scholarly journals Central Demyelination in the Pathogenesis of Trigeminal Neuralgia Associated With Cerebellopontine Angle Tumors

Neurosurgery ◽  
2010 ◽  
Vol 66 (4) ◽  
pp. E841-E842 ◽  
Author(s):  
Alfonso Lagares ◽  
Juan José Rivas ◽  
Luis Jiménez ◽  
Marta Cicuendez ◽  
Carlos Avendaño
Keyword(s):  
Trigeminal Neuralgia ◽  
Cerebellopontine Angle ◽  
Inflammatory Cells ◽  
Complete Relief ◽  
Vascular Compression ◽  
Compression Injury ◽  
Epidermoid Tumor ◽  
Central Demyelination ◽  
Trigeminal Root ◽  
The Right

Abstract OBJECTIVE To describe the surgical and ultrastructural findings in the trigeminal root of a patient with trigeminal neuralgia (TN) associated with a cerebellopontine epidermoid tumor, and to relate these to literature reports of patients with vascular compression–related TN. CLINICAL PRESENTATION A 39-year-old woman presented with right TN. She had a 10-year history of lancinating pain paroxysms in the second and third trigeminal branches. Pain exhibited trigger areas and improved partially with carbamazepine. Cranial magnetic resonance imaging revealed an epidermoid tumor in the right cerebellopontine angle that distorted and compressed the right trigeminal root. TECHNIQUE The tumor was resected. At operation, the trigeminal root appeared distorted and compressed by the tumor. A small partial rhizotomy was performed, and the biopsy was processed for ultrastructural study. Complete relief of the symptoms was achieved with no deficits after the procedure. Pathologic changes in the biopsy included axonal loss, demyelination, and the presence of abundant collagen infiltrates and myelin debris. No inflammatory cells were present. In some areas, myelin-denuded axons were in close apposition, allowing the presence of axon-to-axon interactions. These findings are similar to others described previously regarding patients with vascular compression–related TN. CONCLUSION Compression injury to the trigeminal root leading to demyelination is a major determinant in the pathogenesis of TN.

Arteriovenous Micromalformation of the Trigeminal Root: Intraoperative Diagnosis With Indocyanine Green Videoangiography: Case Report

2010 ◽  
Vol 67 (3) ◽  
pp. onsE309-onsE310 ◽  
Author(s):  
Paolo Ferroli ◽  
Francesco Acerbi ◽  
Morgan Broggi ◽  
Giovanni Broggi
Keyword(s):  
Trigeminal Neuralgia ◽  
Indocyanine Green ◽  
Microvascular Decompression ◽  
Single Case ◽  
Preoperative Evaluation ◽  
Vascular Compression ◽  
Contrast Administration ◽  
Intraoperative Diagnosis ◽  
Petrosal Vein ◽  
Trigeminal Root

Abstract BACKGROUND AND IMPORTANCE: To report on a single case of arteriovenous micromalformation (micro-AVM) of the trigeminal root that was diagnosed during microvascular decompression for trigeminal neuralgia with the use of indocyanine green (ICG) videoangiography. CLINICAL PRESENTATION: A 52-year-old woman with drug-resistant trigeminal neuralgia underwent a key hole suboccipital cerebellopontine angle exploration after the usual magnetic resonance imaging (MRI) screening had raised the suspicion of a vascular compression. In surgery, the petrosal vein was found to be bigger than usual and arterialized; the trigeminal root was embedded in a tangle of abnormal arterialized vessels. Intraoperative ICG videoangiography showed that the direction of flow in the arterialized petrosal vein was anterograde, thus allowing for the differential diagnosis between micro-AVM and tentorial dural fistula. It was possible to achieve only a partial nerve decompression because of the intimate relationship between the trigeminal root and the pathological vessels. Postoperative angiography and MRI with contrast administration confirmed the intraoperative diagnosis of micro-AVM. The patient was discharged neurologically intact on postoperative day 4. One month after surgery, she remains pain-free despite a 50% reduction in antiepileptic drugs. CONCLUSION: Surgeons performing microvascular decompression should be aware that a diagnosis of vascular compression based on MRI without contrast administration could not exclude the presence of a pontine micro-AVM. ICG videoangiography provides an elegant means of showing the flow dynamics of these pathological vessels. An MRI protocol that is suitable to avoid this kind of intraoperative drawback should be defined and systematically used in the preoperative evaluation of all such surgical candidates.

scholarly journals Flow cytometry analysis of immune and glial cells in a trigeminal neuralgia rat model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Junjin Lin ◽  
Luxi Zhou ◽  
Zhaoke Luo ◽  
Madeha Ishag Adam ◽  
Li Zhao ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Trigeminal Neuralgia ◽  
Rat Model ◽  
Complement C3 ◽  
Compression Injury ◽  
Root Entry Zone ◽  
Significant Difference ◽  
Post Operation ◽  
Trigeminal Root ◽  
Infiltrating Lymphocytes

AbstractMicrovascular compression of the trigeminal root entry zone (TREZ) is the main cause of most primary trigeminal neuralgia (TN), change of glial plasticity was previously studied in the TREZ of TN rat model induced by chronic compression. To better understand the role of astrocytes and immune cells in the TREZ, different cell markers including glial fibrillary acidic protein (GFAP), complement C3, S100A10, CD45, CD11b, glutamate-aspartate transporter (GLAST), Iba-1 and TMEM119 were used in the TN rat model by immunohistochemistry and flow cytometry. On the post operation day 28, GFAP/C3-positive A1 astrocytes and GFAP/S100A10-positive A2 astrocytes were activated in the TREZ after compression injury, there were no statistical differences in the ratios of A1/A2 astrocytes between the sham and TN groups. There was no significant difference in Iba-1-positive cells between the two groups. The ratios of infiltrating lymphocytes (CD45+CD11b−) (p = 0.0075) and infiltrating macrophages (CD45highCD11b+) (p = 0.0388) were significantly higher than those of the sham group. In conclusion, different subtypes A1/A2 astrocytes in the TREZ were activated after compression injury, infiltrating macrophages and lymphocytes increased, these neuroimmune cells in the TREZ may participate in the pathogenesis of TN rat model.

Vascular compression in trigeminal neuralgia discloses trigeminal root somatotopic organization

2021 ◽  
Vol 429 ◽  
pp. 117754
Author(s):  
Gianfranco De Stefano ◽  
Giulia Di Stefano ◽  
Emanuele Ripiccini ◽  
Giuseppe Di Pietro ◽  
Pietro Falco ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Vascular Compression ◽  
Somatotopic Organization ◽  
Trigeminal Root

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.

scholarly journals Trigeminal Neuralgia associated with Wallenberg Syndrome, a case report

2021 ◽  
Author(s):  
Matheus Goncalves Maia ◽  
Vivian Dias Baptista Gagliardi ◽  
Francisco Tomaz Meneses Oliveira ◽  
Eduardo dos Santos Sousa ◽  
Marina Trombin Marques ◽  
...  
Keyword(s):  
Case Report ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Vascular Compression ◽  
Gasserian Ganglion ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Initial Event ◽  
The Right ◽  
The Brain

Context: Trigeminal neuralgia is typically associated with structural lesions that affect the brainstem, pre-ganglionic roots, gasserian ganglion and the trigeminal nerve. The association of trigeminal neuralgia with infarction of the dorsolateral medulla is rare, being more associated with pontine lesions, in the context of brainstem infarction. Methods: Report the case of a 55-year-old male patient, who presented with a left dorsolateral bulbar infarction, and developed a ipsilateral trigeminal neuralgia afterwards. Case report: A 55-year-old man attended to the emergency room referring sudden incoordination of the left limbs, associated with numbness of the contralateral limbs. The neurological examination showed nystagmus, numbness of the left face, ataxia of the left limbs and numbness of the right limbs. The Magnetic Resonance of the Brain revealed an area of recent infarction in the left posterolateral aspect of the medulla. He underwent thrombolysis, evolving with complete resolution of symptoms. In the week after the initial event, he returned to the outpatient clinic, reporting paroxysms of excruciating pain in the upper lip, nose and left zygomatic region, being diagnosed with neuralgia of the maxillary segment of the trigeminal nerve, improving with introduction of Gabapentin. Conclusion: Although most cases of trigeminal neuralgia are determined by vascular compression of the trigeminal nerve root entry zone, other causes must be considered. The association of this condition with dorsolateral medulla infarction is rare, with only 4 cases reported in the last 10 years.

Operative Findings and Outcomes of Microvascular Decompression for Trigeminal Neuralgia in 35 Patients Affected by Multiple Sclerosis

Neurosurgery ◽  
2004 ◽  
Vol 55 (4) ◽  
pp. 830-839 ◽  
Author(s):  
Giovanni Broggi ◽  
Paolo Ferroli ◽  
Angelo Franzini ◽  
Vittoria Nazzi ◽  
Laura Farina ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Vascular Compression ◽  
Causative Role ◽  
Resonance Imaging ◽  
Root Entry Zone ◽  
Trigeminal Root

Abstract OBJECTIVE: The concept of vascular compression of the trigeminal root as the main etiological factor in idiopathic trigeminal neuralgia has achieved widespread acceptance, and microvascular decompression (MVD) is a well-established surgical procedure for its treatment. Multiple sclerosis (MS) has long been considered to be an absolute contraindication to MVD because of the supposed exclusive causative role of a demyelinating lesion affecting the trigeminal root entry zone. Magnetic resonance imaging preoperative identification of suspicious vessels along the cisternal course of the trigeminal nerve in MS patients raises the question of a possible causative role of vascular compression in MS patients. METHODS: We describe magnetic resonance imaging findings, surgical findings, and outcomes in 35 MS patients who underwent MVD for medically intractable trigeminal neuralgia. Results were assessed by clinical follow-up and periodic phone surveys. The mean follow-up was 44 months (range, 6–108 mo). RESULTS: Magnetic resonance imaging revealed the presence of demyelinating lesions affecting the brainstem trigeminal pathways of the painful side in 26 (74%) of 35 patients. During surgery, severe neurovascular compression at the trigeminal root entry zone was found in 16 (46%) of 35 patients. The long-term outcome was excellent in 39%, good in 14%, fair in 8%, and poor in 39% of patients. No statistically significant prognostic factor predicting good outcome could be found. There was no mortality, with a 2.5% long-term morbidity rate (facial nerve palsy in one patient). CONCLUSION: Results of MVD in trigeminal neuralgia MS patients are much less satisfactory than in the idiopathic group, indicating that central mechanisms play a major role in pain genesis.

Trigeminal root compression for trigeminal neuralgia in patients with no vascular compression

2015 ◽  
Vol 157 (2) ◽  
pp. 323-327 ◽  
Author(s):  
Jian Cheng ◽  
Ding Lei ◽  
Heng Zhang ◽  
Ke Mao
Keyword(s):  
Trigeminal Neuralgia ◽  
Vascular Compression ◽  
Trigeminal Root

A Unique Case of Microvascular Triple Decompression for Combined Simultaneous Trigeminal Neuralgia, Hemifacial Spasm, and Glossopharyngeal Neuralgia Because of the Dolichoectatic Vertebrobasilar System

2019 ◽  
Vol 18 (6) ◽  
pp. 692-697 ◽  
Author(s):  
Roberto J Perez-Roman ◽  
Stephanie H Chen ◽  
Samir Sur ◽  
Roberto Leon-Correa ◽  
Jacques J Morcos
Keyword(s):  
Trigeminal Neuralgia ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Glossopharyngeal Neuralgia ◽  
Complete Relief ◽  
Root Entry Zone ◽  
Vertebrobasilar System ◽  
Effective Option ◽  
The Right ◽  
Surgical Treatments

Abstract BACKGROUND Trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN) are hyperactive dysfunction syndromes (HDS) commonly caused by microvascular compression of their root entry zone. Cases of combined HDS involving 2 or more of these entities are extremely rare. Although microvascular decompression is the surgical treatment of choice, there are additional techniques that have been described as efficient methods to accomplish vessel transposition. OBJECTIVE To our knowledge, we present the first reported case of triple simultaneous HDS successfully treated using the clip-sling technique to achieve microvascular decompression. We discuss several technical pearls and pitfalls relevant to the use of the sling suspension technique. METHODS We report the rare case of a 66-yr-old male with combined simultaneous unilateral right-sided TN, HFS, and GPN because of a dolichoectatic vertebrobasilar system compressing the exit zones of the right trigeminal, facial, and glossopharyngeal nerves and present a literature review of combined HDS and their different surgical treatments. RESULTS Symptomatic TN, HFS, and GPN have been reported 8 times in the literature with our case being the ninth. A retrosigmoid craniotomy was performed for microvascular decompression of the brainstem with a clip-sling suspension technique augmented with Teflon felt pledgets. The patient had immediate complete relief from TN, HFS, and GPN postoperatively. CONCLUSION Microvascular decompression using the clip-sling technique via a retrosigmoid approach should be considered as a safe and effective option for transposition and suspension of the offending artery and decompression of the affected nerve roots in cases of combined HDS.

Technique of microvascular decompression

2005 ◽  
Vol 18 (5) ◽  
pp. 1-5 ◽  
Author(s):  
Peter J. Jannetta ◽  
Mark R. Mclaughlin ◽  
Kenneth F. Casey
Keyword(s):  
Surgical Technique ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Cerebellopontine Angle ◽  
Wound Closure ◽  
Primary Source ◽  
Vascular Compression ◽  
Pathological Features ◽  
The Third

Vascular compression of the trigeminal nerve in the cerebellopontine angle is now generally accepted as the primary source or “trigger” causing trigeminal neuralgia. A clear clinicopathological association exists in the neurovascular relationship. In general, pain in the third division of the trigeminal nerve is caused by rostral compression, pain in the second division is caused by medial or more distant compression, and pain in the first division is caused by caudal compression. This discussion of the surgical technique includes details on patient position, placement of the incision and craniectomy, microsurgical exposure of the supralateral cerebellopontine angle, visualization of the trigeminal nerve and vascular pathological features, microvascular decompression, and wound closure. Nuances of the technique are best learned in the company of a surgeon who has a longer experience with this procedure.

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