scholarly journals Trigeminal neuralgia caused by an arachnoid cyst in Meckel’s cave: A case report and literature review

2021 ◽  
Vol 12 ◽  
pp. 45
Author(s):  
Shunya Hanakita ◽  
Soichi Oya ◽  
Toru Matsui
Keyword(s):  
Literature Review ◽  
Trigeminal Neuralgia ◽  
Arachnoid Cyst ◽  
Trigeminal Nerve ◽  
Neurovascular Compression ◽  
Mr Images ◽  
Meckel’S Cave ◽  
Suboccipital Craniotomy ◽  
Meckel's Cave ◽  
Asymmetric Shape

Background: We present a rare case of trigeminal neuralgia (TN) caused by an arachnoid cyst (AC) in Meckel’s cave (MC). Case Description: A 35-year-old man presented with facial pain in the left maxillary and mandibular regions. Since the initial magnetic resonance (MR) imaging showed no apparent offending vessels or tumors, the patient was diagnosed with idiopathic TN, for which carbamazepine was initially effective. When his pain worsened, he was referred to our hospital. A slightly asymmetric shape of MC and distorted course of the trigeminal nerve was confirmed on the initial and repeat MR images. His pain was characterized as electric-shock-like pain, which was triggered by touching the face. Under the tentative diagnosis of an AC confined to MC compressing the trigeminal nerve, the exploration of MC through suboccipital craniotomy was performed. Intraoperatively, the AC was identified in the rostral portion of MC. The indentation of the trigeminal nerve was also observed at the orifice of MC, indicating severe compression by the AC. The wall of the AC was fenestrated. The patient’s pain was relieved immediately after surgery. Postoperative MR images showed that the course of the trigeminal nerve was straightened. Although our literature review found five similar cases, the size of the AC was the smallest in our case. Conclusion: Although it is rare, the AC confined to MC can cause TN. The findings of this study emphasize the importance of evaluating subtle radiological findings of compression on the trigeminal nerve in cases of TN seemingly without neurovascular compression.

Trigeminal Neuralgia Caused by Venous Compression

Neurosurgery ◽  
2004 ◽  
Vol 55 (2) ◽  
pp. 334-339 ◽  
Author(s):  
Toshio Matsushima ◽  
Phuong Huynh-Le ◽  
Masayuki Miyazono
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Complete Relief ◽  
Surgical Results ◽  
Meckel’S Cave ◽  
Trigeminal Pain ◽  
Venous Compression ◽  
Facial Numbness ◽  
Meckel's Cave

Abstract OBJECTIVE: The purpose of this study is to clarify whether venous compression on the trigeminal nerve really causes trigeminal neuralgia or not, and to identify which veins are the offending veins. METHODS: We used microvascular decompression in operations on 121 patients with typical trigeminal neuralgia. We analyzed the intraoperative findings and surgical results in these 121 cases. RESULTS: In 7 of the 121 cases, only the vein was identified as a compressive factor on the trigeminal nerve. In 6 of these 7 cases, single venous compression was found, whereas the remaining case had two offending veins. The transverse pontine vein was most frequently found as the offending vein near Meckel's cave. All patients showed complete relief of trigeminal pain after decompression of the veins, but four of them developed facial numbness after surgery, which tended to be slight and did not require any treatment. CONCLUSION: Our surgical experiences showed that venous compression could cause trigeminal neuralgia by itself and that the transverse pontine vein should be carefully observed because it is most frequently the offending vein.

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 in a Patient with a Dural Arteriovenous Fistula in Meckel's Cave: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (1) ◽  
pp. 216-221 ◽  
Author(s):  
Rose Du ◽  
Devin K. Binder ◽  
Van Halbach ◽  
Nancy Fischbein ◽  
Nicholas M. Barbaro
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Arteriovenous Fistula ◽  
Trigeminal Nerve ◽  
Dural Arteriovenous Fistula ◽  
Gasserian Ganglion ◽  
Resonance Imaging ◽  
Meckel’S Cave ◽  
Meckel's Cave

Abstract OBJECTIVE AND IMPORTANCE Trigeminal neuralgia is often the result of vascular compression at the root entry zone of the trigeminal nerve. We report a case of trigeminal neuralgia in a patient with a dural arteriovenous fistula in Meckel's cave. Endovascular closure of the fistula resulted in elimination of the patient's pain at the gasserian ganglion level. CLINICAL PRESENTATION A 77-year-old woman was referred for treatment of trigeminal neuralgia after failed conservative treatment, including multiple gasserian ganglion blocks. Magnetic resonance imaging of the brain suggested a vascular lesion, and cerebral angiography demonstrated a dural arteriovenous fistula in Meckel's cave. INTERVENTION Endovascular coil embolization was performed, with obliteration of the dural arteriovenous fistula and resolution of facial pain but with decreased sensation in the face. CONCLUSION Trigeminal neuralgia may be associated with complex vascular lesions around the base of the brain and along the course of the trigeminal nerve. The evaluation of patients with trigeminal neuralgia should include high-quality, thin-section, magnetic resonance imaging scans, to exclude the possibility of vascular lesions and other structural lesions. In particular, patients who are being evaluated for surgical treatment of trigeminal neuralgia should undergo magnetic resonance imaging, with a focus on the course of the trigeminal nerve.

Contralateral Trigeminal Neuralgia as a False Localizing Sign in Intracranial Tumors

Neurosurgery ◽  
1987 ◽  
Vol 20 (1) ◽  
pp. 1-3 ◽  
Author(s):  
R. Florensa ◽  
J. Llovet ◽  
A. Pou ◽  
E. Galitó ◽  
J. Vilato ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Brain Stem ◽  
Trigeminal Nerve ◽  
Intracranial Tumor ◽  
Intracranial Tumors ◽  
Meckel’S Cave ◽  
Meckel's Cave ◽  
False Localizing Sign ◽  
The Brain

Abstract Three cases of contralateral trigeminal neuralgia as a false localizing sign in intracranial tumors are reported. In each patient (meningioma, 2 cases; cholesteatoma, 1 case) the tumor was asymptomatic, so that intracranial tumor had not been suspected preoperatively. In all cases, tumors were large and firm. The tumor was supratentorial in two cases. In one case, a cortically mediated mechanism may have caused the neuralgia, whereas in the remaining two cases distortion and displacement of the brain stem and compression of the contralateral Meckel's cave would explain the trigeminal nerve signs.

MRI features of responsible contacts in vascular compressive trigeminal neuralgia and prediction modeling

2021 ◽  
pp. 028418512098397
Author(s):  
Yufei Zhao ◽  
Jianhua Chen ◽  
Rifeng Jiang ◽  
Xue Xu ◽  
Lin Lin ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Predictive Model ◽  
Trigeminal Nerve ◽  
Roc Curve ◽  
Neurovascular Compression ◽  
Diagnostic Efficiency ◽  
Mri Features ◽  
Vascular Origin ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Characteristics

Background Multiple neurovascular contacts in patients with vascular compressive trigeminal neuralgia often challenge the diagnosis of responsible contacts. Purpose To analyze the magnetic resonance imaging (MRI) features of responsible contacts and establish a predictive model to accurately pinpoint the responsible contacts. Material and Methods Sixty-seven patients with unilateral trigeminal neuralgia were enrolled. A total of 153 definite contacts (45 responsible, 108 non-responsible) were analyzed for their MRI characteristics, including neurovascular compression (NVC) grading, distance from pons to contact (Dpons-contact), vascular origin of compressing vessels, diameter of vessel (Dvessel) and trigeminal nerve (Dtrigeminal nerve) at contact. The MRI characteristics of the responsible and non-responsible contacts were compared, and their diagnostic efficiencies were further evaluated using a receiver operating characteristic (ROC) curve. The significant MRI features were incorporated into the logistics regression analysis to build a predictive model for responsible contacts. Results Compared with non-responsible contacts, NVC grading and arterial compression ratio (84.44%) were significantly higher, Dpons-contact was significantly lower at responsible contacts ( P < 0.001, 0.002, and 0.033, respectively). NVC grading had a highest diagnostic area under the ROC curve (AUC) of 0.742, with a sensitivity of 64.44% and specificity of 75.00%. The logistic regression model showed a higher diagnostic efficiency, with an AUC of 0.808, sensitivity of 88.89%, and specificity of 62.04%. Conclusion Contact degree and position are important MRI features in identifying the responsible contacts of the trigeminal neuralgia. The logistic predictive model based on Dpons-contact, NVC grading, and vascular origin can qualitatively improve the prediction of responsible contacts for radiologists.

scholarly journals Trigeminal Nerve Schwannoma of the Cerebellopontine Angle

2018 ◽  
Vol 79 (S 05) ◽  
pp. S389-S390
Author(s):  
Maria Peris-Celda ◽  
Christopher Graffeo ◽  
Avital Perry ◽  
Lucas Carlstrom ◽  
Michael Link
Keyword(s):  
Trigeminal Nerve ◽  
Cerebellopontine Angle ◽  
Incidental Finding ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Clinical History ◽  
Sensory Loss ◽  
Meckel’S Cave ◽  
Neurologic Deficits ◽  
Meckel's Cave

Introduction Large and even moderate sized, extra-axial cerebellopontine angle (CPA) tumors may fill this restricted space and distort the regional anatomy. It may be difficult to determine even with high resolution magnetic resonance imaging (MRI) if the tumor is dural-based, or what the nerve of origin is if a schwannoma. While clinical history and exam are helpful, they are not unequivocal, particularly since many patients present with a myriad of symptoms, or conversely an incidental finding. We present an atypical appearing, asymptomatic CPA tumor, ultimately identified at surgery to be a trigeminal schwannoma. Case History A 40-year-old man presented with new-onset seizure. MRI identified an incidental heterogeneously contrast-enhancing CPA lesion (Fig. 1A–D). The tumor was centered on the internal auditory canal (IAC) with no tumor extension into Meckel's cave, IAC or jugular foramen. Audiometry demonstrated 10db of relative left-sided hearing loss with 100% word recognition. Physical examination was negative for focal neurologic deficits. A retrosigmoid craniotomy was performed and an extra-axial, yellow-hued mass was encountered and resected, which was ultimately confirmed to originate from the trigeminal nerve (Video 1). Gross total resection was achieved, and the patient recovered from surgery with partial ipsilateral trigeminal sensory loss and no other new neurologic deficits. Conclusion Pure CPA trigeminal schwannomas are rare, but should be considered in the differential for enhancing CPA lesions. Although, Meckel's cave involvement is frequently observed, it is not universal, and pure CPA schwannomas of all cranial nerves IV–XII have been reported in the literature.The link to the video can be found at: https://youtu.be/AlodYCu70F8.

Significance of degree of neurovascular compression in surgery for trigeminal neuralgia

2020 ◽  
Vol 133 (2) ◽  
pp. 411-416 ◽  
Author(s):  
Marion A. Hughes ◽  
Ronak H. Jani ◽  
Saeed Fakhran ◽  
Yue-Fang Chang ◽  
Barton F. Branstetter ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Multivariate Regression ◽  
Strong Predictor ◽  
Multivariate Regression Analysis ◽  
Preoperative Imaging ◽  
Neurovascular Compression ◽  
Mr Images ◽  
P Values ◽  
Surgical Success ◽  
Pain Status

OBJECTIVEThe aim of this study was to identify preoperative imaging predictors of surgical success in patients with classic trigeminal neuralgia (cTN) undergoing microvascular decompression (MVD) via retrospective multivariate regression analysis.METHODSAll included patients met criteria for cTN and underwent preoperative MRI prior to MVD. MR images were blindly graded regarding the presence and severity (i.e., mild or severe) of neurovascular compression (NVC). All patients were contacted by telephone to determine their postoperative pain status.RESULTSA total of 79 patients were included in this study. Sixty-two patients (78.5%) were pain-free without medication following MVD. The following findings were more commonly observed with the symptomatic nerve when compared to the contralateral asymptomatic nerve: NVC (any form), arterial compression alone, NVC along the proximal trigeminal nerve, and severe NVC (p values < 0.0001). The only imaging variable that was a statistically significant predictor of being pain-free without medication following MVD was severe NVC. Patients with severe NVC were 6.36 times more likely to be pain-free following MVD compared to those without severe NVC (p = 0.007).CONCLUSIONSIn patients with cTN undergoing MVD, severe NVC on preoperative MRI is a strong predictor of an excellent surgical outcome.

TRIGEMINAL NEURALGIA AND VASCULAR COMPRESSION IN PATIENTS WITH TRIGEMINAL SCHWANNOMAS

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. E974-E975 ◽  
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.

Rare cause of trigeminal neuralgia: Meckel’s cave meningocele

2015 ◽  
Vol 157 (7) ◽  
pp. 1183-1186 ◽  
Author(s):  
Abdullah Alobaid ◽  
Todd Schaeffer ◽  
Justin Virojanapa ◽  
Amir R. Dehdashti
Keyword(s):  
Trigeminal Neuralgia ◽  
Meckel’S Cave ◽  
Meckel's Cave
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