Petrosal Vein Involvement in Neurovascular Conflict in Trigeminal Neuralgia: Surgical Technique and Clinical Outcomes

Abstract BACKGROUND Contact of the main stem of the petrosal vein (PV) to the nerve root is a rare cause of trigeminal neuralgia (TGN). The implication of the PV in relation with neurovascular contact (NVC) is not fully understood. OBJECTIVE To assess the operative procedures in microvascular decompression (MVD) in patients with PV involvement in the long-term. METHODS We retrospectively reviewed 34 cases (7.0%) in 485 consecutive MVDs for TGN, whose PV main stem had contact with the trigeminal nerve root (PV-NVC). PV-NVCs were divided into 2 groups: concomitant arterial contact or no concomitant arterial contact. Surgical techniques, outcomes, complications, and recurrence were assessed. RESULTS The anatomical relationship of the PV with the trigeminal nerve root was consistent with preoperative 3-dimensional imaging in all patients. Pain relief was obtained in most patients immediately after surgery (97.1%) by separating the PV from the nerve root. Postoperative facial numbness was noted in 9 patients (26.5%). Symptomatic venous infarctions occurred in 2 patients (5.9%). Recurrence of facial pain occurred in 3 patients (8.8%) with a median 48 mo follow-up period. Re-exploration surgery revealed adhesion being the cause of recurrence. The statistical analyses showed no difference in the surgical outcomes of the 2 groups. CONCLUSION Separating the PV from the nerve root contributes to pain relief in patients with PV conflict regardless of concomitant arteries. Preserving venous flow is crucial to avoid postoperative venous insufficiency.

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Microvascular decompression for trigeminal neuralgia caused by trigeminocerebellar artery

Neurosurgical Focus: Video ◽

10.3171/2020.7.focvid2017 ◽

2020 ◽

Vol 3 (2) ◽

pp. V4

Author(s):

Norio Ichimasu ◽

Nobuyuki Nakajima ◽

Ken Matsushima ◽

Michihiro Kohno ◽

Yutaka Takusagawa

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Basilar Artery ◽

Microvascular Decompression ◽

Nerve Root ◽

Cerebellar Hemisphere ◽

Link Type ◽

Trigeminal Nerve Root ◽

Close Relationship

In this operative video, the authors demonstrate the case of a 53-year-old woman who presented with typical right trigeminal neuralgia by a trigeminocerebellar artery (TCA). The TCA was first defined by Marinković as a unique branch of the basilar artery supplying both the trigeminal nerve root and the cerebellar hemisphere. As a result of the close relationship between this vessel and the nerve root, the TCA might compress the nerve root, thereby causing trigeminal neuralgia. However, few cases of trigeminal neuralgia caused by TCA have been reported. This video shows the microvascular decompression for trigeminal neuralgia by the TCA.The video can be found here: https://youtu.be/UnGsCQRK6aY

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Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia

Journal of Neurosurgery ◽

10.3171/2016.5.jns151692 ◽

2017 ◽

Vol 126 (5) ◽

pp. 1691-1697 ◽

Cited By ~ 7

Author(s):

Debebe Theodros ◽

C. Rory Goodwin ◽

Matthew T. Bender ◽

Xin Zhou ◽

Tomas Garzon-Muvdi ◽

...

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Microvascular Decompression ◽

Pain Control ◽

Surgical Intervention ◽

Patient Records ◽

Duration Of Symptoms ◽

Facial Numbness ◽

Lancinating Pain

OBJECTIVETrigeminal neuralgia (TN) is characterized by intermittent, paroxysmal, and lancinating pain along the distribution of the trigeminal nerve. Microvascular decompression (MVD) directly addresses compression of the trigeminal nerve. The purpose of this study was to determine whether patients undergoing MVD as their first surgical intervention experience greater pain control than patients who undergo subsequent MVD.METHODSA retrospective review of patient records from 1998 to 2015 identified a total of 942 patients with TN and 500 patients who underwent MVD. After excluding several cases, 306 patients underwent MVD as their first surgical intervention and 175 patients underwent subsequent MVD. Demographics and clinicopathological data and outcomes were obtained for analysis.RESULTSIn patients who underwent subsequent MVD, surgical intervention was performed at an older age (55.22 vs 49.98 years old, p < 0.0001) and the duration of symptoms was greater (7.22 vs 4.45 years, p < 0.0001) than for patients in whom MVD was their first surgical intervention. Patients who underwent initial MVD had improved pain relief and no improvement in pain rates compared with those who had subsequent MVD (95.8% and 4.2% vs 90.3% and 9.7%, respectively, p = 0.0041). Patients who underwent initial MVD had significantly lower rates of facial numbness in the pre- and postoperative periods compared with patients who underwent subsequent MVD (p < 0.0001). The number of complications in both groups was similar (p = 0.4572).CONCLUSIONSThe results demonstrate that patients who underwent other procedures prior to MVD had less pain relief and a higher incidence of facial numbness despite rates of complications similar to patients who underwent MVD as their first surgical intervention.

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MICROVASCULAR DECOMPRESSION IN THE TREATMENT OF PATIENTS WITH TRIGEMINAL NEURALGIA

Aspirantskiy Vestnik Povolzhiya ◽

10.17816/2072-2354.2019.19.1.101-106 ◽

2019 ◽

Vol 19 (1-2) ◽

pp. 101-106

Author(s):

D. M Lazarchuk ◽

G. N Alekseev ◽

O. O Kamadey ◽

S. N Chemidronov

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Microvascular Decompression ◽

Nerve Root ◽

Treatment Method ◽

Neurovascular Conflict ◽

Neurosurgical Department ◽

Trigeminal Nerve Root ◽

Trigeminal Root ◽

Cranial Fossa

This work highlights the main variant treatment of patients with trigeminal neuralgia, with a proven neurovascular conflict, microvascular decompression of the trigeminal root. Microvascular decompression is the main radical treatment method which allows to relieve hyperfunctional syndrome manifested by prosopalgia. In the course of this study, the variant anatomy of the neurovascular conflict in patients with trigeminal neuralgia was described in detail. The group of patients whose clinical diagnosis at the stage of selection was based on a neurological examination and taking into account the progression of symptoms as well as the performed instrumental examination (CT angiography). The results are described in the article. Atrophic changes of the root of the trigeminal nerve are visualized and described. The nature of its blood supply is classified according to the type of the origin of the artery or arterial branches of the trigeminal nerve root. The main types of neurovascular conflict classified according to the type of blood vessel are presented. Variant neuroanatomy of the trigeminal nerve root as well as the interaction with the arteries of the vertebrobasilar basin and the veins of the posterior cranial fossa are described. The course of microvascular decompression of the trigeminal nerve root, used in the neurosurgical department of Samara Regional Clinical Hospital n.a. V.D. Seredavin is described

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An Animal Model for Trigeminal Neuralgia by Compression of the Trigeminal Nerve Root

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/187 ◽

2012 ◽

Vol 2;15 (2;3) ◽

pp. 187-196

Author(s):

Yun-Qing Li

Keyword(s):

Animal Model ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Nerve Root ◽

Sham Operation ◽

Calcitonin Gene ◽

Trigeminal Nerve Root ◽

Trigeminal Root ◽

Isolectin B4 ◽

Heat Hyperalgesia

Background: Microvascular compression of the trigeminal nerve root is a major cause of most trigeminal neuralgia (TN) in patients; however, no reliable animal model to further study the pathogenesis of TN currently exists. Objective: Our objective was to establish a novel and practical animal model for TN by chronic compression of the trigeminal (CCT) nerve root in rats, which would provide a better animal model to mimic the clinical feature of TN on the research of the pathogenesis of TN. Study Design: A randomized, double blind, controlled animal trial. Methods: Sixteen adult male Sprague-Dawley rats (200-220 g) were randomly divided into 2 groups: one group that received chronic compression of the trigeminal nerve root (the CCT group, n=8) and another group that received sham operation without compression (the sham operation group, n=8). A small plastic filament was retrogressively inserted into the intracalvarium from the inferior orbital fissure until it reached the trigeminal nerve root for compression in CCT group. Animal behaviors were observed for 4 weeks after operation. Immunohistochemistry of glial fibrillary acidic protein (GFAP), isolectin B4 (IB4), substance P (SP) and calcitonin gene-related peptide (CGRP) were performed in the trigeminal root entry zone (TREZ) and medullary dorsal horn (MDH). Results: The orofacial mechanical allodynia and heat hyperalgesia in the CCT rats were obviously increased after the operation and lasted for 28 days. Increased facegrooming behavior was also observed in the CCT rats and continued for over 21 days, returning to baseline by day 28. Immunohistochemistry for GFAP in the TREZ revealed a progressive extension of astrocytic processes in the ipsilateral TREZ of rats in the CCT group. Furthermore, the IB4 positive immunoreactive nonpeptidergic C-fiber terminals in the MDH were reduced for 4 weeks after the operation. Both SP and CGRP, expressed in the peptidergic C-fiber terminals, were found to be decreased in the ipsilateral MDH of CCT animals after the trigeminal nerve root injury. Limitations: CCT animal model with a plastic filament only imitated the mechanical compression of the trigeminal root but not to display the complex vascular physiological feature as the microvascular in the TN patient. Conclusions: The chronic compression of the trigeminal nerve root in rats effectively induced persistent orofacial neuropathic pain behaviors, and it would provide a novel and practical animal model for future research on the pathogenesis of TN. Key words: trigeminal neuralgia, nerve root compression, animal model, mechanical allodynia, heat hyperalgesia, substance P, calcitonin gene-related peptide, isolectin B4

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Case Report: Trigeminal Neuralgia Caused by a Minute Meningioma with Hyperostosed Suprameatal Tubercle

Case Reports in Neurology ◽

10.1159/000438856 ◽

2015 ◽

Vol 7 (2) ◽

pp. 167-172 ◽

Cited By ~ 7

Author(s):

Yukitomo Ishi ◽

Katsuyuki Asaoka ◽

Taku Sugiyama ◽

Yuka Yokoyama ◽

Kazuyoshi Yamazaki ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Nerve Root ◽

Cerebellopontine Angle ◽

Preoperative Imaging ◽

Decompression Surgery ◽

Vascular Compression ◽

Meckel’S Cave ◽

Trigeminal Nerve Root ◽

Meckel's Cave

Cerebellopontine angle tumors might occasionally provoke trigeminal neuralgia but are usually large enough to be diagnosed radiographically. We present a case of trigeminal neuralgia caused by a very small meningioma covering the suprameatal tubercle that displayed hyperostosis at the entrance of Meckel's cave and was not obvious on routine magnetic resonance (MR) images. A 72-year-old woman with intractable trigeminal neuralgia in the left V3 territory was referred to our institution. Preoperative imaging studies revealed that the left trigeminal nerve was medially distorted at the entrance of Meckel's cave by a laterally seated bone bulge covered by a minute enhanced lesion. Trigeminal nerve decompression surgery was performed via a retrosigmoid intradural suprameatal approach. We found a small meningioma that had compressed and flattened the trigeminal nerve root at the entrance of Meckel's cave, which was grossly and totally removed by suprameatal tubercle resection. There was no vascular compression of the trigeminal nerve root. The trigeminal neuralgia ceased completely after the operation. Accurate preoperative determination of the causative pathologies is essential to achieve adequate surgical results after microvascular decompression for neurovascular compression syndrome. Because conventional MR sequences are inadequate for the precise interpretation of complex neurovascular anatomy in the cerebellopontine angle and such small tumors can be overlooked on routine MR studies, high-resolution thin-slice MR examinations and careful radiological interpretations are required for correct diagnosis and treatment.

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Primary glioblastoma of the trigeminal nerve root entry zone: case report

Journal of Neurosurgery ◽

10.3171/2014.10.jns14449 ◽

2015 ◽

Vol 122 (1) ◽

pp. 78-81 ◽

Cited By ~ 6

Author(s):

Jonathan D. Breshears ◽

Michael E. Ivan ◽

Jennifer A. Cotter ◽

Andrew W. Bollen ◽

Phillip V. Theodosopoulos ◽

...

Keyword(s):

Case Report ◽

Trigeminal Nerve ◽

Nerve Root ◽

Cranial Nerve ◽

Entry Zone ◽

Primary Glioblastoma ◽

Root Entry Zone ◽

Trigeminal Nerve Root ◽

Facial Numbness ◽

Symptom Progression

Gliomas of the cranial nerve root entry zone are rare clinical entities. There have been 11 reported cases in the literature, including only 2 glioblastomas. The authors report the case of a 67-year-old man who presented with isolated facial numbness and was found to have a glioblastoma involving the trigeminal nerve root entry zone. After biopsy the patient completed treatment with conformal radiation and concomitant temozolomide, and at 23 weeks after surgery he demonstrated symptom progression despite the treatment described. This is the first reported case of a glioblastoma of the trigeminal nerve root entry zone.

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Five-year result of microvascular decompression using video endoscopy in the treatment of classic trigeminal neuralgia with paroxysmal pain syndrome

Clinical Practice ◽

10.17816/clinpract50130 ◽

2021 ◽

Author(s):

Alexe Vinokurov ◽

Alexandr Kalinkin

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Microvascular Decompression ◽

Nerve Root ◽

Facial Pain ◽

Pain Syndrome ◽

Long Term Results ◽

Video Endoscopy ◽

Trigeminal Nerve Root ◽

Paroxysmal Pain

Background. The incidence of trigeminal neuralgia (TN) is 15 per 100,000 people per year. The effectiveness of the existing conservative methods of therapy does not exceed 50%. The use of carbamazepine doubles the frequency of depressive conditions, and 40% of suicidal thoughts. Purpose of the study. To evaluate the long-term results of microvascular decompression using video endoscopy in the treatment of patients with classical trigeminal neuralgia (cNTN) with paroxysmal facial pain. Methods. At the Federal Research and Clinical Center of the FMBA of Russia in the period from 2014 to 2019. 96 patients with cNTN were operated on in 62 (64%) of whom neuralgia was with paroxysmal facial pain, and in 34 (36%) - with constant pain. The average period from the onset of pain syndrome to surgery was 5 years (from 2 months to 15 years). The maximum pain intensity upon admission to the hospital according to the visual analogue scale (VAS) was 10 points, according to the BNI (Barrow Neurological Institute) pain syndrome scale - V. All patients underwent MIA of the trigeminal nerve root using Teflon, and in 9 patients during surgery used video endoscopic assistance. The average follow-up period after surgery was 3.4 1.7 years (from 1 to 5 years).Results. In all (100%) patients, pain was completely relieved after surgery (BNI - I). Excellent and good results after MVD within 5 years were achieved in 98% of patients (BNI - I-II). Facial hypesthesia, which does not bring discomfort and anxiety (BNI-II), developed in 8% (n = 5) of patients. The use of video endoscopy made it possible to identify vessels compressing the trigeminal nerve root with minimal traction of the cerebellum and cranial nerves. The development of cerebellar edema and ischemia occurred in one (1.6%) patient.Conclusion. The MVD method with video endoscopy is effective in the treatment of patients with cNTN with paroxysmal pain syndrome.

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Basilar artery dolichoectasia an unusual and rare cause of secondary trigeminal neuralgia: a clinical report

Brazilian Dental Science ◽

10.14295/bds.2021.v24i1.2273 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Zafar Ali Khan Ali Khan ◽

Shammas Raza Khan Raza Khan ◽

Tariq Mehmood ◽

Chaudhary Umar Asghar ◽

Naseer Ahmed

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Basilar Artery ◽

Nerve Root ◽

Neurological Deficits ◽

Clinical Report ◽

Entry Zone ◽

Root Entry Zone ◽

Trigeminal Nerve Root ◽

Corneal Reflex

Objective: Patients with Trigeminal Neuralgia often consults a dentist for relief of their symptoms as the pain seems to be arising from teeth and allied oral structures. Basilar artery Dolichoectasia is an unusual and very rare cause of secondary Trigeminal Neuralgia as it compresses the Trigeminal nerve Root Entry Zone. Case reports: We report three cases of Trigeminal Neuralgia caused by Basilar artery Dolichoectasia compression. The corneal reflex was found absent in all three of the cases along with mild neurological deficits in one case. Multiplanar T1/T2W images through the brain disclosed an aberrant, cirsoid (S-shaped) and torturous Dolichoectasia of basilar artery offending the Trigeminal nerve Root Entry Zone. Discussion: Based on these findings we propose a protocol for general dentist for diagnosis of patients with trigeminal neuralgia and timely exclusion of secondary intracranial causes. Conclusion: General dentists and oral surgeons ought to consider this diagnosis in patients presenting with chronic facial pain especially pain mimicking neuralgia with loss of corneal reflex or other neurosensory deficit on the face along with nighttime pain episodes. Timely and accurate diagnosis and prompt referral to a concerned specialist can have an enormous impact on patient survival rate in such cases. KEYWORDS Basilar artery; Cirsoid dolichoectasia; Corneal reflex; Trigeminal neuralgia.

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