Management of Petrous Endostosis in Posterior Fossa Procedures for Trigeminal Neuralgia

2007 ◽  
Vol 60 (suppl_2) ◽  
pp. ONS-63-ONS-69 ◽  
Author(s):  
Emad F. Shenouda ◽  
Hugh B. Coakham
Keyword(s):  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Trigeminal Nerve ◽  
Nerve Root ◽  
Preoperative Imaging ◽  
Neurovascular Conflict ◽  
Trigeminal Nerve Root ◽  
Air Cells ◽  
Posterior Fossa Procedures

Abstract Objective: Within a series of 440 consecutive patients who underwent posterior fossa procedures for trigeminal neuralgia (TN), the site of neurovascular conflict was obscured by petrous endostosis in 15 patients. The surgical management and clinical outcomes of these patients are presented. Methods: We retrospectively analyzed the prospectively collected data of all patients with a diagnosis of TN from 1980 to 2005. Clinical presentation, preoperative imaging, intraoperative findings, surgical technique, and outcomes were recorded. A postal follow-up questionnaire and a visual analog scale of 100 points were used for outcome assessment and patient satisfaction. Results: All 15 patients presented with typical TN, had preoperative imaging suggestive of vascular compression of the trigeminal nerve root, and underwent standard retro-mastoid craniotomy. The juxta-petrous portion of the trigeminal nerve root was obscured by petrous endostosis. The neurovascular conflict was revealed and dealt with after drilling of the endostosis in 11 patients, and four patients had endoscopic-assisted exploration of the region of the endostosis. A pontotrigeminal vein caused compression in most cases. Three patients had endoscopic-assisted division of the vein. All patients had immediate relief of pain and were 100% satisfied with the results of surgery after a mean follow-up period of 38.6 months. Four patients developed a cere-brospinal fluid leak, and five patients experienced postoperative headaches. Conclusion: Petrous endostosis is an uncommon finding in posterior fossa procedures for TN (3.4%). However, it can obscure the region of neurovascular conflict, which is venous compression in these cases. We have found that drilling away endos-tosis or using endoscopic-assisted microsurgery increases the chances of good outcome and avoids unnecessary rhizotomy. All magnetic resonance imaging scans should be inspected for evidence of petrous endostosis and, when present, a bone window computed tomographic scan should be performed to clarify the image and check for the presence of petrous air cells. If the endostosis is drilled, failure to detect and to seal these air cells thoroughly can result in postoperative cerebrospinal fluid rhinorrhea. Attention to these details will optimize the surgical results. However, the use of an angled endoscope avoids this problem and is now our preferred method.

scholarly journals MICROVASCULAR DECOMPRESSION IN THE TREATMENT OF PATIENTS WITH TRIGEMINAL NEURALGIA

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

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.

Trigeminal neuralgia caused by microarteriovenous malformations of the trigeminal nerve root entry zone: symptomatic relief following complete excision of the lesion with nerve root preservation

2002 ◽  
Vol 97 (4) ◽  
pp. 874-880 ◽  
Author(s):  
Richard J. Edwards ◽  
Yvonne Clarke ◽  
Shelley A. Renowden ◽  
Hugh B. Coakham
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Nerve Root ◽  
Preoperative Imaging ◽  
Posterior Fossa Surgery ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Trigeminal Nerve Root ◽  
Fine Print

Object. Within a series of 341 consecutive patients who underwent posterior fossa surgery for trigeminal neuralgia (TN), in five the cause was found to be a microarteriovenous malformation (micro-AVM) located in the region of the trigeminal nerve root entry zone (REZ). The surgical management and clinical outcomes of these cases are presented. Methods. Patients were identified from a prospectively collected database of all cases of TN treated at one institution between 1980 and 2000. Presentation was clinically indistinguishable from TN caused by vascular compression. Preoperative imaging, including computerized tomography scanning (two cases) and magnetic resonance (MR) imaging and MR angiography (three cases), failed to demonstrate an AVM except for one case in which multiple abnormal vessels were identified in the trigeminal REZ on an MR image obtained using a 1.5-tesla magnet. All patients underwent a standard retromastoid craniotomy. In all cases a small AVM embedded in the trigeminal REZ was identified and completely excised, with preservation of the trigeminal nerve. All patients experienced immediate relief of pain following surgery. Postoperatively, in one patient a small pontine hematoma developed, resulting in permanent trigeminal nerve anesthesia in the V2 and V3 divisions. All patients were free from pain at a mean follow-up period of 30 months. Conclusions. These rare lesions are usually angiographically occult, but may sometimes be identifiable on high-resolution MR images. Total microsurgical resection with nerve preservation is possible, although operative complications are relatively common, reflecting the intimate association between these lesions and the pons. Complete resection is advised not only for symptom relief, but also to eliminate the theoretical risk of pontine hemorrhage.

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

scholarly journals Isolated Trigeminal Neuropathy due to Trigeminal Nerve Root Hemorrhage

1999 ◽  
Vol 26 (3) ◽  
pp. 204-206 ◽  
Author(s):  
S. Almeida ◽  
C. Chalk ◽  
J. Minuk ◽  
R. Del Carpio ◽  
M. Guerin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Head Trauma ◽  
Trigeminal Nerve ◽  
Nerve Root ◽  
Sensory Neuropathy ◽  
Trigeminal Neuropathy ◽  
Trigeminal Nerve Root ◽  
Structural Lesion ◽  
Symptoms And Signs

Background:Isolated trigeminal neuropathy is uncommon; causes include trauma, inflammation, or neoplasm.Methods:We report a patient who fell and struck his head during a myocardial infarction, was treated with streptokinase, and developed symptoms and signs of an isolated trigeminal sensory neuropathy.Results:Imaging showed hemorrhage in the trigeminal nerve root; follow-up imaging showed resolution of the hemorrhage, but no underlying structural lesion.Conclusion:A combination of head trauma plus thrombolysis resulted in an isolated trigeminal neuropathy.

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

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

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

2020 ◽  
Author(s):  
Takuro Inoue ◽  
Satoshi Shitara ◽  
Yukihiro Goto ◽  
Mustaqim Prasetya ◽  
Takanori Fukushima
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Nerve Root ◽  
Surgical Techniques ◽  
Main Stem ◽  
Venous Flow ◽  
Petrosal Vein ◽  
Trigeminal Nerve Root ◽  
Facial Numbness

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.

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

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.

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

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.

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.

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