A juvenile case of idiopathic hypertrophic pachymeningitis involved cavernous sinus and proximal trigeminal nerve

2019 ◽  
Vol 8 (2) ◽  
pp. 82-85
Author(s):  
Zhihong Bian ◽  
Yoshio Omote ◽  
Koh Tadokoro ◽  
Ken Ikegami ◽  
Yosuke Osakada ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Hypertrophic Pachymeningitis

Isolated Trigeminal Nerve Sarcoid Granuloma Mimicking Trigeminal Schwannoma: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 700-705 ◽  
Author(s):  
Alfredo Quinones-Hinojosa ◽  
Edward F. Chang ◽  
Saad A. Khan ◽  
Michael W. McDermott
Keyword(s):  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Frozen Section ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Neurophysiological Monitoring ◽  
Pathology Report ◽  
Trigeminal Schwannoma ◽  
Sarcoid Granuloma

Abstract OBJECTIVE AND IMPORTANCE Sarcoidosis most commonly presents as a systemic disorder. Infrequently, sarcoidosis can manifest itself in the central nervous system, with granulomas involving the leptomeninges and presenting with facial nerve weakness. Sarcoid of the trigeminal nerve is exceedingly rare and can mimic trigeminal schwannoma. We review the literature on sarcoid granulomas of the trigeminal nerve and compare their radiological features with the more common schwannoma. CLINICAL PRESENTATION A 33-year-old woman presented with a history of left-sided facial pain and numbness for 11 months, which was presumed to be trigeminal neuralgia. A trial of carbamazepine had been unsuccessful in relieving the facial pain. Her neurological examination revealed decreased facial sensation in the V1–V2 distribution. Preoperative magnetic resonance imaging demonstrated a contrast-enhancing mass centered in the left cavernous sinus with extension along the cisternal portion of the left trigeminal nerve. INTERVENTION The patient underwent a left frontotemporal orbitozygomatic craniotomy with intraoperative neurophysiological monitoring of Cranial Nerves III, V, and VI and image guidance for subtotal microsurgical resection of what appeared, grossly and on frozen section, to be a neurofibroma. The final pathology report, however, revealed a sarcoid granuloma of the trigeminal nerve. CONCLUSION The differential diagnosis of contrast-enhancing lesions in the lateral wall of the cavernous sinus should include inflammatory conditions such as sarcoidosis. We recommend that surgery for biopsy or decompression be used only for those patients in whom a diagnosis cannot be confirmed with noninvasive testing. If surgery is performed, intraoperative frozen pathology is very useful in guiding the extent of resection.

scholarly journals Tolosa-Hunt Syndrome: A Case Report and Review of the Literature

2013 ◽  
Vol 29 (2) ◽  
pp. 130-133
Author(s):  
Md Rafiqul Islam ◽  
Hasan Zahidur Rahman ◽  
Akm Anwar Ullah ◽  
Md Amir Hossain ◽  
- Md Ziauddin
Keyword(s):  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Cranial Nerve ◽  
Motor Nerve ◽  
Pathological Process ◽  
Sensory Loss ◽  
Oral Steroid ◽  
Superior Orbital Fissure ◽  
Hunt Syndrome ◽  
Cranial Nerve Palsies

Tolosa-Hunt Syndrome is a painful ophthalmoplegia which is characterized by periorbital or hemicranial pain, with ipsilateral ocular motor nerve palsies, oculosympathetic paralysis, sensory loss in the distribution of the ophthalmic and occasionally the maxillary division of the trigeminal nerve. Various combinations of these cranial nerve palsies may occur, localising the pathological process to the region of the cavernous sinus/superior orbital fissure. We report the case of a patient presented with severe pain in the right side of face which was periorbital with ipsilateral 3rd,4th, 6th cranial nerve palsies along with ophthalmic and maxillary division of trigeminal nerve involvement. MRI of orbit showed hypo-intense lesion in right cavernous sinus extending to right superior orbital fissure (suggestive of granulomatous infiltration). After taking oral steroid her pain was relieved quickly and cranial nerve palsies reversed within one week. Azathioprin was added and she was completely cured of within next three months. Bangladesh Journal of Neuroscience 2013; Vol. 29 (2) : 130-133

scholarly journals Infraorbital nerve: a surgically relevant landmark for the pterygopalatine fossa, cavernous sinus, and anterolateral skull base in endoscopic transmaxillary approaches

2016 ◽  
Vol 125 (6) ◽  
pp. 1460-1468 ◽  
Author(s):  
Ali M. Elhadi ◽  
Hasan A. Zaidi ◽  
Kaan Yagmurlu ◽  
Shah Ahmed ◽  
Albert L. Rhoton ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Skull Base ◽  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Infratemporal Fossa ◽  
Pterygopalatine Fossa ◽  
Infraorbital Nerve ◽  
External Carotid ◽  
Infraorbital Foramen ◽  
Foramen Rotundum

OBJECTIVE Endoscopic transmaxillary approaches (ETMAs) address pathology of the anterolateral skull base, including the cavernous sinus, pterygopalatine fossa, and infratemporal fossa. This anatomically complex region contains branches of the trigeminal nerve and external carotid artery and is in proximity to the internal carotid artery. The authors postulated, on the basis of intraoperative observations, that the infraorbital nerve (ION) is a useful surgical landmark for navigating this region; therefore, they studied the anatomy of the ION and its relationships to critical neurovascular structures and the maxillary nerve (V2) encountered in ETMAs. METHODS Endoscopic anatomical dissections were performed bilaterally in 5 silicone-injected, formalin-fixed cadaveric heads (10 sides). Endonasal transmaxillary and direct transmaxillary (Caldwell-Luc) approaches were performed, and anatomical correlations were analyzed and documented. Stereotactic imaging of each specimen was performed to correlate landmarks and enable precise measurement of each segment. RESULTS The ION was readily identified in the roof of the maxillary sinus at the beginning of the surgical procedure in all specimens. Anatomical dissections of the ION and the maxillary branch of the trigeminal nerve (V2) to the cavernous sinus suggested that the ION/V2 complex has 4 distinct segments that may have implications in endoscopic approaches: 1) Segment I, the cutaneous segment of the ION and its terminal branches (5–11 branches) to the face, distal to the infraorbital foramen; 2) Segment II, the orbitomaxillary segment of the ION within the infraorbital canal from the infraorbital foramen along the infraorbital groove (length 12 ± 3.2 mm); 3) Segment III, the pterygopalatine segment within the pterygopalatine fossa, which starts at the infraorbital groove to the foramen rotundum (13 ± 2.5 mm); and 4) Segment IV, the cavernous segment from the foramen rotundum to the trigeminal ganglion (15 ± 4.1 mm), which passes in the lateral wall of the cavernous sinus. The relationship of the ION/V2 complex to the contents of the cavernous sinus, carotid artery, and pterygopalatine fossa is described in the text. CONCLUSIONS The ION/V2 complex is an easily identifiable and potentially useful surgical landmark to the foramen rotundum, cavernous sinus, carotid artery, pterygopalatine fossa, and anterolateral skull base during ETMAs.

Anatomy of the cavernous sinus

1976 ◽  
Vol 45 (2) ◽  
pp. 169-180 ◽  
Author(s):  
Frank S. Harris ◽  
Albert L. Rhoton
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Surgical Approaches ◽  
Lateral Side ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Meningeal Arteries ◽  
Triangular Area ◽  
Tentorial Artery

✓ Fifty cavernous sinuses from cadavers were studied in detail using magnification, with special attention to the relationships important in surgical approaches on the intracavernous structures, and to understanding arterial contributions to arteriovenous fistulas involving the cavernous sinus. Significant findings were: 1) The three main branches of the intracavernous portion of the carotid artery were the meningohypophyseal artery, present in 100% of the specimens, the artery of the inferior cavernous sinus (84%), and McConnell's capsular arteries (28%). In addition, the ophthalmic and dorsal meningeal arteries arose from the carotid artery within the cavernous sinus in 8% and 6%, respectively. The three main branches of the meningohypophyseal trunk were the tentorial artery, present in 100%, the dorsal meningeal (90%), and the inferior hypophyseal (80%). 2) The carotid artery was separated from the trigeminal nerve just proximal to the sinus by only dura in 84% of the specimens, and the artery was exposed in the floor of the middle fossa lateral to the trigeminal nerve in 38%. 3) The intracavernous portion of the carotid artery indented the lateral side of the pituitary gland in 28% of dissections but could be as far as 7 mm from it. 4) A triangular area, described by Parkinson, through which the intracavernous portion of the carotid artery could be exposed surgically was found in all specimens. 5) The sixth cranial nerve may split into as many as five rootlets as it passes lateral to the intracavernous portion of the carotid artery. 6) The three major venous spaces within the sinus were posterosuperior, anteroinferior, and medial to the intracavernous portion of the carotid artery.

scholarly journals Pituitary Adenoma Presenting As Trigeminal Neuralgia

2017 ◽  
Vol 06 (03) ◽  
pp. 220-222
Author(s):  
Abrar Wani ◽  
Altaf Ramzan ◽  
Abdul Khan ◽  
Nayil Malik ◽  
Khalid Pervez
Keyword(s):  
Pituitary Adenoma ◽  
Trigeminal Neuralgia ◽  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Pituitary Tumor ◽  
Pituitary Macroadenoma

AbstractCompression of trigeminal nerve in cavernous sinus leading to trigeminal neuralgia is one of the rare presentations of pituitary tumor. We report a patient whose presenting complaint was trigeminal neuralgia in V1, V2 distribution and he had pituitary macroadenoma invading ipsilateral cavernous sinus. After surgery, the neuralgia disappeared completely.

Does the maxillary division of the trigeminal nerve traverse the cavernous sinus? An anatomical study and review of the literature

2007 ◽  
Vol 30 (1) ◽  
pp. 37-40 ◽  
Author(s):  
R. Shane Tubbs ◽  
Mark Hill ◽  
William R. May ◽  
Erik Middlebrooks ◽  
Selma Z. Kominek ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Anatomical Study ◽  
Review Of The Literature

Trigeminofacial reflex: a means of detecting proximity to ophthalmic and maxillary divisions of the trigeminal nerve during surgery

2014 ◽  
Vol 121 (5) ◽  
pp. 1271-1274
Author(s):  
Omar A. AlMasri ◽  
Emma E. Brown ◽  
Alan Forster ◽  
Mahmoud H. Kamel
Keyword(s):  
Observational Study ◽  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Cranial Nerves ◽  
University Hospital ◽  
Time Base ◽  
Tumor Surgery ◽  
Facial Electromyography ◽  
A New Technique ◽  
Trigeminofacial Reflex

Object The aim in this paper was to localize and detect incipient damage to the ophthalmic and maxillary branches of the trigeminal nerve during tumor surgery. Methods This was an observational study of patients with skull base, retroorbital, or cavernous sinus tumors warranting dissection toward the cavernous sinus at a university hospital. Stimuli were applied as normal during approach to the cavernous sinus to localize cranial nerves (CNs) III, IV, and VI. Recordings were also obtained from the facial muscles to localize CN VII. The trigeminofacial reflex was sought simply by observing a longer time base routinely. Results Clear facial electromyography responses were reproduced when stimuli were applied to the region of V1, V2, and V3. Response latency was increased compared with direct CN VII stimuli seen in some cases. Responses gave early warning of approach to these sensory trigeminal branches. Conclusions The authors submit this as a new technique, which may improve the chances of preserving trigeminal sensory branches during surgery in this region.

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