scholarly journals Central Demyelination of the Vth Nerve Root in Trigeminal Neuralgia Associated with Vascular Compression

2006 ◽  
Vol 8 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Seth Love ◽  
David A. Hilton ◽  
Hugh B. Coakham
Keyword(s):  
Trigeminal Neuralgia ◽  
Nerve Root ◽  
Vascular Compression ◽  
Central Demyelination

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

2015 ◽  
Vol 7 (2) ◽  
pp. 167-172 ◽  
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.

scholarly journals Central Demyelination in the Pathogenesis of Trigeminal Neuralgia Associated With Cerebellopontine Angle Tumors

Neurosurgery ◽  
2010 ◽  
Vol 66 (4) ◽  
pp. E841-E842 ◽  
Author(s):  
Alfonso Lagares ◽  
Juan José Rivas ◽  
Luis Jiménez ◽  
Marta Cicuendez ◽  
Carlos Avendaño
Keyword(s):  
Trigeminal Neuralgia ◽  
Cerebellopontine Angle ◽  
Inflammatory Cells ◽  
Complete Relief ◽  
Vascular Compression ◽  
Compression Injury ◽  
Epidermoid Tumor ◽  
Central Demyelination ◽  
Trigeminal Root ◽  
The Right

Abstract OBJECTIVE To describe the surgical and ultrastructural findings in the trigeminal root of a patient with trigeminal neuralgia (TN) associated with a cerebellopontine epidermoid tumor, and to relate these to literature reports of patients with vascular compression–related TN. CLINICAL PRESENTATION A 39-year-old woman presented with right TN. She had a 10-year history of lancinating pain paroxysms in the second and third trigeminal branches. Pain exhibited trigger areas and improved partially with carbamazepine. Cranial magnetic resonance imaging revealed an epidermoid tumor in the right cerebellopontine angle that distorted and compressed the right trigeminal root. TECHNIQUE The tumor was resected. At operation, the trigeminal root appeared distorted and compressed by the tumor. A small partial rhizotomy was performed, and the biopsy was processed for ultrastructural study. Complete relief of the symptoms was achieved with no deficits after the procedure. Pathologic changes in the biopsy included axonal loss, demyelination, and the presence of abundant collagen infiltrates and myelin debris. No inflammatory cells were present. In some areas, myelin-denuded axons were in close apposition, allowing the presence of axon-to-axon interactions. These findings are similar to others described previously regarding patients with vascular compression–related TN. CONCLUSION Compression injury to the trigeminal root leading to demyelination is a major determinant in the pathogenesis of TN.

Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia

1989 ◽  
Vol 71 (3) ◽  
pp. 359-367 ◽  
Author(s):  
Joshua B. Bederson ◽  
Charles B. Wilson
Keyword(s):  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Nerve Root ◽  
Trigeminal System ◽  
Vascular Compression ◽  
Duration Of Symptoms ◽  
Content Type ◽  
The Mean

✓ Outcome after 252 posterior fossa explorations for the treatment of trigeminal neuralgia was determined by a retrospective review. Patients with distortion of the fifth nerve root caused by extrinsic vascular compression underwent microvascular decompression, those with no compression underwent partial sensory rhizotomy, and those with vascular contact but no distortion of the nerve root underwent decompression and rhizotomy. The mean follow-up period was 5.1 years. An excellent (75%) or good (8%) clinical outcome was achieved in 208 patients; 13 patients (5%) experienced little or no pain relief. Thirty-one patients (12%) suffered recurrent trigeminal neuralgia an average of 1.9 pain-free years after operation; recurrence continued at a rate of approximately 2% per year thereafter. Reoperation for recurrent or persistent pain provided excellent or good results in 85% of reoperated patients, but partial sensory rhizotomy was required in most of these patients. Outcome was affected by previous surgical procedures. A previous percutaneous radiofrequency lesion was associated with a significantly greater incidence of fifth nerve complications and a worse outcome after posterior fossa exploration. Because of this finding, the authors recommend that percutaneous radiofrequency rhizolysis be reserved for patients who have failed posterior fossa exploration or who are not candidates for surgery. Patients with compressive nerve root distortion and a short duration of symptoms before surgery had a significantly better outcome than patients with a longer duration of symptoms. In contrast, there was no relationship between the duration of symptoms and outcome of patients without nerve root distortion. Vascular decompression may cause dysfunction of the trigeminal system in tic douloureux, but in patients who remain untreated for long periods an intrinsic abnormality develops that may perpetuate pain even after microvascular decompression. Posterior fossa exploration is recommended as the procedure of choice for patients with trigeminal neuralgia who are surgical candidates.

Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

2021 ◽  
Author(s):  
Ming-Wu Li ◽  
Xiao-feng Jiang ◽  
Chaoshi Niu
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Chart Review ◽  
Vascular Compression ◽  
Internal Neurolysis ◽  
Facial Numbness ◽  
Relief Rate

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.

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

2005 ◽  
Vol 102 ◽  
pp. 107-110 ◽  
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.

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 ◽  
2006 ◽  
Vol 26 (3) ◽  
pp. 266-276 ◽  
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.

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

2002 ◽  
Vol 9 (2) ◽  
pp. 200-204 ◽  
Author(s):  
Masatsune Ishikawa ◽  
Shogo Nishi ◽  
Tomokazu Aoki ◽  
Takashi Takase ◽  
Eiki Wada ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Vascular Compression ◽  
Operative Findings

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

2004 ◽  
Vol 101 (5) ◽  
pp. 872-873 ◽  
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.

scholarly journals Microvascular decompression for trigeminal neuralgia caused by trigeminocerebellar artery

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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