CHIARI I MALFORMATION AS A CAUSE OF TRIGEMINAL NEURALGIA

ABSTRACT OBJECTIVE Trigeminal neuralgia (TN) is usually associated with vascular compression of the trigeminal nerve, but some cases are associated with central lesions such as tumors, aneurysms, or arteriovenous malformations. In this article, we report the 19th case of TN associated with Chiari I malformation and review clinical outcomes and pathophysiology. CLINICAL PRESENTATION A 63-year-old right-handed man initially presented in 1993 with left-sided lancinating facial pain in the V2 distribution of the trigeminal nerve; the pain was triggered by certain movements, tactile stimulation, or a hot shower. Magnetic resonance imaging revealed a Chiari I malformation associated with a syrinx from C1 to C3. INTERVENTION The patient underwent uncomplicated suboccipital craniectomy, C1 laminectomy, and duraplasty for Chiari decompression. Postoperatively, his pain resolved over a period of 1 year. CONCLUSION Chiari I malformation has been found to be associated with TN in 19 cases in the English-language literature. In patients refractory to medical treatment, suboccipital decompression leads to resolution of pain in about two-thirds of patients. Potential mechanisms for the pathogenesis of TN in the setting of Chiari I malformation are discussed. Chiari I malformation is important to consider as a rare cause of TN that responds to surgical therapy.

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Anterior atlas fracture following suboccipital decompression for Chiari I malformation

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.1.1.0137 ◽

2004 ◽

Vol 1 (1) ◽

pp. 137-140 ◽

Cited By ~ 9

Author(s):

Brian A. O'Shaughnessy ◽

Sean A. Salehi ◽

Saad Ali ◽

John C. Liu

Keyword(s):

Foramen Magnum ◽

Chiari I Malformation ◽

Posterior Arch ◽

Cervical Pain ◽

Content Type ◽

Suboccipital Craniectomy ◽

Increased Risk ◽

Downward Displacement ◽

Chiari I ◽

Suboccipital Decompression

✓ Chiari I malformation, a congenital disorder involving downward displacement of the cerebellar tonsils through the foramen magnum, is often treated surgically by performing suboccipital craniectomy and C-1 laminectomy. The authors report two cases in which fracture of the anterior atlantal arch occurred during the postoperative period following Chiari I decompression and C-1 laminectomy causing significant neck pain. The findings indicate that interruption of the integrity of the posterior arch of C-1, iatrogenically or otherwise, confers increased risk of anterior arch fracture. A C-1 fracture should therefore be considered in the differential diagnosis of posterior cervical pain in patients who have previously undergone decompression for Chiari I malformation.

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Course of papilloedema following surgical decompression in CHIARI I malformation with raised intracranial pressure

BMJ Case Reports ◽

10.1136/bcr-2016-218228 ◽

2021 ◽

Vol 14 (10) ◽

pp. e218228

Author(s):

Li Jiang ◽

Kyaw Zayar Thant ◽

Hongguang Bao ◽

Tsveta Ivanova

Keyword(s):

Clinical Signs ◽

Visual Disturbance ◽

Craniocervical Junction ◽

Chiari I Malformation ◽

Surgical Decompression ◽

Cerebellar Dysfunction ◽

Ocular Manifestations ◽

Cranial Nerve Palsies ◽

Chiari I ◽

Suboccipital Decompression

Arnold-Chiari malformations (ACM) is a rare congenital hindbrain maldevelopment, leading to downward herniation of the cerebellar tonsils. Clinical features relates to cerebrospinal fluid disturbances, manifesting as symptoms of headaches, pseudotumour-like episodes, cranial nerve palsies and cerebellar dysfunction. Ocular manifestations includes varying ophthalmoloplegia and accommodation abnormalities. Papilloedema has been rarely implicated and remains an uncommon feature of ACM. We report a case of ACM who developed papilloedema and visual disturbance, that was successfully treated with suboccipital decompression. The presentation of patients with ACM-I and papilloedema unaccompanied by localising signs may resemble that of IIH. Neuroimaging with special attention to the craniocervical junction in saggital and transverse planes is crucial. Surgical decompression of the posterior fossa seems to improve headache symptoms and clinical signs of papilloedema.

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

Journal of Neurosurgery ◽

10.3171/jns.2005.102.s_supplement.0107 ◽

2005 ◽

Vol 102 ◽

pp. 107-110 ◽

Cited By ~ 13

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.

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Chiari I malformation with neurogenic hypertension after suboccipital decompression

Child s Nervous System ◽

10.1007/s00381-020-04670-y ◽

2020 ◽

Author(s):

Abdulelah A. Alluhaybi ◽

Sarah Bin Abdulqader ◽

Turki Alanazi ◽

Khalid Altuhayni ◽

Ayman Albanyan

Keyword(s):

Chiari I Malformation ◽

Neurogenic Hypertension ◽

Chiari I ◽

Suboccipital Decompression

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Clinical and radiological outcomes of arachnoid-preseving suboccipital decompression for adult chiari I malformation with and without syringomyelia

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2019.105598 ◽

2020 ◽

Vol 188 ◽

pp. 105598 ◽

Cited By ~ 2

Author(s):

Rahsan Kemerdere ◽

Mehmet Yigit Akgun ◽

Semih Can Cetintas ◽

Tibet Kacira ◽

Taner Tanriverdi

Keyword(s):

Chiari I Malformation ◽

Chiari I ◽

Suboccipital Decompression

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Microanatomy of the Central Myelin-Peripheral Myelin Transition Zone of the Trigeminal Nerve

Neurosurgery ◽

10.1227/01.neu.0000223501.27220.69 ◽

2006 ◽

Vol 59 (2) ◽

pp. 354-359 ◽

Cited By ~ 66

Author(s):

Selçuk Peker ◽

Özlem Kurtkaya ◽

İbrahim Üzün ◽

M Necmettin Pamir

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Transitional Zone ◽

Vascular Compression ◽

Lateral Aspect ◽

Entry Zone ◽

Root Entry Zone ◽

Central Myelin ◽

Trigeminal Nerves ◽

Vascular Decompression

Abstract OBJECTIVE: The aim of this study was to evaluate the microanatomy of the central myelin-peripheral myelin transitional zone (TZ) in trigeminal nerves from cadavers. METHODS: One hundred trigeminal nerves from 50 cadaver heads were examined. The cisternal portion of the nerve (from the pons to Meckel's cave) was measured. Horizontal sections were stained and photographed. The photomicrographs were used to measure the extent of central myelin on the medial and lateral aspects of the nerve and to classify TZ shapes. RESULTS: The cisternal portions of the specimens ranged from 8 to 15 mm long (mean, 12.3 mm; median, 11.9 mm). The data from the photomicrographs revealed that the extent of central myelin (distance from pons to TZ) on the medial aspect of the nerve (range, 0.1–2.5 mm; mean, 1.13 mm; median, 1 mm) was shorter than that on the lateral aspect (range, 0.17–6.75 mm; mean, 2.47 mm; median, 2.12 mm). CONCLUSION: The data definitively prove that the root entry zone (REZ, nerve-pons junction) and TZ of the trigeminal nerve are distinct sites and that these terms should never be used interchangeably. The measurements showed that the central myelin occupies only the initial one-fourth of the trigeminal nerve length. If trigeminal neuralgia is caused exclusively by vascular compression of the central myelin, the problem vessel would always have to be located in this region. However, it is well known that pain from trigeminal neuralgia can resolve after vascular decompression at more distal sites. This suggests that the effects of surgical decompression are caused by another mechanism.

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TRIGEMINAL NEURALGIA AND VASCULAR COMPRESSION IN PATIENTS WITH TRIGEMINAL SCHWANNOMAS

Neurosurgery ◽

10.1227/01.neu.0000318187.10536.bf ◽

2008 ◽

Vol 62 (4) ◽

pp. E974-E975 ◽

Cited By ~ 12

Author(s):

Jonathan P. Miller ◽

Feridun Acar ◽

Kim J. Burchiel

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Gamma Knife Radiosurgery ◽

Vascular Compression ◽

Neurovascular Compression ◽

Intracranial Tumors ◽

Resonance Imaging

Abstract OBJECTIVE Trigeminal neuralgia (TN) is often associated with neurovascular compression. However, intracranial tumors are occasionally observed, particularly when symptoms are atypical. We describe three patients with Type-1 TN and trigeminal schwannoma diagnosed by magnetic resonance imaging, with concomitant arterial compression of the trigeminal nerve. CLINICAL PRESENTATION All three patients had Type-1 TN with spontaneous onset, paroxysm-triggered pain, and response to antiepileptic medication. Contrast-enhanced T1-weighted magnetic resonance imaging scans demonstrated an ipsilateral enhancing perineural mass consistent with a schwannoma. Two of the three patients had previously undergone gamma knife radiosurgery without improvement. Subsequent high-resolution magnetic resonance imaging in all three patients revealed obvious compression of the trigeminal nerve by an arterial structure. INTERVENTION Two patients underwent retrosigmoid craniectomy followed by microvascular decompression and remain pain-free. One patient elected not to pursue surgical intervention. CONCLUSION Although intracranial tumors are occasionally observed in patients with TN, neurovascular compression must still be considered as an etiology, especially if typical TN symptoms are reported.

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Surgical Treatment of Chiari I Malformation—Analysis of Intraoperative Findings, Complications, and Outcome for 371 Foramen Magnum Decompressions

Neurosurgery ◽

10.1227/neu.0b013e31825c3426 ◽

2012 ◽

Vol 71 (2) ◽

pp. 365-380 ◽

Cited By ~ 98

Author(s):

Jörg Klekamp

Keyword(s):

Clinical Symptoms ◽

Foramen Magnum ◽

Chiari I Malformation ◽

Outcome Data ◽

Long Term Outcomes ◽

Recurrence Rates ◽

Surgical Morbidity ◽

Suboccipital Craniectomy ◽

Chiari I

Abstract BACKGROUND: Foramen magnum decompression is widely accepted as the treatment of choice for Chiari I malformation. However, important surgical details of the procedure are controversial. OBJECTIVE: This study analyzes 371 decompressions focusing on intraoperative findings, analysis of complications, and long-term outcomes. METHODS: Among 644 patients between 1985 and 2010, 359 patients underwent 371 decompressions. Surgery for symptomatic patients consisted of suboccipital craniectomy, C1 laminectomy, arachnoid dissection, and duraplasty. Short-term results were determined after 3 months; long-term outcomes were evaluated with Kaplan-Meier statistics. RESULTS: The mean age was 40 ± 16 years; mean follow-up was 49 ± 56 months; 75.8% demonstrated syringomyelia. The complication rate was 21.8% with permanent surgical morbidity of 3.2% and surgical mortality of 1.3%. Of the patients, 73.6% reported improvement after 3 months; 21% were unchanged. Overall, 14.3% demonstrated a neurological deterioration within 5 years and 15.4% within 10 years. The severity of neurological symptoms correlated with the grade of arachnoid pathology. Outcome data correlated with the number of previous decompressions, severity of arachnoid pathology, handling of the arachnoid, type of duraplasty, and surgical experience. First-time decompressions with arachnoid dissection and an alloplastic duraplasty resulted in surgical morbidity for 2.0%, a 0.9% mortality rate, postoperative improvement after 3 months for 82%, and neurological recurrence rates of 7% after 5 years and 8.7% after 10 years. CONCLUSION: Arachnoid pathology in Chiari I malformation has an impact on clinical symptoms and postoperative results. Decompressions with arachnoid dissection and an alloplastic duraplasty performed by surgeons experienced with this pathology offer a favorable long-term prognosis.

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