Disease of lower cranial nerves caused by vascular compression

Between April 1989 and September 2007, 181 patients with disease of lower cranial nerves (DLCN) underwent posterior fossa exploration. As a cause of DLCN, vascular compression (VC) was present in 89 patients with trigeminal neuralgia (TN), in 6 with hemifacial spasm (HFS), in 1 with glossopharyngeal neuralgia, in 1 with Meniere?s disease, and in 5 with multiple DLCN. Depending on intraoperative findings, different surgical options were used: microvascular decompression (MVD), MVD with partial sensory rhizotomy (PSR) or total sensory rhizotomy (TSR). Statistic analysis was made using the Fisher?s exact 2-side test. In patients with TN, excellent outcome was archived in 83 patients and good in 6. Postoperative outcome was better (p = 0.007) in cases with severe VC, but without significant correlation between used surgical option and outcome (p = 0.402). Frequency rate of relapses did not depend on severity of VC (p = 0.502) and used surgical option (p = 0.175). In 6 patients with HFS, excellent outcome was archived in 5 with arterial compression and poor in 1 with venous contact. In patients with Meniere?s disease and glossopharyngeal neuralgia, MVD result with excellent outcome. In 5 patients with multiple DLCN, excellent outcome was archived in 3 and good in 2. MVD is method of choice in surgical treatment of DLCN caused by VC. Overall outcome is better with severity of VC.

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Gamma Knife surgery for glossopharyngeal neuralgia

Journal of Neurosurgery ◽

10.3171/2008.8.17641 ◽

2009 ◽

Vol 110 (3) ◽

pp. 559-563 ◽

Cited By ~ 26

Author(s):

Shoji Yomo ◽

Yasser Arkha ◽

Anne Donnet ◽

Jean Régis

Keyword(s):

Pain Relief ◽

Gamma Knife ◽

Cranial Nerves ◽

Initial Response ◽

Neurological Complications ◽

Gamma Knife Surgery ◽

Glossopharyngeal Neuralgia ◽

Invasive Treatment ◽

Neurological Effects ◽

Lower Cranial Nerves

Gamma Knife surgery (GKS) is widely recognized as an effective, minimally invasive treatment for intractable trigeminal neuralgia, but the role of GKS in glossopharyngeal neuralgia (GPN) remains unclear. This study involved 2 patients with medically intractable GPN who were treated using GKS. One patient required 2 treatments because of a recurrence of symptoms (at maximum doses of 60 and 70 Gy), and the other patient had a single intervention (at a maximum dose of 75 Gy). The GKS target was the distal part of the glossopharyngeal nerve. Patients were investigated prospectively, treated, and then assessed periodically with respect to pain relief and neurological function. Complete pain relief was achieved initially after all 3 interventions. The first patient was pain free without medication for 2 months after the first treatment (60 Gy) and for 4 months after the second treatment (70 Gy). The second patient (treated with 75 Gy) was still pain free without medication at the last follow-up (12 months). Neither patient had any neurological complications. The initial response of GPN to low-dose GKS was favorable, but symptoms may recur. No adverse neurological effects were observed in any of the lower cranial nerves. It will be necessary to investigate the optimal radiation dose and target of GKS for achieving long-term pain relief in GPN.

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The microsurgical anatomy of the glossopharyngeal nerve with respect to the jugular foramen lesions

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.2.3 ◽

2004 ◽

Vol 17 (2) ◽

pp. 12-21 ◽

Cited By ~ 12

Author(s):

Mehmet Faik Özveren ◽

Uđur Türe

Keyword(s):

Surgical Treatment ◽

Cranial Nerves ◽

Jugular Foramen ◽

Glossopharyngeal Nerve ◽

Detailed Knowledge ◽

Microsurgical Anatomy ◽

Anatomical Landmarks ◽

Related Area ◽

Deep Layers ◽

Lower Cranial Nerves

Removal of lesions involving the jugular foramen region requires detailed knowledge of the anatomy and anatomical landmarks of the related area, especially the lower cranial nerves. The glossopharyngeal nerve courses along the uppermost part of the jugular foramen and is well hidden in the deep layers of the neck, making this nerve is the most difficult one to identify during surgery. It may be involved in various pathological entities along its course. The glossopharyngeal nerve can also be compromised iatrogenically during the surgical treatment of such lesions. The authors define landmarks that can help identify this nerve during surgery and discuss the types of lesions that may involve each portion of the glossopharyngeal nerve.

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Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery

Journal of Neurosurgery ◽

10.3171/jns.2000.93.4.0586 ◽

2000 ◽

Vol 93 (4) ◽

pp. 586-593 ◽

Cited By ~ 156

Author(s):

Johann Romstöck ◽

Christian Strauss ◽

Rudolf Fahlbusch

Keyword(s):

Detailed Analysis ◽

Cranial Nerve ◽

Cerebellopontine Angle ◽

Operative Procedure ◽

Cranial Nerves ◽

Postoperative Outcome ◽

Lower Cranial Nerve ◽

Content Type ◽

Lower Cranial Nerves ◽

Fine Print

Object. Electromyography (EMG) monitoring is expected to reduce the incidence of motor cranial nerve deficits in cerebellopontine angle surgery. The aim of this study was to provide a detailed analysis of intraoperative EMG phenomena with respect to their surgical significance.Methods. Using a system that continuously records facial and lower cranial nerve EMG signals during the entire operative procedure, the authors examined 30 patients undergoing surgery on acoustic neuroma (24 patients) or meningioma (six patients). Free-running EMG signals were recorded from muscles targeted by the facial, trigeminal, and lower cranial nerves, and were analyzed off-line with respect to waveform characteristics, frequencies, and amplitudes. Intraoperative measurements were correlated with typical surgical maneuvers and postoperative outcomes.Characteristic EMG discharges were obtained: spikes and bursts were recorded immediately following the direct manipulation of a dissecting instrument near the cranial nerve, but also during periods when the nerve had not yet been exposed. Bursts could be precisely attributed to contact activity. Three distinct types of trains were identified: A, B, and C trains. Whereas B and C trains are irrelevant with respect to postoperative outcome, the A train—a sinusoidal, symmetrical sequence of high-frequency and low-amplitude signals—was observed in 19 patients and could be well correlated with additional postoperative facial nerve paresis (in 18 patients).Conclusions. It could be demonstrated that the occurrence of A trains is a highly reliable predictor for postoperative facial palsy. Although some degree of functional worsening is to be expected postoperatively, there is a good chance of avoiding major deficits by warning the surgeon early. Continuous EMG monitoring is superior to electrical nerve stimulation or acoustic loudspeaker monitoring alone. The detailed analysis of EMG-waveform characteristics is able to provide more accurate warning criteria during surgery.

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VASCULAR COMPRESSION OF LOWER CRANIAL NERVES: OBSERVATIONS USING MICROSURGERY, WITH PARTICULAR REFERENCE TO TRIGEMINAL NEURALGIA

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.1977.tb04296.x ◽

1977 ◽

Vol 47 (3) ◽

pp. 314-320 ◽

Cited By ~ 25

Author(s):

Peter G. Petty ◽

Robert Southby

Keyword(s):

Trigeminal Neuralgia ◽

Cranial Nerves ◽

Vascular Compression ◽

Lower Cranial Nerves

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Glossopharyngeal neuralgia

Journal of Neurosurgery ◽

10.3171/jns.1977.47.3.0316 ◽

1977 ◽

Vol 47 (3) ◽

pp. 316-320 ◽

Cited By ~ 143

Author(s):

Ranjit K. Laha ◽

Peter J. Jannetta

Keyword(s):

Posterior Inferior Cerebellar Artery ◽

Cranial Nerves ◽

Glossopharyngeal Neuralgia ◽

Vascular Compression ◽

Entry Zone ◽

Content Type ◽

Root Entry Zone ◽

Cerebellar Artery ◽

Sporadic Cases ◽

Fine Print

✓ Various factors have been considered in the etiology and pathogenesis of glossopharyngeal neuralgia. Vascular compression of the involved cranial nerves has been demonstrated in sporadic cases. In this series of six patients, it was noted with the aid of the operating microscope that the ninth and tenth cranial nerves were compressed by a tortuous vertebral artery or posterior inferior cerebellar artery at the nerve root entry zone in five cases. In selected patients, microvascular decompression without section of the nerves may result in a cure.

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Clinical characteristics and results of surgical treatment of petroclival meningioma

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0606183t ◽

2006 ◽

Vol 134 (5-6) ◽

pp. 183-186

Author(s):

Goran Tasic ◽

Vladimir Jovanovic ◽

Danilo Radulovic ◽

Branko Djurovic ◽

Ivan Piscevic ◽

...

Keyword(s):

Surgical Treatment ◽

Cranial Nerves ◽

Postoperative Outcome ◽

Diagnostic Procedures ◽

Treatment Method ◽

Neurological Status ◽

Surgical Morbidity ◽

Petroclival Meningiomas ◽

Group I ◽

Neurovascular Structures

Introduction: The size of meningioma and its relation with neurovascular structures in petroclival region stipulate the degree of surgical radicalism and determine an operation risk. In spite of progress of surgical technology, the rate of surgical morbidity in view of cranial nerves deficit is 30%-50%. Objective: The objective of our study was to present the results of treatment of patients with petroclival meningiomas and to point to correlation of preoperative radiological findings and intraoperative results as well as neurological status of patients before and after surgical treatment. Method: Retrospective analysis of 35 operated petroclival meningiomas at the Institute of Neurosurgery, CCS, in the period from 1995 to 2004 was presented. The following parameters were analyzed: size of tumor, relation with bone and neurovascular structures, preoperative condition, degree of surgical radicalism and postoperative outcome. Results: The size of tumor was classified in four groups. There were 20 tumors at the right, and 15 at the left side. At the time of diagnostic procedures (based on CT and MRI), 20 tumors were in contact with brainstem, 9 compressed the brainstem, and 6 obstructed the IV ventricle. Preoperative patient condition was evaluated by Karnofsky index. Mean value for group I was 90, II - 80, III - 70 and IV - 50. In 9 cases, liquor drainage was performed preoperatively. In 3 cases, external liquor drainage was carried out postoperatively, and in one case it was replaced by permanent liquor drainage. Radical operation was performed in 44%, and significant reduction was done in other cases. In the postoperative period, 11% patients died, 28% had cranial nerves deficit, and pyramid deficit was recorded in 14% of the patients. The tumor size (III-IV) and brainstem compression were found to be statistically significant (p<0.05) as predisposed factors of deficit prolongation. Conclusion: Petroclival meningoma surgery is reljuired upon precise preoperative analysis. Radicalism of operation is reserved for small and medium tumors, younger patients, and patients in good preoperative condition.

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Chiari Type I Malformation Presenting as Glossopharyngeal Neuralgia: Case Report

Neurosurgery ◽

10.1097/00006123-200101000-00044 ◽

2001 ◽

Vol 48 (1) ◽

pp. 226-228 ◽

Cited By ~ 2

Author(s):

Yucel Kanpolat ◽

Agahan Unlu ◽

Ali Savas ◽

Funda Tan

Keyword(s):

Clinical Presentation ◽

Cranial Nerves ◽

Glossopharyngeal Neuralgia ◽

Cerebellar Tonsil ◽

Pathological State ◽

Type I ◽

Chiari Type ◽

Chiari Type I Malformation ◽

Lower Cranial Nerves ◽

Chiari Type I

Abstract OBJECTIVE AND IMPORTANCE Chiari Type I malformation is an important pathological state in which the brainstem is compressed by the cerebellar tonsil. We present a case of glossopharyngeal neuralgia caused by Chiari Type I malformation. CLINICAL PRESENTATION A 50-year-old male patient was admitted with glossopharyngeal neuralgia. Magnetic resonance imaging studies revealed caudal displacement of the left cerebellar tonsil. INTERVENTION Small occipital craniectomy and C1 laminectomy were performed. The left cerebellar tonsil was resected. CONCLUSION This glossopharyngeal neuralgia was caused by compression of the lower cranial nerves and brainstem by the displaced left cerebellar tonsil. Decompression and pain relief were obtained with resection of the cerebellar tonsil. The patient was pain-free 30 weeks after the operation.

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Complications of Microsurgery of Vestibular Schwannoma

BioMed Research International ◽

10.1155/2014/315952 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 18

Author(s):

Jan Betka ◽

Eduard Zvěřina ◽

Zuzana Balogová ◽

Oliver Profant ◽

Jiří Skřivan ◽

...

Keyword(s):

Retrospective Study ◽

Surgical Treatment ◽

Vestibular Schwannoma ◽

Neurological Complication ◽

Cranial Nerves ◽

High Tech ◽

Csf Leakage ◽

Nerve Dysfunction ◽

Grade 3 ◽

Lower Cranial Nerves

Background. The aim of this study was to analyze complications of vestibular schwannoma (VS) microsurgery.Material and Methods. A retrospective study was performed in 333 patients with unilateral vestibular schwannoma indicated for surgical treatment between January 1997 and December 2012. Postoperative complications were assessed immediately after VS surgery as well as during outpatient followup.Results. In all 333 patients microsurgical vestibular schwannoma (Koos grade 1: 12, grade 2: 34, grade 3: 62, and grade 4: 225) removal was performed. The main neurological complication was facial nerve dysfunction. The intermediate and poor function (HB III–VI) was observed in 124 cases (45%) immediately after surgery and in 104 cases (33%) on the last followup. We encountered disordered vestibular compensation in 13%, permanent trigeminal nerve dysfunction in 1%, and transient lower cranial nerves (IX–XI) deficit in 6%. Nonneurological complications included CSF leakage in 63% (lateral/medial variant: 99/1%), headache in 9%, and intracerebral hemorrhage in 5%. We did not encounter any case of meningitis.Conclusions. Our study demonstrates that despite the benefits of advanced high-tech equipment, refined microsurgical instruments, and highly developed neuroimaging technologies, there are still various and significant complications associated with vestibular schwannomas microsurgery.

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Combined hyperactive dysfunctional cranial nerve syndrome: trigeminal neuralgia, facial hemispasm, and glossopharyngeal neuralgia

Neurology Bulletin ◽

10.17816/nb80996 ◽

1999 ◽

Vol XXXI (1-4) ◽

pp. 94-94

Keyword(s):

Trigeminal Neuralgia ◽

Cranial Nerve ◽

Cranial Nerves ◽

Glossopharyngeal Neuralgia ◽

Vascular Compression ◽

Pathological Conditions

Pathological conditions resulting from vascular compression of the input or output zone of the cranial nerves cause the so-called hyperactive dysfunctional cranial nerve syndrome (HDS).

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