Vestibular Paroxysmia with Trigeminal Neuralgia: Simultaneous Occurrence of Two Compression Syndromes: A Rare Case Report

Simultaneous Occurrence ◽

Vestibular Paroxysmia ◽

Cerebellar Artery ◽

Rare Case Report ◽

Compression Syndromes

AbstractNeurovascular compression syndromes are compression of cranial nerves by blood vessels leading to troublesome symptoms. They mostly occur due to a single vessel loop compression. Here, we report two rare cases with simultaneous fifth and eighth nerve compression by anterior inferior cerebellar artery and superior cerebellar artery loops together.

Right Retrosigmoid Approach for In Situ Occlusion of Brainstem Arteriovenous Malformation Surrounding the Trigeminal Nerve: 3-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy171 ◽

2018 ◽

Vol 16 (2) ◽

pp. E42-E42 ◽

Cited By ~ 2

Author(s):

Roberto Rodriguez Rubio ◽

Vera Vigo ◽

Rina Di Bonaventura ◽

Adib A Abla

Keyword(s):

Trigeminal Nerve ◽

Cranial Nerves ◽

Venous Drainage ◽

Lateral Position ◽

Retrosigmoid Approach ◽

Cerebellar Artery

Abstract Arteriovenous malformations (AVMs) of the trigeminal root entry zone are rare and can be associated with neurovascular compression syndromes as well as intracranial hemorrhage.1 They generally have a small nidus located on and around the pial surface of the brainstem; thus, they are feasible for surgery. Nevertheless, they represent a challenge given the vicinity and involvement of cranial nerves and brainstem perforators.2–4 This video demonstrates the case of a 57-yr-old man with new onset of a severe headache without neurological deficit associated with MRI evidence of a vascular malformation around the cisternal right trigeminal nerve. The nerve showed an altered signal on the MRI. Angiography revealed a Spetzler–Martin grade II AVM with a 16-mm nidus supplied by basilar artery perforators, right anterior inferior cerebellar artery, and the superior cerebellar artery (SCA), with drainage into the superior petrosal vein and sigmoid sinus. After an unsuccessful attempted embolization, the patient was referred for and elected microsurgical treatment. With the patient in a lateral position, a right retrosigmoid approach was performed. After cisternal dissection and identification of the nidus, the feeders were occluded by alternating cauterization and clipping to avoid damage to the critical surrounding structures. The AVM in-situ occlusion was carried on without resection, given the involvement of the trigeminal nerve. The intraoperative indocyanine green angiography allowed recognition of the venous drainage and helped to localize and differentiate the feeders from normal perforators. In the immediate postoperative course, the patient suffered from mild numbness with a V2-V3 distribution that progressively improved. Angiography showed no residual AVM.

Spontaneous resolution of ruptured dissecting anterior inferior cerebellar artery aneurysm: A rare case report

Asian Journal of Neurosurgery ◽

10.4103/1793-5482.145561 ◽

2017 ◽

Vol 12 (3) ◽

pp. 570 ◽

Cited By ~ 3

Author(s):

Sumeet Singh ◽

RS Mittal ◽

Devendra Purohit ◽

Jetendra Shekhawat

Keyword(s):

Case Report ◽

Rare Case ◽

Artery Aneurysm ◽

Spontaneous Resolution ◽

Cerebellar Artery ◽

Rare Case Report

A rare case report of simultaneous occurrence of a pediatric pleuropulmonary blastoma and an intralobar pulmonary sequestration

Radiology Case Reports ◽

10.1016/j.radcr.2021.04.040 ◽

2021 ◽

Vol 16 (7) ◽

pp. 1727-1731

Author(s):

Marjeta Tanka ◽

Anila Kristo ◽

Dritan Alushani ◽

Irena Kasmi ◽

Nikollaq Leka

Keyword(s):

Case Report ◽

Rare Case ◽

Pulmonary Sequestration ◽

Pleuropulmonary Blastoma ◽

Simultaneous Occurrence ◽

Intralobar Pulmonary Sequestration ◽

Rare Case Report

Extreme Lateral Supracerebellar Infratentorial Approach to the Lateral Midbrain

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1669981 ◽

2018 ◽

Vol 79 (S 05) ◽

pp. S415-S417

Author(s):

M. Kalani ◽

William Couldwell

Keyword(s):

Cranial Nerves ◽

Sudden Onset ◽

Entry Zone ◽

Cerebellar Artery ◽

Sensory Disturbances ◽

History Of ◽

Supracerebellar Infratentorial Approach ◽

The Right ◽

Piecemeal Resection

This video illustrates the case of a 52-year-old man with a history of multiple bleeds from a lateral midbrain cerebral cavernous malformation, who presented with sudden-onset headache, gait instability, and left-sided motor and sensory disturbances. This lesion was eccentric to the right side and was located in the dorsolateral brainstem. Therefore, the lesion was approached via a right-sided extreme lateral supracerebellar infratentorial (exSCIT) craniotomy with monitoring of the cranial nerves. This video demonstrates the utility of the exSCIT for resection of dorsolateral brainstem lesions and how this approach gives the surgeon ready access to the supracerebellar space, and cerebellopontine angle cistern. The lateral mesencephalic safe entry zone can be accessed from this approach; it is identified by the intersection of branches of the superior cerebellar artery and the fourth cranial nerve with the vein of the lateral mesencephalic sulcus. The technique of piecemeal resection of the lesion from the brainstem is presented. Careful patient selection and respect for normal anatomy are of paramount importance in obtaining excellent outcomes in operations within or adjacent to the brainstem.The link to the video can be found at: https://youtu.be/aIw-O2Ryleg.

Retrosigmoid Craniotomy for the Removal of Left Sided Tentorial and Posterior Fossa Meningioma Combined with Microvascular Decompression for Hemifacial Spasm

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1675167 ◽

2018 ◽

Vol 80 (S 03) ◽

pp. S294-S295

Author(s):

Yu-Wen Cheng ◽

Chun-Yu Cheng ◽

Zeeshan Qazi ◽

Laligam N. Sekhar

Keyword(s):

Facial Nerve ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Preoperative Imaging ◽

Root Exit Zone ◽

Tentorial Meningioma ◽

Cerebellar Artery ◽

The Right

This 68-year-old woman presented with repeated episodes of bilateral hemifacial spasm with headache for 5 years and with recent progression of left sided symptoms. Preoperative imaging showed a left sided tentorial meningioma with brain stem and cerebellar compression. Left facial nerve was compressed by the vertebral artery (VA) and the right facial nerve by the anterior inferior cerebellar artery (AICA). This patient underwent left side retrosigmoid craniotomy and mastoidectomy. The cisterna magna was drained to relax the brain. The tumor was very firm, attached to the tentorium and had medial and lateral lobules. The superior cerebellar artery was adherent to the lateral lobule of the tumor and dissected away. The tumor was detached from its tentorial base; we first removed the lateral lobule. Following this, the medial lobule was also completely dissected and removed. The root exit zone of cranial nerve (CN) VII was dissected and exposed. The compression was caused both by a prominent VA and AICA. Initially, the several pieces of Teflon felt were placed for the decompression. Then vertebropexy was performed by using 8–0 nylon suture placed through the VA media to the clival dura. A further piece of Teflon felt was placed between cerebellopontine angle region and AICA. Her hemifacial spasm resolved postoperatively, and she discharged home 1 week later. Postoperative imaging showed complete tumor removal and decompression of left CN VII. This video shows the complex surgery of microsurgical resection of a large tentorial meningioma and microvascular decompression with a vertebropexy procedure.The link to the video can be found at: https://youtu.be/N5aHN9CRJeM.

Retrosigmoid Approach for Trapping and Removal of a Distal Dissecting Superior Cerebellar Artery Aneurysm in a Child

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1675172 ◽

2018 ◽

Vol 80 (S 03) ◽

pp. S335-S338 ◽

Cited By ~ 1

Author(s):

Javier Ros de San Pedro

Keyword(s):

Artery Aneurysm ◽

Vascular Lesion ◽

Retrosigmoid Approach ◽

Vascular Lesions ◽

Unsteady Gait ◽

Cerebellar Artery ◽

Preoperative Magnetic Resonance ◽

Magnetic Resonance Imaging Mri

Objectives To demonstrate the feasibility of the retrosigmoid craniotomy for surgical management of vascular lesions located in the cerebellopontine angle (CPA). Method A previously healthy 2-year-old boy presented a sudden episode of torticollis to the left while sleeping. This episode was selflimited but it occurred two more times in a 6-day span. Torticollis worsened in the upright position, caused unsteady gait and refusal to walk from the child. The preoperative magnetic resonance imaging (MRI) showed the presence of a round, heterogenous vascular lesion in the left CPA. The lesion clearly enhanced after contrast administration. The preoperative angiography demonstrated the absence of left anterior inferior cerebellar artery anterior inferior cerebellar artery (AICA), being the left superior cerebellar artery (SCA) the supplier of the left lateral cerebellum. A blurred blush on the distal left SCA was compatible with a fusiform aneurysm. A standard retrosigmoid approach was planned for trapping and removal of the aneurysm. Results Through a left retrosigmoid craniotomy the aneurysm was approached, along with the different neurovascular structures of the CPA. The aneurysm leaned on the VII, VIII nerves complex and the superior petrosal vein, while tightly attached to the lateral cerebellum. Both proximal and distal SCA segments to the aneurysm were dissected, clipped, and divided for a complete trapping. Finally, the aneurysm was completely detached and removed in a whole piece. The patient fully recovered after surgery with no relapse of his symptoms. Conclusion The retrosigmoid craniotomy is a versatile approach that permits wide exposure of all CPA structures and adequate removal of distal aneurysms located in those cerebellar arteries supplying the lateral cerebellum.The link to the video can be found at: https://youtu.be/oEVfy4goFYM.

Microsurgical resection of ambient cistern arteriovenous malformation

Neurosurgical FOCUS ◽

10.3171/2016.1.focusvid.15414 ◽

2016 ◽

Vol 40 (videosuppl1) ◽

pp. 1

Author(s):

Omar Choudhri ◽

Michael T. Lawton

Keyword(s):

Arteriovenous Malformations ◽

Posterior Cerebral Artery ◽

Cranial Nerves ◽

Technical Aspects ◽

The Third ◽

Cerebellar Artery ◽

Basal Vein Of Rosenthal ◽

Microsurgical Resection ◽

Ambient Cistern

The middle tentorial incisural space, located lateral to the midbrain and medial to the temporal lobe, contains the ambient cistern through which courses the third, fourth, and fifth cranial nerves, posterior cerebral artery (PCA), superior cerebellar artery, and the choroidal arteries. Arteriovenous malformations (AVMs) in this compartment are supplied by the thalamogeniculate and posterior temporal branches of the PCA, and drain into tributaries of the basal vein of Rosenthal. We present a case of an AVM in this middle tentorial incisural space that persisted after embolization and radiosurgery, and was microsurgically resected through a subtemporal approach. This case demonstrates the anatomy of the middle incisural space and technical aspects in microsurgical resection of these rare AVMs.The video can be found here: https://youtu.be/V-dIWh8ys3E.

Microvascular decompression for hemifacial spasm

Journal of Neurosurgery ◽

10.3171/jns.1991.75.3.0388 ◽

1991 ◽

Vol 75 (3) ◽

pp. 388-392 ◽

Cited By ~ 45

Author(s):

Shinji Nagahiro ◽

Akira Takada ◽

Yasuhiko Matsukado ◽

Yukitaka Ushio

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Posterior Inferior Cerebellar Artery ◽

Cranial Nerves ◽

Vascular Compression ◽

Content Type ◽

Seventh Cranial Nerve ◽

Cerebellar Artery

✓ To determine the causative factors of unsuccessful microvascular decompression for hemifacial spasm, the follow-up results in 53 patients were assessed retrospectively. The mean follow-up period was 36 months. There were 32 patients who had compression of the seventh cranial nerve ventrocaudally by an anterior inferior cerebellar artery (AICA) or a posterior inferior cerebellar artery. Of these 32 patients, 30 (94%) had excellent postoperative results. Of 14 patients with more severe compression by the vertebral artery, nine (64%) had excellent results, three (21%) had good results, and two (14%) had poor results; in this group, three patients with excellent results experienced transient spasm recurrence. There were seven patients in whom the meatal branch of the AICA coursed between the seventh and eighth cranial nerves and compressed the dorsal aspect of the seventh nerve; this was usually associated with another artery compressing the ventral aspect of the nerve (“sandwich-type” compression). Of these seven patients, five (71%) had poor results including operative failure in one and recurrence of spasm in four. The authors conclude that the clinical outcome was closely related to the patterns of vascular compression.

Microsurgical Treatment of Glossopharyngeal Neuralgia: Case Reports

Neurosurgery ◽

10.1227/00006123-198910000-00018 ◽

1989 ◽

Vol 25 (4) ◽

pp. 630-632 ◽

Cited By ~ 34

Author(s):

Bernardo Fraioli ◽

Vincenzo Esposito ◽

Luigi Ferrante ◽

Lanfranco Trubiani ◽

Pierpaolo Lunardi

Keyword(s):

Vagus Nerve ◽

Cranial Nerve ◽

Open Surgery ◽

Case Reports ◽

Cranial Nerves ◽

Posterior Cranial Fossa ◽

Glossopharyngeal Neuralgia ◽

Cerebellar Artery ◽

Cranial Fossa

Abstract Three patients with excruciating glossopharyngeal neuralgia underwent microsurgical operations in the posterior cranial fossa. In each patient, neurovascular compression was found involving the posteroinferior cerebellar artery and involving the 9th and 10th cranial nerves. In two of the patients, the compression was caused by arachnoiditis and in the other by an arterial loop. In each patient, neuralgia was successfully eliminated by microvascular decompression and by section of the upper rootlets of the vagus nerve. In one patient, partial section of the 9th cranial nerve was also performed. Because of the frequent involvement of the vagus nerve in the pathogenesis of this condition, open surgery should be preferable to percutaneous thermorhizotomy, which is unable to act selectively on the 10th cranial nerve.

Neurovascular compression findings in hemifacial spasm

Journal of Neurosurgery ◽

10.3171/jns/2008/109/9/0416 ◽

2008 ◽

Vol 109 (3) ◽

pp. 416-420 ◽

Cited By ~ 119

Author(s):

Mauricio Campos-Benitez ◽

Anthony M. Kaufmann

Keyword(s):

Facial Nerve ◽

Hemifacial Spasm ◽

Nerve Root ◽

Posterior Inferior Cerebellar Artery ◽

Vascular Compression ◽

Exit Point ◽

Root Exit Zone ◽

Cerebellar Artery

Object It is generally accepted that hemifacial spasm (HFS) is caused by pulsatile vascular compression upon the facial nerve root exit zone. This 2–3 mm area, considered synonymous with the Obersteiner–Redlich zone, is a transition zone (TZ) between central and peripheral axonal myelination that is situated at the nerve's detachment from the pons. Further proximally, however, the facial nerve is exposed on the pontine surface and emerges from the pontomedullary sulcus. The incidence and significance of neurovascular compression upon these different segments of the facial nerve in patients with HFS has not been previously reported. Methods The nature of neurovascular compression was determined in 115 consecutive patients undergoing their first microvascular decompression (MVD) for HFS. The location of neurovascular compression was categorized to 1 of 4 anatomical portions of the facial nerve: RExP = root exit point; AS = attached segment; RDP = root detachment point that corresponds to the TZ; and CP = distal cisternal portion. The severity of compression was defined as follows: mild = contact without indentation of nerve; moderate = indentation; and severe = deviation of the nerve course. Success in alleviating HFS was documented by telephone interview conducted at least 24 months following MVD surgery. Results Neurovascular compression was found in all patients, and the main culprit was the anterior inferior cerebellar artery (in 43%), posterior inferior cerebellar artery (in 31%), vertebral artery (in 23%), or a large vein (in 3%). Multiple compressing vessels were found in 38% of cases. The primary culprit location was at RExP in 10%, AS in 64%, RDP in 22%, and CP in 3%. The severity of compression was mild in 27%, moderate in 61%, and severe in 12%. Failure to alleviate HFS occurred in 9 cases, and was not related to compression location, severity, or vessel type. Conclusions The authors observed that culprit neurovascular compression was present in all cases of HFS, but situated at the RDP or Obersteiner–Redlich zone in only one-quarter of cases and rarely on the more distal facial nerve root. Since the majority of culprit compression was found more proximally on the pontine surface or even pontomedullary sulcus origin of the facial nerve, these areas must be effectively visualized to achieve consistent success in performing MVD for HFS.