Microvascular Relations of the Trigeminal Nerve: An Anatomical Study

Neurosurgery ◽  
1986 ◽  
Vol 19 (4) ◽  
pp. 535-539 ◽  
Author(s):  
Boris Klun ◽  
Borut Prestor
Keyword(s):  
Trigeminal Neuralgia ◽  
Anatomical Study ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Marked Contrast ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
History Of ◽  
Trigeminal Root

Abstract The neurovascular relationships in the trigeminal root entry zone were studied in 130 trigeminal root entry zones of 65 cadavers. No history of facial or trigeminal pain had been obtained during life in these subjects. The technique of intravascular injection, which allowed good visualization and evaluation of the neurovascular relationships, is described. A total of 42 examples of contact with the root entry zone and 10 examples of compression were identified. In 30 of the examples of contact, the finding could be related to an artery; in the other examples, it appeared to be due to veins. Of the arterial compressions, the superior cerebellar artery was responsible in 53.8%, the anterior inferior cerebellar artery was responsible in 25.6%, and pontine branches of the basilar artery were responsible for the remaining 20.6%. Only one instance of unequivocal compression by a vein was found. Other anatomical observations of interest are reported. The absence of a history of trigeminal neuralgia in the 7% of examined nerves in which root entry zone showed arterial compression is in marked contrast to the finding of 80% or more in the operative series for trigeminal neuralgia. It seems that vascular compressions may be the predominant but not the sole cause of trigeminal neuralgia.

scholarly journals TRIGEMINAL NEURALGIA

2005 ◽  
Vol 12 (04) ◽  
pp. 408-411
Author(s):  
SHAHZAD SHAMS ◽  
FARHAN SHAHZAD BUTT
Keyword(s):  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Cranial Nerve ◽  
Superior Cerebellar Artery ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Trigeminal Root ◽  
Lancinating Pain ◽  
Vascular Decompression

Objectives: trigeminal Neuralgia is a severe lancinating pain and isassociated with conflict between a vessel and 5th cranial nerve. Micro vascular Decompression (MVD) of the nerverelieves this pain. Material & Methods: We reviewed 60 patients who underwent MVD for medically intractabletrigeminal neuralgia. The outcome of procedure was assessed retrospectively. Results: Preoperative symptoms rangedfrom 3 months to 10 years. Right side of face was affected in 32 and left in 28 patients. Mandibular division (21.6%)was the most commonly involved branch for referred pain. Superior cerebellar artery was the commonest offendingvessel in 86.6% of cases. Trigeminal root entry zone location (70%) was the commonest site of conflict. Postoperativepain relief showed excellent results in 86.6%, good in 10.0% and poor in 3.4%. Recurrence rate was 1.5% per year.Conclusion: MVD is safe, effective and treatment of choice for trigeminal neuralgia.

Vascular Transposition of the Superior Cerebellar Artery Using a Fenestrated Clip and Fibrin Glue in Trigeminal Neuralgia: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (1) ◽  
pp. E50-E51 ◽  
Author(s):  
Karl R Abi-Aad ◽  
Evelyn Turcotte ◽  
Devi P Patra ◽  
Matthew E Welz ◽  
Tanmoy Maiti ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Fibrin Glue ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Superior Cerebellar Artery ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Trigeminal Nerve Root ◽  
Made In

Abstract This is the case of an 86-yr-old gentleman who presented with left facial pain exacerbated by eating, drinking, chewing, and shaving (distribution: V2, V3). The patient was diagnosed with trigeminal neuralgia and was refractory to medications. Imaging showed a superior cerebellar artery (SCA) loop adjacent to the trigeminal nerve root entry zone and a decision to perform a microvascular decompression of the fifth nerve was presented to the patient. After patient informed consent was obtained, a standard 3 cm × 3 cm retrosigmoid craniotomy was performed with the patient in a supine head turned position and in reverse Trendelenburg. The arachnoid bands tethering the SCA to the trigeminal nerve were sharply divided. A slit was then made in the tentorium and a 3 mm fenestrated clip was then used to secure the transposed SCA away from the trigeminal nerve. The SCA proximal to this was slightly patulous in its course so a small amount of a fibrin glue was also used to secure the more proximal SCA to the tentorium. The patient was symptom-free postoperatively and no longer required medical therapy. Additionally, imaging was consistent with adequate separation of the nerve from adjacent vessels.1-5

Trigeminal Neuralgia and Multiple Sclerosis

Neurosurgery ◽  
1979 ◽  
Vol 5 (6) ◽  
pp. 711-717 ◽  
Author(s):  
Martin L. Lazar ◽  
Joel B. Kirkpatrick
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Nerve Root ◽  
Superior Cerebellar Artery ◽  
Electron Microscopic ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Microsurgical Approach ◽  
Electron Microscopic Demonstration

Abstract Trigeminal neuralgia is unique to humans. The most common cause seems to be an injury to the myelin of the trigeminal nerve root entry zone as it extends for several millimeters lateral to the pons. Jannetta has developed an elegant retromastoid microsurgical approach to this region. He has identified a compression-distortion phenomenon of this nerve root entry zone, usually from an anomalous position of the superior cerebellar artery. Trigeminal neuralgia can also occur in association with multiple sclerosis, when the plaque lies in this same location. The historical evidence for this explanation is reinforced by the electron microscopic demonstration of the plaque in this region in a patient with multiple sclerosis who was suffering from tic douloureux.

Quantitative Comparison Of Kawase's Approach Versus The Retrosigmoid Approach: Implications For Tumors Involving Both Middle And Posterior Fossae

2009 ◽  
Vol 64 (suppl_1) ◽  
pp. ONS44-ONS52 ◽  
Author(s):  
Steve W. Chang ◽  
Anhua Wu ◽  
Pankaj Gore ◽  
Elisa Beres ◽  
Randall W. Porter ◽  
...  
Keyword(s):  
Internal Auditory Canal ◽  
Retrosigmoid Approach ◽  
Anterior Inferior Cerebellar Artery ◽  
Entry Zone ◽  
Dorello’S Canal ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Powerful Approach ◽  
Trigeminal Root ◽  
Cadaveric Model

Abstract Objective: Few quantitative data are available to describe Kawase's exposure of the posterior fossa. We used a cadaveric model to compare Kawase's and the retrosigmoid approach to the petroclival region. Methods: Eighteen cadaveric specimens were dissected and analyzed (6 retrosigmoid, 6 Kawase's, and 6 retrosigmoid intradural suprameatal approaches). Clival and brainstem working areas and surgical freedom were measured. Results: The retrosigmoid approach provided a significantly larger clival and brainstem working area than Kawase's approach. Surgical freedom at the trigeminal root entry zone, origin of the anterior inferior cerebellar artery, and Dorello's canal was equivalent across approaches. Kawase's approach provided the most surgical freedom at the trigeminal porus. However, the addition of a suprameatal extension significantly improved the surgical freedom provided by the retrosigmoid approach. Conclusion: The retrosigmoid approach is a powerful approach to lesions of the cerebellopontine angle and ventral brainstem. Lesions involving the trigeminal porus and Meckel's cave can be approached through Kawase's approach or a suprameatal extension of the retrosigmoid approach. Kawase's approach is best suited for accessing middle fossa lesions with smaller petroclival components located above the internal auditory canal.

Intrinsic Arteriovenous Malformation of the Trigeminal Nerve in a Patient with Trigeminal Neuralgia: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (6) ◽  
pp. E1445-E1449 ◽  
Author(s):  
Hiroshi Karibe ◽  
Reizo Shirane ◽  
Hidefumi Jokura ◽  
Takashi Yoshimoto
Keyword(s):  
Trigeminal Neuralgia ◽  
Arteriovenous Malformation ◽  
Trigeminal Nerve ◽  
Three Dimensional ◽  
Vascular Lesion ◽  
Superior Cerebellar Artery ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Offending Artery

Abstract OBJECTIVE AND IMPORTANCE: Intrinsic arteriovenous malformation (AVM) of the trigeminal nerve is extremely uncommon and may be associated with trigeminal neuralgia. CLINICAL PRESENTATION: A 55-year-old man experienced severe lightning pain in the second and third divisions of the left trigeminal nerve territory. Vertebral angiography demonstrated an AVM fed by the superior cerebellar artery. Magnetic resonance imaging with three-dimensional spoiled gradient recalled acquisition at steady state revealed an AVM intrinsic to the left trigeminal nerve and a small arterial loop causing compression at the root entry zone of the trigeminal nerve. INTERVENTION: Intraoperative inspection revealed an indentation of the root entry zone caused by a small arterial loop but not by the AVM. The offending artery was displaced to decompress the root entry zone using a prosthesis without resection of the AVM. The patient was relieved of the neuralgia immediately after surgery without further neurological deficit. He has been free of trigeminal neuralgia during a follow-up period of 2 years and is scheduled to undergo stereotactic radiosurgery for the treatment of the AVM. CONCLUSION: Intrinsic AVM of the trigeminal nerve may cause trigeminal neuralgia. However, as in the present case, a coexistent vascular lesion rather than the intrinsic AVM could be a cause of the neuralgia.

scholarly journals Teflon bridge technique for endoscopic-assisted microvascular decompression of ectatic basilar artery and anterior inferior cerebellar artery for trigeminal neuralgia: operative video and technical nuances

2020 ◽  
Vol 3 (2) ◽  
pp. V5
Author(s):  
James K. Liu ◽  
Asif Shafiq
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Basilar Artery ◽  
Microvascular Decompression ◽  
Facial Pain ◽  
Anterior Inferior Cerebellar Artery ◽  
Safe Alternative ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Cerebellar Artery

In this illustrative operative video, the authors demonstrate a Teflon bridge technique to achieve safe transposition of a large, tortuous ectatic basilar artery (BA) and anterior inferior cerebellar artery (AICA) complex to decompress the root entry zone (REZ) of the trigeminal nerve in a 61-year-old woman with refractory trigeminal neuralgia via an endoscopic-assisted retractorless microvascular decompression. Postoperatively, the patient experienced immediate facial pain relief without requiring further medications. The Teflon bridge technique can be a safe alternative to sling techniques when working in narrow surgical corridors between delicate nerves and vessels. The operative technique and surgical nuances are demonstrated.The video can be found here: https://youtu.be/hIHX7EvZc1c

Tic douloureux caused by primitive trigeminal artery or its variant

1989 ◽  
Vol 70 (3) ◽  
pp. 415-419 ◽  
Author(s):  
Akio Morita ◽  
Takanori Fukushima ◽  
Shinichiro Miyazaki ◽  
Tsuneo Shimizu ◽  
Masayuki Atsuchi
Keyword(s):  
Internal Carotid ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Trigeminal Artery ◽  
Entry Zone ◽  
Content Type ◽  
Tic Douloureux ◽  
Root Entry Zone ◽  
Cerebellar Artery ◽  
Primitive Trigeminal Artery

✓ Primitive trigeminal artery (PTA) is an extremely rare cause of tic douloureux. None of the reports on PTA variant, which is an anomalous cerebellar artery arising from the internal carotid artery without anastomosis to the basilar artery, has suggested the possibility of this vessel causing tic douloureux. Eight cases of tic douloureux are reported in which a PTA or PTA variant was found during microvascular decompression (MVD). These cases were derived from a series of 1257 patients treated with MVD for tic douloureux. In one patient, the neuralgia was caused by a combination of vessels: a PTA, the superior cerebellar artery, and the anterior inferior cerebellar artery. In the other seven cases, a PTA variant was compressing the root entry zone of the trigeminal nerve. All eight patients gained excellent pain relief after MVD of the root entry zone. The significance of PTA's and PTA variants as the cause of tic douloureux and the effectiveness of MVD in the management of such cases are discussed.

scholarly journals Extreme Lateral Supracerebellar Infratentorial Approach to the Lateral Midbrain

2018 ◽  
Vol 79 (S 05) ◽  
pp. S415-S417
Author(s):  
M. Kalani ◽  
William Couldwell
Keyword(s):  
Cranial Nerves ◽  
Sudden Onset ◽  
Superior Cerebellar Artery ◽  
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.

Diagnostic relevance of trigeminal evoked potentials following infraorbital nerve stimulation

1991 ◽  
Vol 75 (2) ◽  
pp. 244-250 ◽  
Author(s):  
Massimo Leandri ◽  
Emilio Favale
Keyword(s):  
Trigeminal Neuralgia ◽  
Infraorbital Nerve ◽  
Entry Zone ◽  
Content Type ◽  
Maxillary Nerve ◽  
Root Entry Zone ◽  
Idiopathic Trigeminal Neuralgia ◽  
Parasellar Region ◽  
Trigeminal Root ◽  
The Brain

✓ A new tool in neurophysiological exploration of the trigeminal nerve has recently been introduced. It has been demonstrated that stimulation of the infraorbital nerve trunk gives rise to very reliable scalp responses reflecting the activity of the afferent pathway between the maxillary nerve and the brain stem. The authors demonstrate that alterations of such trigeminal evoked responses fit with documented pathological processes at various locations along the trigeminal pathway (maxillary sinus, parasellar region, and within the brainstem parenchyma). They report the findings in 68 patients suffering from “idiopathic” trigeminal neuralgia. Alterations of the response were detected in 33 cases, suggesting that some damage of the nerve had taken place either at the root entry zone into the pons (23 cases) or slightly distal to it (10 cases). Such results support the hypothesis that trigeminal neuralgia may be due to a compression of the trigeminal root at the pons entry zone.

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