microvascular decompression surgery
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2021 ◽  
Author(s):  
Mohammad H Abul

Abstract Background Crocodile tear syndrome (CTS) is a condition characterised by excessive tear secretion in response to eating, drinking, or smelling foods. Traditionally, acquired cases are most commonly reported following facial nerve trauma or paralysis, or in slow-growing facial nerve tumours. More recently, it has been reported following vestibular Schwannoma surgery. We report the first case of crocodile tear syndrome following microvascular decompression of the trigeminal nerve. Case presentation A 61-year-old lady presented with excessive lacrimation and clear rhinorrhoea one month post-operatively from a re-do trigeminal microvascular decompression surgery. The patient experienced similar symptoms following her initial surgery two years prior, which had resolved spontaneously. CT and MRI head, and comprehensive clinical examination showed no evidence of CSF rhinorrhoea or cause of her symptoms. An ENT opinion was sought, and the patient was diagnosed with post-operative crocodile tear syndrome.Literature review revealed no reported cases of CTS following microvascular decompression of the trigeminal nerve. Surgical technique and relevant imaging were reviewed for any possible explanation for the condition. Considering the accepted pathogenesis of CTS, we discuss the aetio-pathogenesis for the development of the condition following this procedure. Conclusions We conclude CTS should be considered in patients presenting with rhinorrhoea following microvascular decompression of the trigeminal nerve. In patients presenting with post-operative rhinorrhoea after MVD, after excluding CSF leak, CTS should be considered as a potential differential diagnosis. Treatment for CTS in this context may pose a challenge. The patient has undergone botulinum toxin injection of the lacrimal gland and will need long term follow up. This is the first documented case of CTS post microvascular decompression of the trigeminal nerve.


2021 ◽  
pp. 5-11
Author(s):  
Victor Souza ◽  
Maria Passerini ◽  
Bianca Sobral ◽  
Vinicius Baiardi ◽  
Hilton Junior

Introduction Glossopharyngeal neuralgia is a rare syndrome characterized by paroxysms of unilateral and severe stabbing pain occurring in the nerve’s distribution. Although other neuralgias are well described in the medical literature, glossopharyngeal neuralgia and its physiopathology are not. The vascular compression at the nerve root entry zone is the primary explanation for the disease. The first-line treatment is pharmacological, including carbamazepine, oxcarbazepine, and gabapentin. Surgical treatment is offered to medication-refractory patients, and microvascular decompression surgery has the best outcomes. Objective To investigate the pathophysiological and clinical aspects of the different presentations of glossopharyngeal neuralgia. Method: A systematic review of the literature including case reports and clinical trials, was done. Results A search of the literature yielded 31 papers that regarded glossopharyngeal neuralgia or its variants. Eight of these reports regarded vagoglossopharyngeal neuralgia. Seven regarded the glossopharyngeal neuralgia followed by or caused by another disease. Conclusion Glossopharyngeal neuralgia is a rare disease and requires further studies on its mechanism and clinical assessment; the physician needs to know how to distinguish it from its variants and underlying causes.


2021 ◽  
Vol 35 (2) ◽  
pp. 23-27
Author(s):  
Sri Maliawan ◽  
Tjokorda G.B. Mahadewa ◽  
Nyoman Golden ◽  
Wayan Niryana

Pendahuluan : Menurut konsesus spesialis bedah saraf pada The 5th International Meeting of The Society for Microvascular Decompression Surgery, 2002, di Matsumoto, Jepang, terapi terpilih untuk neuralgia trigeminalis dan spasme hemifasialis adalah melakukan operasi dekompresi mikrovaskular (DMV). Tujuan penulisan ini untuk mengetahui hasil operasi DMV pada penderita dengan neuralgia trigeminalis (NT) dan spasme hemifasialis (SHF) di RS Sanglah (RSS), Denpasar. Metode : Studi kohort tanpa kelompok kontrol dilakukan terhadap data rekam medis penderita NT dan SHF di RS Sanglah (RSS), Denpasar, yang menjalani DMV selama periode tahun 1991-2006. Prosedur DMV terdiri atas tindakan memperbaiki posisi pembuluh darah yang menekan dan membebaskan sumbu nervus trigeminus dengan meletakkan teflon di antara nervus dan pembuluh darah. Subjek dievaluasi dalam kurun waktu antara 1 sampai 12 tahun pascoperasi. Data dianalisis untuk memperoleh angka kesembuhan segera, tingkat kepuasan pasien, angka kesembuhan tidak sempurna, angka kekambuhan, dan komplikasi operasi. Hasil : Dari 37 orang subjek terdapat 30 orang dengan NT dan 7 orang dengan SHF. Kesembuhan segera setelah operasi 93,3% pada NT dan 85,7% pada SHF. Subjek merasa puas dengan tindakan yang dilakukan sebanyak 83,3% pada NT dan 71,4% pada SHF. Kesembuhan tidak total 10% pada NT dan 14% pada SHF. Gangguan pendengaran pascaoperasi 13,3% pada NT dan 14% pada SHF. Diskusi : Teknik reposisi pembuluh darah yang menekan nervus trigeminus atau nervus fasialis sebagai prosedur DMV dapat memberikan hasil yang memuaskan untuk mengobati NT dan SHF.


2020 ◽  
Vol 17 (3) ◽  
pp. 55-58
Author(s):  
Prasanna Karki ◽  
Damber Bikram Shah ◽  
Sumit Joshi ◽  
Prakash Poudel ◽  
Jessica Kayastha ◽  
...  

It is well known that brainstem dysfunction may be caused by vascular compression of the medulla oblongata. However, only a limited number of reports have found microvascular decompression surgery to be an effective treatment for symptomatic patients with medulla oblongata dysfunction. This report describes a patient with vertebral artery compression of lateral medulla oblongata who presented with lateral medullary syndrome. Microvascular decompression surgery using the transcondylar fossa approach was effective in relieving patient symptoms. The transcondylar fossa approach and the transposition of vertebral artery along with autologous muscle graft interposition technique is appropriate in microvascular decompression surgery to relieve vertebral artery compression of medulla oblongata.  


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