Trigeminal Neuralgia Caused by Vascular Compression from the Petrous Carotid Artery with Bony Erosion and Meckel Cave Encephalocele: Clinical Imaging with Surgical Video

Abstract Background and Objective Trigeminal neuralgia is a common neurologic disease that seriously impacts a patient's quality of life. We retrospectively investigated the efficacy and safety of internal neurolysis (nerve combing) for trigeminal neuralgia without vascular compression. Patients and Methods This study was a retrospective review of all patients with trigeminal neuralgia who were admitted between January 2014 and February 2019. A subgroup of 36 patients had no vascular compression at surgery and underwent internal neurolysis. Chart review and postoperative follow-up were performed to assess the overall outcomes of internal neurolysis. Results Thirty-six patients were identified, with a mean age of 44.89 ± 7.90 (rang: 31–65) years and a disease duration of 5.19 ± 2.61 years. The immediate postoperative pain relief (Barrow Neurological Institute [BNI] pain score of I or II) rate was 100%. The medium- to long-term pain relief rate was 91.7%. Three patients experienced recurrence. Facial numbness was the primary postoperative complication. Four patients with a score of III on the BNI numbness scale immediately after surgery had marked improvement at 6 months. No serious complications occurred. Conclusion Internal neurolysis is a safe and effective treatment for trigeminal neuralgia without vascular compression or clear responsible vessels.

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Trigeminal Neuralgia Associated with a Primitive Trigeminal Artery Variant: Case Report

Neurosurgery ◽

10.1093/neurosurgery/52.5.1217 ◽

2003 ◽

Vol 52 (5) ◽

pp. 1217-1220

Author(s):

Yoji Tamura ◽

Hiroshi Shimano ◽

Toshihiko Kuroiwa ◽

Yoshihito Miki

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Trigeminal Neuralgia ◽

Internal Carotid ◽

Left Internal Carotid Artery ◽

Decompression Surgery ◽

Trigeminal Artery ◽

Cerebellar Artery ◽

Primitive Trigeminal Artery ◽

Perforating Arteries

Abstract OBJECTIVE AND IMPORTANCE A variant type of the primitive trigeminal artery (PTA) is a rare anomalous vessel that originates from the internal carotid artery and directly supplies the territory of the anteroinferior cerebellar artery and/or the superior cerebellar artery. We report a case of trigeminal neuralgia associated with this PTA variant, and we discuss the characteristics of this vessel. CLINICAL PRESENTATION A 51-year-old woman presented with a 10-year history of left paroxysmal facial pain. Magnetic resonance angiography and cerebral angiography demonstrated that an aberrant vessel originating from the left internal carotid artery directly supplied the cerebellum, without a basilar artery anastomosis. INTERVENTION Surgical exploration was performed via a left retrosigmoid approach. A loop of the aberrant vessel, which entered the posterior fossa through the isolated dural foramen, was compressing the trigeminal nerve. This aberrant vessel was displaced medially from the nerve with a prosthesis, with care to avoid kinking and avulsion of the perforating arteries. The patient's neuralgia resolved postoperatively. CONCLUSION Although the PTA variant is frequently associated with intracranial aneurysms, it is extremely rare for the variant to lead to trigeminal neuralgia. During microvascular decompression surgery, surgeons should be careful to prevent injury of the perforating arteries arising from the PTA variant.

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Targeting the cranial nerve: microradiosurgery for trigeminal neuralgia with CISS and 3D-Flash MR imaging sequences

Journal of Neurosurgery ◽

10.3171/jns.2005.102.s_supplement.0107 ◽

2005 ◽

Vol 102 ◽

pp. 107-110 ◽

Cited By ~ 13

Author(s):

Vasilios A. Zerris ◽

Georg C. Noren ◽

William A. Shucart ◽

Jeff Rogg ◽

Gerhard M. Friehs

Keyword(s):

Mr Imaging ◽

Trigeminal Neuralgia ◽

Gamma Knife ◽

Trigeminal Nerve ◽

Cranial Nerve ◽

Fusion Imaging ◽

Vascular Compression ◽

Content Type ◽

History Of ◽

Fine Print

Object.The authors undertook a study to identify magnetic resonance (MR) imaging techniques that can be used reliably during gamma knife surgery (GKS) to identify the trigeminal nerve, surrounding vasculature, and areas of compression.Methods.Preoperative visualization of the trigeminal nerve and surrounding vasculature as well as targeting the area of vascular compression may increase the effectiveness of GKS for trigeminal neuralgia. During the past years our gamma knife centers have researched different MR imaging sequences with regard to their ability to visualize cranial nerves and vascular structures. Constructive interference in steady-state (CISS) fusion imaging with three-dimensional gradient echo sequences (3D-Flash) was found to be of greatest value in the authors' 25 most recent patients.In 24 (96%) out of the 25 patients, the fifth cranial nerve, surrounding vessels, and areas of compression could be reliably identified using CISS/3D-Flash. The MR images were acceptable despite patients' history of microvascular decompression, radiofrequency (RF) ablation, or concomitant disease. In one of 25 patients with a history of multiple RF lesions, the visualization was inadequate due to severe trigeminal nerve atrophy.Conclusions.The CISS/3D-Flash fusion imaging has become the preferred imaging method at the authors' institutions during GKS for trigeminal neuralgia. It affords the best visualization of the trigeminal nerve, surrounding vasculature, and the precise location of vascular compression.

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Comparison of Clinical Symptoms and Magnetic Resonance Angiographic (MRA) Results in Patients with Trigeminal Neuralgia and Persistent Idiopathic Facial Pain. Medium-Term Outcome after Microvascular Decompression of Cases with Positive MRA Findings

Cephalalgia ◽

10.1111/j.1468-2982.2005.01030.x ◽

2006 ◽

Vol 26 (3) ◽

pp. 266-276 ◽

Cited By ~ 41

Author(s):

A Kuncz ◽

E Vörös ◽

P Barzó ◽

J Tajti ◽

P Milassin ◽

...

Keyword(s):

Magnetic Resonance ◽

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Facial Pain ◽

Clinical Symptoms ◽

Vascular Compression ◽

Term Outcome ◽

Persistent Idiopathic Facial Pain ◽

Venous Compression ◽

Imaging Results

To evaluate whether NC could be demonstrated preoperatively, high-resolution magnetic resonance angiography (MRA) was performed in 287 consecutive patients with TN and persistent idiopathic facial pain (PIFP) on a 0.5-T and a 1-T MR unit. Depending on the clinical symptoms, the TN cases were divided into typical TN and trigeminal neuralgia with non-neuralgic interparoxysmal pain (TNWIP) groups. Microvascular decompression (MVD) was performed in 103 of the MRA-positive cases. The patients were followed up postoperatively for from 1 to 10 years. The clinical symptoms were compared with the imaging results. The value of MRA was assessed on the basis of the clinical symptoms and surgical findings. The outcome of MVD was graded as excellent, good or poor. The clinical symptoms were compared with the type of vascular compression and the outcome of MVD. The MRA image was positive in 161 (56%) of the 287 cases. There were significant differences between the clinical groups: 66.5% of the typical TN group, 47.5% of the TNWIP group and 3.4% of the PIFP group were positive. The quality of the MR unit significantly determined the ratio of positive/negative MRA results. The surgical findings corresponded with the MRA images. Six patients from the MRA-negative group were operated on for selective rhizotomy and no NC was found. Venous compression of the trigeminal nerve was observed in a significantly higher proportion in the background of TNWIP than in that of typical TN on MRA imaging (24.1% and 0.8%, respectively) and also during MVD (31.2% and 1.2%, respectively). Four years following the MVD, 69% of the patients gave an excellent, 23% a good and 8% a poor result. The rate of some kind of recurrence of pain was 20% in the typical TN and 44% in TNWIP group. The rate of recurrence was 57% when pure venous compression was present. The only patient who was operated on from the PIFP group did not react to the MVD. The clinical symptoms and preoperative MRA performed by at least a 1-T MR unit furnish considerable information, which can play a role in the planning of the treatment of TN.

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Operative findings in cases of trigeminal neuralgia without vascular compression: proposal of a different mechanism

Journal of Clinical Neuroscience ◽

10.1054/jocn.2001.0922 ◽

2002 ◽

Vol 9 (2) ◽

pp. 200-204 ◽

Cited By ~ 51

Author(s):

Masatsune Ishikawa ◽

Shogo Nishi ◽

Tomokazu Aoki ◽

Takashi Takase ◽

Eiki Wada ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Vascular Compression ◽

Operative Findings

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How often does an incomplete circle of Willis predispose to cerebral ischemia during closure of carotid artery? Postmortem and clinical imaging studies

Acta Neurochirurgica ◽

10.1007/s00701-009-0468-1 ◽

2009 ◽

Vol 151 (9) ◽

pp. 1099-1105 ◽

Cited By ~ 22

Author(s):

Hannu Manninen ◽

Kimmo Mäkinen ◽

Ritva Vanninen ◽

Antti Ronkainen ◽

Harri Tulla

Keyword(s):

Cerebral Ischemia ◽

Carotid Artery ◽

Circle Of Willis ◽

Imaging Studies ◽

Clinical Imaging

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Pathophysiology of trigeminal neuralgia: new evidence from a trigeminal ganglion intraoperative microneurographic recording

Journal of Neurosurgery ◽

10.3171/jns.2004.101.5.0872 ◽

2004 ◽

Vol 101 (5) ◽

pp. 872-873 ◽

Cited By ~ 23

Author(s):

Kim J. Burchiel ◽

Thomas K. Baumann

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Ganglion ◽

Physiological Mechanism ◽

Vascular Compression ◽

Entry Zone ◽

Content Type ◽

Root Entry Zone ◽

Trigeminal Ganglion Neurons ◽

Ganglion Neurons ◽

New Evidence

✓ The origin of trigeminal neuralgia (TN) appears to be vascular compression of the trigeminal nerve at the root entry zone; however, the physiological mechanism of this disorder remains uncertain. The authors obtained intraoperative microneurographic recordings from trigeminal ganglion neurons in a patient with TN immediately before percutaneous radiofrequency-induced gangliolysis. Their findings are consistent with the idea that the pain of TN is generated, at least in part, by an abnormal discharge within the peripheral nervous system.

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Endoscopic-Assisted Microvascular Decompression

Effective Techniques for Managing Trigeminal Neuralgia - Advances in Medical Diagnosis, Treatment, and Care ◽

10.4018/978-1-5225-5349-6.ch007 ◽

2018 ◽

pp. 139-154

Author(s):

M. Yashar S. Kalani ◽

Michael R. Levitt ◽

Celene B. Mulholland ◽

Charles Teo ◽

Peter Nakaji

Keyword(s):

Trigeminal Neuralgia ◽

Minimally Invasive ◽

Effective Treatment ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Patient Population ◽

Surgical Intervention ◽

Cranial Nerves ◽

Vascular Compression ◽

Ephaptic Transmission

Diseases of ephaptic transmission are commonly caused by vascular compression of cranial nerves. The advent of microvascular decompression has allowed for surgical intervention for this patient population. This chapter highlights the technique of endoscopic-assisted microvascular decompression for trigeminal neuralgia and hemifacial spasm. Endoscopy and keyhole techniques have resulted in a minimally invasive and effective treatment of symptoms for patients with neuralgia.

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Persistent trigeminal artery: angio-tomography and angio-magnetic resonance finding

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000500019 ◽

2009 ◽

Vol 67 (3b) ◽

pp. 882-885 ◽

Cited By ~ 4

Author(s):

Lícia Pachêco Pereira ◽

Lara A.M. Nepomuceno ◽

Pablo Picasso Coimbra ◽

Sabino Rodrigues de Oliveira Neto ◽

Marcelo Ricardo C. Natal

Keyword(s):

Magnetic Resonance ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Trigeminal Neuralgia ◽

Basilar Artery ◽

Internal Carotid ◽

Incidental Finding ◽

Persistent Trigeminal Artery ◽

Trigeminal Artery ◽

Magnetic Resonance Finding

The trigeminal artery (TA) is the most common embryonic carotid-vertebrobasilar anastomosis to persist into adulthood. It typically extends from the internal carotid artery to the basilar artery. Persistent primitive arteries are usually found incidentally, but are often associated with vascular malformation, cerebral aneurysm and, in case of TA, with trigeminal neuralgia. We present one patient with TA as a cause of trigeminal neuralgia and in other three as an incidental finding, on TC and MR angiograms.

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