% of these cases are reported before the age of 18 years. The initial management of pediatric TN is based on symptomatic treatment, using first-line medications including carbamazepine, based on data from adult treatment studies. Many of these children are refractory to medication and undergo excessive workup and ineffective therapies before neurosurgical referral. The objective of this study was to perform a comprehensive review of literature-reported pediatric-onset TN, analyzing demographics, diagnostic practices, and complications in this population. METHODS An institutional, retrospective chart review was performed to identify patients younger than 18 years old who were diagnosed with classic TN and referred for surgical evaluation at Oklahoma Children's Hospital (OCH). A systematic review of all pediatric patients undergoing microvascular decompression (MVD) for pediatric-onset TN was also performed. RESULTS Three patients from OCH were identified, ranging in age from 3 to 11 years. All 3 patients had received multiple ineffective medical therapies before referral for neurosurgical evaluation. In 2 cases, imaging demonstrated potential vascular compression of the trigeminal nerve. In the final case, imaging demonstrated no vascular compression, but compression was found at the time of MVD. All cases were successfully treated using MVD. The literature review identified 49 cases of pediatric TN treated using MVD. All 49 cases were identified as classic TN with neurovascular compression demonstrated either on imaging or found at the time of surgery. The average age at symptom onset was 11.72 years, while the average age at MVD was 19.6 years. The average duration of symptoms before undergoing MVD was 8.2 years. There was a female predominance in the literature review, with a female-to-male ratio of 1.88:1. The right side was involved in 56% of cases, the left side in 40%, and bilateral involvement occurred in 4% of cases. The most common distribution of TN was both V2/3 branches (38%) of the trigeminal nerve, followed by solely the V2 branch (22%). A successful outcome (Barrow Neurological Institute pain intensity score of I or II) was reported in 79% of patients at the last follow-up (mean 69.1 months). CONCLUSIONS There are currently no guidelines for diagnosing or treating pediatric TN. MVD is a safe and effective option in this patient population. Early evaluation for surgical intervention could be critical for early pain relief and reduced disease morbidity.
Collapse
Affiliation(s)
- Audrey A Grossen
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital; and
| | - Courtney R Iser
- 3Neurology, University of Oklahoma Health Sciences Center
- 4Department of Neurology, Section of Pediatric Neurology, Oklahoma Children's Hospital, Oklahoma City, Oklahoma
| | - Amy B Leming
- 3Neurology, University of Oklahoma Health Sciences Center
- 4Department of Neurology, Section of Pediatric Neurology, Oklahoma Children's Hospital, Oklahoma City, Oklahoma
| | - Virendra R Desai
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital; and
| | - Deepti G Chrusciel
- 3Neurology, University of Oklahoma Health Sciences Center
- 4Department of Neurology, Section of Pediatric Neurology, Oklahoma Children's Hospital, Oklahoma City, Oklahoma
| |
Collapse
|
45
|
Sehgal A, Kumar J, Singh I, Gopal A. Trigeminal Lipomatosis: A Rare Cause of Intractable Neuralgia. J Radiol Case Rep 2023; 17:49-56. [PMID: 38090637 PMCID: PMC10713231 DOI: 10.3941/jrcr.v17i8.4709] [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: 12/18/2023] Open
Abstract
Lipomatosis of nerve, earlier known as fibrolipomatous hamartoma is a rare condition which predominantly affects peripheral nerves, cranial nerve involvement being extremely uncommon. Preoperative consideration of this entity is of paramount importance as its inadvertent complete surgical resection may inevitably result in significant neurological deficit. We report a case of trigeminal lipomatosis in a young patient with trigeminal neuralgia.
Collapse
Affiliation(s)
- Apoorva Sehgal
- Department of Radio-diagnosis, Maulana Azad Medical College, New Delhi, India
| | - Jyoti Kumar
- Department of Radio-diagnosis, Maulana Azad Medical College, New Delhi, India
| | - Ishwar Singh
- Department of E.N.T, Maulana Azad Medical College, New Delhi, India
| | - Ashish Gopal
- Department of E.N.T, Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
46
|
Leduc W, Mathieu D, Adam E, Ferreira R, Iorio-Morin C. Gamma Knife Stereotactic Radiosurgery for Trigeminal Neuralgia Secondary to Multiple Sclerosis: A Case-Control Study. Neurosurgery 2023; 93:453-461. [PMID: 36861995 DOI: 10.1227/neu.0000000000002440] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/09/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The efficacy of stereotactic radiosurgery (SRS) for the relief of trigeminal neuralgia (TN) is well established. Much less is known, however, about the benefit of SRS for multiple sclerosis (MS)-related TN (MS-TN). OBJECTIVE To compare outcomes in patients who underwent SRS for MS-TN vs classical/idiopathic TN and identify relative risk factors for failure. METHODS We conducted a retrospective, case-control study of patients who underwent Gamma Knife radiosurgery at our center for MS-TN between October 2004 and November 2017. Cases were matched 1:1 to controls using a propensity score predicting MS probability using pretreatment variables. The final cohort consisted of 154 patients (77 cases and 77 controls). Baseline demographics, pain characteristics, and MRI features were collected before treatment. Pain evolution and complications were obtained at follow-up. Outcomes were analyzed using the Kaplan-Meir estimator and Cox regressions. RESULTS There was no statistically significant difference between both groups with regards to initial pain relief (modified Barrow National Institute IIIa or less), which was achieved in 77% of patients with MS and 69% of controls. In responders, 78% of patients with MS and 52% of controls eventually had recurrence. Pain recurred earlier in patients with MS (29 months) than in controls (75 months). Complications were similarly distributed in each group and consisted, in the MS group, of 3% of new bothersome facial hypoesthesia and 1% of new dysesthesia. CONCLUSION SRS is a safe and effective modality to achieve pain freedom in MS-TN. However, pain relief is significantly less durable than in matched controls without MS.
Collapse
Affiliation(s)
- William Leduc
- Department of Neurology, Université de Sherbrooke, Qc, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Qc, Canada
| | - Elizabeth Adam
- Department of Neurosurgery, Université de Sherbrooke, Qc, Canada
| | | | | |
Collapse
|
47
|
Petitt JC, Murayi R, Potter T, Ahorukomeye P, Jarmula J, Recinos PF, Barnett GH, Kshettry VR. Percutaneous Rhizotomy of the Gasserian Ganglion in Patients With Mass Lesion-Associated Trigeminal Neuralgia: A Case Series. Oper Neurosurg (Hagerstown) 2023; 25:142-149. [PMID: 37039576 DOI: 10.1227/ons.0000000000000707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/08/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Patients with trigeminal neuralgia (TN) secondary to mass lesions are typically treated by directly addressing the underlying pathology. In cases of TN not alleviated by treatment of the pathology, percutaneous balloon compression (PBC) and glycerol rhizotomy (Gly) are simple and effective ways to alleviate pain. However, there is limited literature on the use of these techniques for patients with TN caused by mass lesions. OBJECTIVE To describe the use of PBC/Gly to treat mass lesion-related TN. METHODS We report a retrospective, single-institution, descriptive case series of patients who presented with TN secondary to tumor or mass-like inflammatory lesion from 1999 to 2021. Patients with primary, idiopathic, or multiple sclerosis-related TN were excluded. Outcomes included Barrow Neurological Institute (BNI) pain intensity and hypesthesia scores, pain persistence, and postoperative complications. RESULTS A total of 459 procedures were identified, of which 16 patients met the inclusion criterion (14 PBC and 2 Gly). Of the 15 patients with tumors, 12 had TN pain despite prior tumor-targeted radiation. Short-term (<3 months) BNI pain intensity improvement occurred in 15 (93.8%) patients. The mean follow-up was 54.4 months. Thirteen (81.3%) patients were pain-free (Barrow Neurological Institute pain intensity scale: IIIa-50%; I-25.0%; II-6.3%) for a mean of 23.8 (range 1-137) months. Ten patients (62.5%) had pain relief for ≥6 months from first procedure. New facial numbness developed immediately postprocedure in 8 (50%) patients. Transient, partial abducens nerve palsy occurred in 1 patient. CONCLUSION PBC/Gly is an effective option for medically refractory TN in patients with mass-associated TN and is a viable option for repeat treatment.
Collapse
Affiliation(s)
- Jordan C Petitt
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Roger Murayi
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Tamia Potter
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Peter Ahorukomeye
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jakub Jarmula
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Pablo F Recinos
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
- Department of Neurosurgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gene H Barnett
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
- Department of Neurosurgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Varun R Kshettry
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
- Department of Neurosurgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
48
|
Li C, Yang J, Han F, Hu T, Zhang J, Liu B, Yan L, Liu W, Wang K. Predictive value of foramen ovale size on pain recurrence after percutaneous balloon compression. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:682-690. [PMID: 37539570 PMCID: PMC10930410 DOI: 10.11817/j.issn.1672-7347.2023.220472] [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] [Grants] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Primary trigeminal neuralgia (PTN) is a common cranial nerve disease in neurosurgery, which seriously endangers the physical and mental health of patients. Percutaneous balloon compression (PBC) has become an effective procedure for the treatment of PTN by blocking pain conduction through minimally invasive puncture. However, the recurrence of facial pain after PBC is still a major problem for PTN patients. Intraoperative balloon shape, pressure and compression time can affect the prognosis of patients with PBC after surgery. The foramen ovale size has an effect on the balloon pressure in Meckel's lumen. This study aims to analyse the predictive value of foramen ovale size for postoperative pain recurrence of PBC by exploring the relationship between foramen ovale size and postoperative pain recurrence of PBC. METHODS A retrospectively analysis was conducted on the clinical data of 60 patients with PTN who were treated with PBC in Department of Neurosurgery, Affiliated Hospital of Chengde Medical College from November 2018 to December 2021. We followed-up and recorded the Barrow Neurological Institute (BNI) pain score at 1, 3, 6 and 12 months after operation. According to the BNI pain score at 12 months after surgery, the patients were divided into a cure group (BNI pain score I to Ⅱ) and a recurrence group (BNI pain score Ⅲ to Ⅴ). The long diameter, transverse diameter and area of foramen ovale on the affected side and the healthy side of the 2 groups were measured. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used for analysis the relationship between the recurrence of pain and the long diameter, transverse diameter, area of foramen ovale on the affected side, and aspect ratio, transverse diameter ratio, area ratio of foramen ovale on the affected side to healthy side in the 2 groups. RESULTS At the end of 12 months of follow-up, 50 (83.3%) patients had pain relief (the cured group), 10 (16.7%) patients had different degrees of pain recurrence (the recurrence group), and the total effective rate was 83.3%. There were no significant differences in preoperative baseline data between the 2 groups (all P>0.05). The long diameter of foramen ovale on the affected side, the long diameter ratio and area ratio of foramen ovale on the affected/healthy side in the cured group were significantly higher than those in the recurrence group (all P<0.05), and there were no significant differences in the transverse diameter and area of foramen ovale on the affected side and the transverse diameter ratio of foramen ovale on the affected/healthy side between the 2 groups (all P>0.05). The ROC curve analysis showed that the AUC of the long diameter of foramen ovale on the affected side was 0.290 (95% CI 0.131 to 0.449, P=0.073), and the AUC of aspect ratio of foramen ovale on the affected side to healthy side was 0.792 (95% CI 0.628 to 0.956, P=0.004). The AUC of area ratio of foramen ovale on the affected side to healthy side was 0.766 (95% CI 0.591 to 0.941, P=0.008), indicating that aspect ratio and area ratio of foramen ovale on the affected side to healthy side had a good predictive effect on postoperative pain recurrence of PBC. When aspect ratio of foramen ovale on the affected side to healthy side was less than 0.886 3 or area ratio of foramen ovale on the affected side to healthy side was less than 0.869 4, postoperative pain recurrence was common. CONCLUSIONS Accurate evaluation of the foramen ovale size of skull base before operation is of great significance in predicting pain recurrence after PBC.
Collapse
Affiliation(s)
- Chuansheng Li
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical College, Chengde Hebei 067000.
| | - Jie Yang
- Department of Nutrition, Affiliated Hospital of Chengde Medical College, Chengde Hebei 067000, China
| | - Fengwei Han
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical College, Chengde Hebei 067000
| | - Tiemin Hu
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical College, Chengde Hebei 067000
| | - Jiwei Zhang
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical College, Chengde Hebei 067000
| | - Bing Liu
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical College, Chengde Hebei 067000
| | - Lina Yan
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical College, Chengde Hebei 067000
| | - Wenxia Liu
- Department of Nutrition, Affiliated Hospital of Chengde Medical College, Chengde Hebei 067000, China
| | - Kunpeng Wang
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical College, Chengde Hebei 067000.
| |
Collapse
|
49
|
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
|
50
|
Dzhindzhikhadze RS, Polyakov AV, Ermolaev AY, Kambiev RL, Grigoryan GY. [Anterior transpetrosal (Kawase) approach for petroclival meningioma with trigeminal neuralgia: case report and literature review]. Zh Vopr Neirokhir Im N N Burdenko 2023; 87:98-105. [PMID: 37325832 DOI: 10.17116/neiro20238703198] [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] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The authors present a patient with petroclival meningioma complicated by trigeminal neuralgia. Resection of tumor via anterior transpetrosal approach with microvascular decompression of the trigeminal nerve was performed. A 48-year-old female patient presented with left-sided (V1-V2) trigeminal neuralgia. Magnetic resonance imaging revealed a tumor 33´27´25 mm with a base adjacent to the top of petrous part of the left temporal bone, tentorium cerebelli and clivus. Intraoperative examination revealed true petroclival meningioma extending to trigeminal notch of petrous part of temporal bone. There was additional compression of trigeminal nerve by caudal branch of superior cerebellar artery. Total resection of tumor was followed by disappearance of vascular compression of trigeminal nerve and regression of trigeminal neuralgia. Anterior transpetrosal approach provides early devascularization and resection of true petroclival meningioma, as well as wide imaging of anterolateral surface of the brainstem, identification of neurovascular conflict and vascular decompression.
Collapse
Affiliation(s)
- R S Dzhindzhikhadze
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - A V Polyakov
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - A Yu Ermolaev
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - R L Kambiev
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - G Yu Grigoryan
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| |
Collapse
|