scholarly journals Trigeminal Neuralgia due to Vertebrobasilar Dolichoectasia

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Wuilker Knoner Campos ◽  
André Accioly Guasti ◽  
Benjamin Franklin da Silva ◽  
José Antonio Guasti
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Nerves ◽  
Rare Condition ◽  
Vascular Compression ◽  
Drug Resistant ◽  
Neurovascular Conflict ◽  
Vertebrobasilar Dolichoectasia ◽  
Intracranial Arteries

We presented a case of drug-resistant trigeminal neuralgia attributed to vertebrobasilar dolichoectasia, a rare condition characterized by enlargement, tortuosity, or elongation of intracranial arteries. Dolichoectatic vessels can cause dysfunction of cranial nerves through direct vascular compression. The relationships of vertebrobasilar dolichoectasia with the particularities of neurovascular conflict and images findings are discussed.

scholarly journals Painful tic convulsif syndrome due to vertebrobasilar dolichoectasia

2011 ◽  
Vol 02 (01) ◽  
pp. 071-073 ◽  
Author(s):  
Puneet Mittal ◽  
Gaurav Mittal
Keyword(s):  
Mr Angiography ◽  
Rare Condition ◽  
Nerve Compression ◽  
Vascular Compression ◽  
Contrast Resolution ◽  
Vertebrobasilar Dolichoectasia ◽  
Basilar Arteries ◽  
Mri Sequences ◽  
Magnetic Resonance Imaging Mri ◽  
Painful Tic Convulsif

ABSTRACTCombined clinical presentation of hemifacial spasm and ipsilateral trigeminal neuralgia is also known as painful tic convulsif (PTC). It is a rare condition and the most common cause is vascular compression. Vertebrobasilar dolichoectasia (VBD) is characterized by dilated and tortuous vertebral and basilar arteries. VBD is an uncommon and rarely reported cause of PTC. Magnetic resonance imaging (MRI), due to its inherent excellent contrast resolution, is an excellent modality for demonstrating the nerve compression by dilated and tortuous vessels seen in this condition. For this purpose, 3D MRI sequences are especially useful like constructive interference in steady state (CISS) and MR angiography. Both of these have been reported to be helpful in the diagnosis of this condition. We report a case of PTC in which we were able to document facial and trigeminal nerve compression by VBD on MRI, using CISS and time-of-fl ight MR angiography.

Endoscopic-Assisted Microvascular Decompression

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.

Endoscope-assisted Microsurgery for Microvascular Compression Syndromes

Neurosurgery ◽  
2004 ◽  
Vol 54 (4) ◽  
pp. 876-883 ◽  
Author(s):  
Ramin Rak ◽  
Laligam N. Sekhar ◽  
Dinko Stimac ◽  
Peter Hechl
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Nerves ◽  
Vascular Compression ◽  
Primary Role ◽  
Multiple Sources ◽  
Root Exit Zone ◽  
Venous Compression ◽  
Microsurgical Approach ◽  
Grade Ii ◽  
Neural Anatomy

Abstract OBJECTIVE To discuss the results of endoscope-assisted surgery in microvascular decompression (MVD) of Cranial Nerves (CNs) V, VII, and VIII. METHODS Neuroendoscopy was used as an adjunct to the surgical microscope in the MVD of the trigeminal (17 patients), facial (10 patients), and vestibulocochlear (1 patient) nerves in a series of 28 consecutive patients. After a standard microsurgical approach to CNs V, VII, and VIII, the endoscope was used to inspect all aspects of neural anatomy, to assess vascular compression, and to check the results of the decompression. Endoscope use was graded in four categories: Grade I, used but no definite role; Grade II, visualization assisted; Grade III, procedure assisted; and Grade IV, primary role. The usefulness of the endoscope was evaluated in each case. RESULTS The endoscope was useful in visualizing the anatomy in all cases. It was especially useful in establishing trigeminal vein compression of CN V in Meckel's cave; observing multiple sources of vascular compression; ensuring adequate decompression after cauterization of vein, insertion of the Teflon felt, or a pexy procedure; and permitting observation of the compression of CN VII at the root exit zone by small arteries and veins. In six patients with trigeminal neuralgia, the trigeminal vein was cauterized and divided by using endoscopic vision only because the venous compression was not completely visualized with the microscope. During a follow-up period of 6 to 52 months (mean, 29 mo; median, 40 mo), all patients were asymptomatic and receiving no medication. CONCLUSION The endoscope is a useful adjunct to MVD in the treatment of trigeminal neuralgia, hemifacial spasm, and disabling positional vertigo or tinnitus.

scholarly journals Prevalence of elevated intracranial pressure in patients with classical trigeminal neuralgia with overweight and obesity

2020 ◽  
Vol 25 (3) ◽  
pp. 6-13
Author(s):  
Betzaida Saraí Oseguera-Zavala ◽  
Aarón Giovanni Munguía-Rodríguez ◽  
Octavio Carranza-Rentería ◽  
María Dolores Flores-Solís ◽  
Mauro Alberto Segura-Lozano
Keyword(s):  
Intracranial Pressure ◽  
Trigeminal Neuralgia ◽  
Intracranial Hypertension ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
Case Series ◽  
Abducens Nerve ◽  
Overweight And Obesity ◽  
Vascular Compression ◽  
Related Disorder

Background: There is a clear association between obesity and Idiopathic Intracranial Hypertension (IIH), a syndrome characterized by increased Intracranial Pressure (ICP). The clinical manifestations of IHH include headache and visual/oculomotor disorders due to the involvement of abducens nerve. Thus far, it has not been widely studied whether affectations by ICP elevation could involve other cranial nerves such as the trigeminal nerve.Objective: The aim of this study is to analyze the prevalence of elevated ICP in patients with BMI ≥ 25 that suffer vascular compression of the trigeminal nerve. Methods: A case series including 19 patients evaluated during a period of 8 months with BMI ≥ 25 and a clinical diagnosis of classic trigeminal neuralgia (TN) who underwent Microvascular Decompression (MVD) surgery is reported. Patients with TN presenting another cause of intracranial hypertension were excluded. The ICP was determined just before MVD surgery by introducing an enteral tube through a 2 mm incision in the dura and measuring the level reached by the CSF. Results: In our series, 42.1% of patients suffered overweight (n = 8), 47.3% grade I obesity (n = 9) and 10.5% grade II obesity (n = 2). The ICP was elevated in 47.4% of patients. Conclusion: IHH is an obesity-related disorder. Patients with BMI ≥ 25 and TN show a high prevalence of ICP. It is important to consider that an obese patient may present high ICP during and after MVD surger

scholarly journals Radiosurgical treatment of trigeminal neuralgia: experience of the Radiosurgery Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine

2019 ◽  
Vol 21 (3) ◽  
pp. 12-20
Author(s):  
A. S. Tokarev ◽  
M. V. Sinkin ◽  
E. N. Rozhnova ◽  
V. N. Stepanov ◽  
V. A. Rak
Keyword(s):  
Multiple Sclerosis ◽  
Emergency Medicine ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Type I ◽  
Drug Resistant ◽  
Neurovascular Conflict ◽  
Study Objective ◽  
Research Institute

The study objective is to evaluate early results of radiosurgical treatment (RST) of drug-resistant trigeminal neuralgia (TN) of various etiology.Materials and methods. Between 01.01.2016 and 01.07.2018 at the Radiosurgery Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine, 14 patients with drug-resistant TN underwent RST. Per magnetic resonance imaging, prior to treatment 7 patients had neurovascular conflict, 2 had demyelination of the root of the trigeminal nerve due to multiple sclerosis, and 5 patients showed no pathologies of the brain. Irradiation of the cisternal portion of the trigeminal nerve at the distance of 7.5 mm from the entry into the brainstem with prescribed dose of 90 Gy was performed. Follow-up period was 8–20 months. The difference in fractional anisotropy (FA) at the affected and healthy sides was evaluated in patients with TN prior to RST to divide them into 2 groups: with significant FA decrease and with moderate FA decrease.Results. All patients who underwent RST with PD >80 Gy (85.7 %) noted decreased level of pain or its full disappearance. In 11 (78.5 %) patients, anesthetic effect manifested itself 3–6 weeks after RST, in 1–3 months after RST. Full analgesic effect was achieved in a patient with idiopathic type II TN (PD 84 Gy) 3 months after RST, in a patient with neurovascular conflict and type I TN (PD 86 Gy) 6 weeks after RST, in a patient with multiple sclerosis and type I TN (PD 81 Gy) 3 weeks after RST. In the last-mentioned patient, pain returned 12 months after RST but with lower intensity. In 2 (14.3 %) patients (PD 80 Gy), no positive effect was observed in 6 months of follow up. Hypesthesia of a face area (RST complication) was diagnosed in only 1 (7.2 %) patient 8 months after RST, and it persisted for 6 weeks gradually regressing. There was no statistically significant correlation between FA decrease and RST outcome, but it was observed that outcome was more favorable in patients with moderately decreased FA.Conclusion. RST of drug-resistant forms of TN with PD >80 Gy significantly reduces pain syndrome 3–6 weeks after treatment and is characterized by low risk of complications.

scholarly journals Microvascular transposition using Teflon sling technique

2020 ◽  
Vol 3 (2) ◽  
pp. V2
Author(s):  
Mitchell W. Couldwell ◽  
Vance Mortimer, AS ◽  
William T. Couldwell
Keyword(s):  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Vascular Compression ◽  
Link Type ◽  
Pain Syndromes ◽  
Established Technique

Microvascular decompression is a well-established technique used to relieve abnormal vascular compression of cranial nerves and associated pain. Here the authors describe three cases in which a sling technique was used in the treatment of cranial nerve pain syndromes: trigeminal neuralgia with predominant V2 distribution, hemifacial spasm, and geniculate neuralgia and right-sided ear pain. In each case, the artery was mobilized from the nerve and tethered with a sling. All three patients had reduction of symptoms within 6 weeks.The video can be found here: https://youtu.be/iM7gukvPz6E

scholarly journals Geniculate neuralgia in an adolescent treated via sectioning of the nervus intermedius and microvascular decompression

2020 ◽  
Vol 26 (2) ◽  
pp. 189-192
Author(s):  
Derek D. George ◽  
Thomas S. Ridder
Keyword(s):  
Microvascular Decompression ◽  
Facial Pain ◽  
English Language ◽  
Cranial Nerves ◽  
Rare Condition ◽  
Vascular Compression ◽  
External Ear ◽  
Language Literature ◽  
Nervus Intermedius ◽  
Stimulation Of

Geniculate neuralgia or nervus intermedius (NI) neuralgia is a rare condition characterized by intermittent, severe, stabbing deep ear pain. The pain can be triggered by stimulation of the external ear and is sometimes accompanied by facial pain. The condition is thought to result, in part, from vascular compression of the NI, although other etiologies exist. To date, fewer than 150 cases have been described in the English-language literature, and only 1 case of surgically treated geniculate neuralgia with microvascular decompression (MVD) of cranial nerves VIII, IX, and X has been described in a pediatric patient. Here, the authors present the case of an adolescent boy with bilateral geniculate neuralgia treated at two different time points with sectioning of the NI and MVD.

scholarly journals Hemifacial spasm caused by the brainstem developmental venous anomaly: A case report and review of the literature

2020 ◽  
Vol 11 ◽  
pp. 141
Author(s):  
George Grigoryan ◽  
Andrey Sitnikov ◽  
Yuri Grigoryan
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Cranial Nerves ◽  
Rare Condition ◽  
Cerebellar Hemisphere ◽  
Vascular Compression ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly ◽  
Effective Treatment Option ◽  
Main Trunk

Background: Hemifacial spasm (HFS) is usually caused by vascular compression of the root exit zone (REZ) of the facial nerve. Dual compression of the REZ by veins and arteries is also associated with HFS, but venous origin alone is rarely reported. We present a rare case of HFS caused by the brainstem developmental venous anomaly (DVA) treated with microvascular decompression (MVD). Case Description: A 30-year-old women presented with the left-sided HFS since the age of 18 years. The brainstem DVA was diagnosed by magnetic resonance imaging (MRI) and followed by two attempts of MVD at some other clinics without any improvement. At our hospital, MVD was performed through a left retromastoid craniotomy. Intraoperatively, after detaching the strong adhesions between the cerebellar hemisphere, petrosal dura and lower cranial nerves, and removing the Teflon sponge inserted during the previous operations, the compressing large vein was found, separated from facial nerve REZ and MVD was completed. The postoperative computed tomography angiography and MRI showed the thrombosis of the main trunk of DVA and decompression of the facial nerve REZ. Complete cessation of HFS with hearing preservation was observed with only slight weakness of mimic muscles which disappeared within 3 months after surgery. Conclusion: HFS associated with brainstem DVA is a very rare condition. MVD of the facial nerve REZ with transposition of the large draining vein should be considered as an effective treatment option.

Cranial nerve vascular compression syndromes

2019 ◽  
pp. 909-928
Author(s):  
Marc Sindou ◽  
George Georgoulis
Keyword(s):  
High Resolution ◽  
Trigeminal Neuralgia ◽  
Cranial Nerve ◽  
Clinical Manifestations ◽  
Ventrolateral Medulla ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Mri Imaging ◽  
Neurovascular Conflict ◽  
Vestibulocochlear Nerve

Hyperactive cranial nerve syndromes originate in a large number of cases from chronic neurovascular conflict. Classical trigeminal neuralgia is the most frequent syndrome, followed by primary hemifacial spasm. Vago-glossopharyngeal neuralgia is rare, but still underestimated. Vascular compression of the vestibulocochlear nerve may be at the origin of tinnitus and positional disabling vertigo. Vascular compression of the ventrolateral medulla can be a possible cause of neurogenic essential blood hypertension. Chronic pulsatile neurovascular compression would generate ectopic stimuli that are transmitted to neighbouring fibres through focal zones of demyelination, which provokes an ephaptic mechanism between fibres. Also, chronic pulsatile compression would induce hyperactivity of the corresponding cranial nerve nuclei. In trigeminal neuralgia this hyperactivity is expressed by epileptic-like clinical manifestations that respond to anticonvulsants. MRI imaging with high-resolution protocol, and the three following sequences—3D T2 high-resolution, TOF MR-angiography, and T1 with gadolinium—permit to depict the neurovascular conflict and predict the degree of compression. First option of the treatment is microvascular decompression.

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