scholarly journals Subtemporal transtentorial approach for recurrent trigeminal neuralgia after microvascular decompression via the lateral suboccipital approach: case report

2015 ◽  
Vol 122 (6) ◽  
pp. 1429-1432 ◽  
Author(s):  
Toshihiro Ogiwara ◽  
Tetsuya Goto ◽  
Yoshikazu Kusano ◽  
Masafumi Kuroiwa ◽  
Takafumi Kiuchi ◽  
...  
Keyword(s):  
Case Report ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Previous Surgery ◽  
Suboccipital Craniotomy ◽  
Root Entry Zone ◽  
Lateral Suboccipital Approach ◽  
Materials Used ◽  
Suboccipital Approach ◽  
Transtentorial Approach

Microvascular decompression (MVD) via lateral suboccipital craniotomy is the standard surgical intervention for trigeminal neuralgia (TN). For recurrent TN, difficulties are sometimes encountered when performing reoperation via the same approach because of adhesions and prosthetic materials used in the previous surgery. In the present case report the authors describe the efficacy of the subtemporal transtentorial approach for use in recurrent TN after MVD via the lateral suboccipital approach. An 86-year-old woman, in whom an MVD via a lateral suboccipital craniotomy had previously been performed for TN, underwent surgery for recurrent TN via the subtemporal transtentorial approach, which provided excellent visualization of the neurovascular relationships and the trigeminal nerve without adhesions due to the previous surgery. Her TN disappeared after the MVD. The present approach is ideal for visualizing the trigeminal root entry zone, and the neurovascular complex can be easily dissected using a new surgical trajectory. This approach could be another surgical option for reoperation when the previous MVD had been performed via the suboccipital approach.

Trans-sylvian Approach to Microvascular Decompression for Trigeminal Neuralgia in Syndromic Cranial Base Settling

2017 ◽  
Vol 15 (2) ◽  
pp. E9-E12 ◽  
Author(s):  
Mrityunjoy Sarkar ◽  
Ashok Pillai
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Standard Of Care ◽  
Cranial Base ◽  
Basilar Invagination ◽  
3 Dimensional ◽  
Root Entry Zone ◽  
Trigeminal Root ◽  
Lateral Suboccipital Approach ◽  
Suboccipital Approach

Abstract BACKGROUND AND IMPORTANCE The lateral suboccipital approach for microvascular decompression (MVD) of the trigeminal nerve has become a standard-of-care over the past several decades. Syndromic cranial base settling, a rare but known cause for trigeminal neuralgia (TN), poses significant dilemmas in clinical management. In such cases, distorted anatomy may render surgery via the suboccipital approach difficult or even impossible. CLINICAL PRESENTATION A 34-yr-old male with osteogenesis imperfecta and severe basilar invagination suffered from TN that was refractory to medication and stereotactic radiosurgery. MVD of the fifth nerve root was performed via a pterional trans-sylvian approach after 3-dimensional trajectory modeling suggested the feasibility of this approach. He experienced complete resolution of TN and remains free of both pain and medications after 18 mo of follow-up. CONCLUSION This microsurgical trajectory, previously undescribed for TN, provides good visualization of the trigeminal root entry zone, thereby offering an excellent surgical option for severe TN in the setting of abnormal posterior fossa anatomy.

scholarly journals Vertebrobasilar dolichoectasia as a cause of trigeminal neuralgia: the role of microvascular decompression. Case report

2006 ◽  
Vol 64 (1) ◽  
pp. 128-131 ◽  
Author(s):  
Jorge Luiz Kraemer ◽  
Arthur de Azambuja Pereira Filho ◽  
Gustavo de David ◽  
Mario de Barros Faria
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Facial Pain ◽  
Successful Outcome ◽  
Mechanical Compression ◽  
Suboccipital Craniotomy ◽  
Vertebrobasilar Dolichoectasia

Our purpose is to report a case of trigeminal neuralgia caused by vertebrobasilar dolichoectasia treated with microvascular decompression. A 63-year-old man sought treatment for a recurrent lancinating left facial pain in V2 and V3 trigeminal territories. The computed tomography angiography revealed a mechanical compression of the left trigeminal nerve due to vertebrobasilar dolichoectasia. The patient was submitted to a left suboccipital craniotomy. Shredded Teflon® was introduced in the conflicting neurovascular area, achieving a satisfactory decompression. The patient’s pain resolved immediately. Vertebrobasilar dolichoectasia is a rare cause of trigeminal neuralgia and a successful outcome can be achieved with microvascular decompression.

Endoscope-Assisted Microvascular Decompression for Trigeminal Neuralgia:Technical Case Report

2006 ◽  
Vol 59 (suppl_4) ◽  
pp. ONS-E489-ONS-E490 ◽  
Author(s):  
Charles Teo ◽  
Peter Nakaji ◽  
Ralph J. Mobbs
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Trigeminal Neuralgia ◽  
Wound Infection ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Complication Rate ◽  
Entry Zone ◽  
Root Entry Zone

Abstract OBJECTIVE: Microvascular decompression may fail to relieve trigeminal neuralgia because a compressing vessel at the root entry zone may be overlooked during surgery. Alternatively, effective decompression may not always be achieved with the visualization provided by the microscope alone. We theorized that the addition of an endoscope would improve the efficacy of microvascular decompression. METHODS: We retrospectively reviewed microvascular decompression of the trigeminal nerve in 114 patients. Before closure, the endoscope was used to inspect the root entry zone. When visualization with the microscope was poor, the endoscope was used to identify an aberrant vessel and to perform or improve the subsequent decompression. RESULTS: Of 114 patients who underwent microvascular decompression, 113 successfully underwent endoscopy. In 38 patients (33%), endoscopy revealed arteries that were poorly seen (25%) or not seen at all (8%) with the microscope. At a mean follow-up period of 29 months, the pain was completely relieved in 112 patients (99.1%), all of whom were off medication. Complications included trigeminal dyses-thesias in nine patients and a wound infection, partial hearing loss, and complete hearing loss in one patient each. The overall complication rate was 9%. CONCLUSION: Endoscopy is a simple and safe adjunct to microscopic exploration of the trigeminal nerve. The markedly improved visualization increases the likelihood of identifying the offending vessel and consequently of achieving satisfactory decompression of the nerve. Thus far, the success rate has been high, and the complication profile is comparable to that of other large series.

scholarly journals Neurovascular Compression at the Root Entry Zone Correlates with Trigeminal Neuralgia and Early Microvascular Decompression Outcome

2016 ◽  
Vol 95 ◽  
pp. 208-213 ◽  
Author(s):  
Akshitkumar M. Mistry ◽  
Kurt J. Niesner ◽  
Wendell B. Lake ◽  
Jonathan A. Forbes ◽  
Chevis N. Shannon ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Neurovascular Compression ◽  
Entry Zone ◽  
Root Entry Zone

scholarly journals Recurrent Trigeminal Neuralgia due to Granulomatous Change in a Prosthesis for Microvascular Decompression: A Case Report

1997 ◽  
Vol 6 (7) ◽  
pp. 498-502 ◽  
Author(s):  
Hideaki Ishibashi ◽  
Toshio Matsushima ◽  
Yoshihiro Natori ◽  
Toru Iwaki ◽  
Masashi Fukui ◽  
...  
Keyword(s):  
Case Report ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression

scholarly journals Endoscopic assisted microsurgical removal of cerebello-pontine angle and prepontine epidermoid

2012 ◽  
Vol 03 (03) ◽  
pp. 414-419 ◽  
Author(s):  
Forhad H. Chowdhury ◽  
Mohammod R. Haque
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Base ◽  
Surgical Instruments ◽  
Epidermoid Tumor ◽  
Subarachnoid Spaces ◽  
Lateral Suboccipital Approach ◽  
Neurovascular Structures ◽  
Suboccipital Approach

ABSTRACTCerebello-pontine(CP) angle and prepontine epidermoid tumors are challenging lesions because they grow along the subarachnoid spaces around the very important neurovascular structures and often extend into the supratentorial compartment. They have typically been removed through a variety of anterolateral, lateral, and posterolateral cranial base microsurgical approaches. Sometime they were removed by the endoscope-assisted microneurosurgical (EAM) techniques. Here we report a CP angle and preontine epidermoid tumor extended to supratentorial compartment presented with trigeminal neuralgia that was removed by pure endoscopic visualization through retrosigmoid retromastoid lateral suboccipital approach. (The method of using endoscope along with surgical instruments passing along the sides of endoscope is termed as Endoscope-Controlled Microsurgery—ECM.) So far our knowledge, in the literature this type of report is probably very rare.

Peduncular hallucinosis following microvascular decompression for trigeminal neuralgia: Case report

1993 ◽  
Vol 40 (1) ◽  
pp. 31-34 ◽  
Author(s):  
Haruhisa Tsukamoto ◽  
Toshio Matsushima ◽  
Shigeru Fujiwara ◽  
Masashi Fukui
Keyword(s):  
Case Report ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Peduncular Hallucinosis

scholarly journals Surgical Outcomes After Microvascular Decompression With Internal Neurolysis and Partial Neurectomy for Patients With Trigeminal Neuralgia and Negative Neurovascular Compression

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Amanda Carpenter ◽  
James K Liu
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Neurovascular Compression ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Root Entry Zone ◽  
Internal Neurolysis ◽  
Facial Numbness

Abstract INTRODUCTION Microvascular decompression (MVD) is an effective and durable treatment for patients with trigeminal neuralgia (TN) due to neurovascular compression (NVC). In the absence of NVC, the traditional MVD is less effective in achieving long-term pain relief. Internal neurolysis at the root entry zone (REZ) of the trigeminal nerve has been described in the literature; however, there are few reports of long-term outcome after this procedure. Furthermore, this is the first study to combine this procedure with additional partial neurectomy. METHODS This is a retrospective review of the senior author's patients with TN who underwent retrosigmoid craniectomy for MVD with internal neurolysis and partial neurectomy. Primary indications were patients with TN and no evidence of NVC intraoperatively. A total of 9 patients were included in the analysis. Three cases were of recurrent TN. The technique was performed with an 11-blade or arachnoid knife to open the perineurium in a longitudinal fashion at the REZ. A disc dissector was used to comb the fascicles along the longitudinal course, and a partial neurectomy was performed with a microscissors to make three selective cuts into the fascicles at the REZ. Barrow Neurological Institute (BNI) facial pain and numbness scales were used as postoperative assessment. RESULTS At median follow up of 12 mo (range: 2 to 34), 8 of 9 patients (89%) had a BNI-pain score of I (no trigeminal pain, no medications). Two of nine patients (22%) had a BNI-numbness score of I (no numbness); seven (78%) had a BNI-numbness score of II (mild facial numbness that is not bothersome). CONCLUSION Internal neurolysis with partial neurectomy appears to be an effective and potentially durable treatment option for patients with TN (primary or recurrent) without NVC. Larger series with longer follow-up is indicated to further evaluate the utility of this procedure.

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