Cerebellopontine angle epidermoids presenting with trigeminal neuralgia.

We studied the clinical characteristics of cerebellopontine angle (CPA) epidermoids presenting with trigeminal neuralgia (TN). Twenty-four patients were analyzed retrospectively and the literature reviewed with regard to clinical manifestation, imaging features, surgical procedures and prognosis. TN may be the initial symptom of CPA epidermoid, particularly in young patients. Epidermoids are characteristically hypodense nonenhancing lesions on CT scans, while on MRI they exhibit long T1 and T2 relaxation times. Although complete removal is ideal in the surgical management of CPA epidermoid, proximity to cranial nerves and the brain stem may pose technical difficulties in complete resection. In addition to complete resection of the tumour, arterial compression at the root entry zone (REZ) of the trigeminal nerve should be sought, and if found, a microvascular decompression (MVD) should be performed. Cranial nerve dysfunction and aseptic meningitis are the most common operative complications.     

Unusual cause for bilateral trigeminal neuralgia: unilateral racemous cysticercus of cerebellopontine angle. Case report

We report the case of a 42-year-old woman with a racemous cystecercus in the right cerebellopontine angle (CPA), who presented with bilateral trigeminal neuralgia. The parasite was completly removed via a right suboccipital craniotomy. On the first postoperative day, the patient indicated that the pain disappeared. The neuralgia was caused by two probable mechanisms: a distortion of the brain stem and compression of the nerve against an arterial loop at the entry zone or arachnoiditis caused by the parasite in the both CPA cisternae. This case demonstrates the advisability of obtaining imaging studies in all patients with trigeminal neuralgia before starting any management. We must always remind that the cysticercus may be a differential diagnosis of CPA lesions.     

经皮穿刺微球囊压迫治疗三叉神经痛

目的总结球囊形状对于经皮穿刺微球囊压迫(PMC)治疗的临床效果的影响。方法对我院神经外科自2000年12月～2001年9月采用PMC方法治疗的一组94例三叉神经痛病人的临床资料进行分析。结果83例术后疼痛完全缓解,成功率为88%;44例球囊呈梨形者全部获成功治疗,另49例球囊形状不理想者中11例发生早期治疗失败。4例术后疼痛复发及2例术后发生一过性外展神经功能丧失者全部发生于球囊形状不理想者。结论PMC是治疗三叉神经痛的一种有效方法。球囊形状在治疗成功率、并发症发生及疼痛复发方面均有重要意义。     

Cerebellopontine angle lipoma: clinical case

Lipomas of the cerebellopontine angle are extremely rare. These tumors are probably maldevelopment lesions which can cause slowly progressive neurological symptoms. Including the present case, 90 lipomas in this localization have been described in the literature. The authors report a case of cerebellopontine angle lipoma in a 44-year-old male patient who suffered right hearing loss and tinnitus during seven months. The literature concerning this rare cerebellopontine angle tumor is review. The symptoms, radiological features and surgical management are discussed.     

Operative findings in cases of trigeminal neuralgia without vascular compression: proposal of a different mechanism.

Trigeminal neuralgia is known to be caused by vascular compression at the trigeminal root entry zone (REZ) and microvascular decompression provides good outcome in most of cases. However, in some cases, no vascular compression was observed at the REZ. Over the last 2(1/2) years, the first author operated on 53 cases of trigeminal neuralgia with microvascular decompression and encountered nine cases where no offending vessels were noted at or near the REZ. They were divided into two groups: five cases involving an initial operation and four cases involving a second operation. In the former, arachnoid thickening, angulation or torsion of the root axis were common findings. Dissection of thick arachnoid around the root along the whole length reversed the root to be straight and flaccid. Complete pain relief was noted in four of five cases. In one case of atypical pain, constant facial pain remained. In the latter four cases, where the first operations were done more than 4 years before, thick granulation was noted around REZ without new offending vessels in two cases. In the remaining two cases, where no offending vessels were noted in the first operation, thick adhesion of a distal portion of the root with dura on the pyramidal bone was noted. Meticulous dissection of t he whole length of the root was done and complete pain relief was obtained. Delayed but complete pain relief in these nine cases was noted. Based on operative findings, arachnoid thickening or granulomatous adhesion between the root and surrounding structures can cause an abnormal course of the trigeminal nerve root, which causes root angulation and/or torsion. They can also cause pulsatile movement of the trigeminal nerve root. This tethering effect can promote abnormal root stretching force, especially at REZ, which might promote hyperexitability of the nerve.This speculative mechanism suggests that it is important to make the root free along the entire length, especially at its distal portion in cases with no offending vessels.     

Cerebellopontine angle oligodendroglioma in a child; first case report

The reported incidence of oligodendrogliomas in the paediatric population is less than 1 %. The posterior fossa is a rare location, with the vast majority arising in the cerebral hemispheres. We report the first paediatric case of a WHO grade II oligodendroglioma arising in the cerebellopontine angle (CPA). CPA oligodendrogliomas in children appear to behave aggressively and adjuvant therapy must be considered early; especially when complete resection cannot be achieved.     

The effectiveness of microvascular decompression in various types of vascular compression in patients with trigeminal neuralgia

The aim of the work was to evaluate the efficacy of microvascular decompression (MVD) in different types of vascular compression (VC) in 20 patients with the idiopathic form of trigeminal neuralgia (TN). The typical VC was found in 17 cases. An arterial vessel was the cause of VC in 6 cases, a venous vessel in 5. The mixed type of VC was present in 6 cases. In every case of the mixed VC one of the vessels compressing the 5th nerve predominated: arterial in 5 and venous in 1. In 3 cases of TN no VC was found. Observation time after MVD was from 6 to 61 months (median 26.7 months). In the TN patients with the arterial VC (including the mixed VC with the arterial predominance) pain relief was complete in 7 cases, satisfactory in 2 and none in 1 case. In patients with venous VC (including mixed VC with venous predominance) pain relief was complete in 4 cases and satisfactory in 2. In the TN patients without VC pain relief was satisfactory in 1, unsatisfactory in 1 and none in 1 case. Long term results of MVD in the analyzed series of the TN patients confirm the efficacy of MVD when vascular compression of the 5th nerve--either arterial or venous--is found intraoperatively.     

Olfactory threshold increase in trigeminal neuralgia after balloon compression

Idiopathic trigeminal neuralgia (ITN) is a well-known disease often treated with neurosurgical procedures, which may produce sensorial abnormalities, such as numbness, dysesthesia and taste complaints. We studied 12 patients that underwent this technique, in order to verify pain, gustative and olfactory thresholds abnormalities, with a follow-up of 120 days. We compared the patients with a matched control group of 12 patients. Our results found a significant difference in the olfactory threshold at the immediate post-operative period (p = 0.048). We concluded that injured trigeminal fibers are probably associated with the increase in the olfactory threshold after the surgery, supporting the sensorial interaction theory.     

三叉神经痛与静脉压迫关系的探讨

随着显微外科技术的发展,微血管减压术在三叉神经痛的治疗中取得了良好疗效。很多大宗的显微外科减压术(MVD)证实在三叉神经痛的病理中,血管对神经的压迫起着至关重要的作用。但是目前大多数文献倾向于动脉对血管压迫的研究,对于静脉压迫的研究报道很少。本研究报道234例MVD证实有静脉压迫的三叉神经痛病人的手术经验以及相关静脉的术中解剖。     

Idiopathic familial trigeminal neuralgia: a case report

Trigeminal neuralgia (TN) is paroxysmal, lancinant pain often described as an “electric wave” by patients, with involvement of the divisions of the fifth cranial nerve. Demyelinating, compressive, ischaemic diseases are involved in the physiopathology of TN, but there are some cases without explanation. Familial TN (FTN) is a rare condition, about 1%–2% of all TN cases, while sporadic cases are the most common. To date, there have been about 126 reports of FTN. We describe the case of a 66-year-old man who had been complaining for 3 years of right-side paroxysmal lancinating pain in the second division of the fifth cranial nerve. A brain MRI with angiographic sequences did not show neurovascular conflicts or other pathological conditions. The patient had a family history of TN, which had been diagnosed in 3 other family members (father, sister and first cousin), who had undergone medical or surgical treatment for TN. There was no family history of hypertension, metabolic disorders, neurological or traumatic diseases. Animal studies have shown a probable involvement of genes codifying for calcium channels as the starting alterations in trigeminal excitability. Our FTN could be a good model to investigate the role of gene mutations in this condition.     

Dyna-CT在经皮微球囊压迫治疗三叉神经痛中的应用

目的 总结Dyna-CT在穿刺卵圆孔,确定球囊位置及形态,进而辅助经皮微球囊压迫治疗三叉神经痛的经验.方法 回顾分析经皮微球囊压迫术中使用Dyna-CT进行三维重建治疗20例三叉神经痛的病例资料,在穿刺时确定穿刺针与卵圆孔的关系及角度,在压迫时确定球囊的位置、形态,测定体积,并进行随访.结果 穿刺针在正位与中线成角15.17°～35.48°,平均25.28°,侧位与Reid基线成角37.46°～ 53.18°,平均46.09°.球囊的体积为568.2 ～891.4 mm3,平均766.1 mm3.20例术后症状均完全缓解,4例出现咬肌无力合并面部轻度痛觉减退.随访时间6～22个月,平均13.3个月,所有病例无复发,术后并发症消失.结论 Dyna-CT辅助经皮微球囊压迫术能够不依赖患者体位,方便地观察卵圆孔,确定穿刺方向,准确地对穿刺针方向及深度进行调整,立体全面地观察及测定穿刺针的角度、球囊的位置、形态和容量,从而降低手术并发症,改善患者预后.     

桥小脑角脂肪瘤1例报告

患者,女性,49岁,主因左面部发作性疼痛5年余,加剧一周入院。查体:左咬肌较右侧萎缩。头颅CT示:左侧桥小脑角区类圆形低密度影,边界清楚,大小1.1 cm×1.4 cm,CT值-90~ -70 HU(图1);头颅MRI示:左侧桥小脑角区一椭圆形短T1稍长T2信号影,边缘清楚,病灶大小1.7 cm×1.1 cm(图2),考虑脂肪瘤。行左侧乙状窦后入路桥小脑角肿物切除术+左三叉神经感觉后根部分切断术,术中见肿瘤位于左侧桥小脑角,椭圆形,内侧与脑干紧密粘连,边界清楚,血供丰富,质地中等,大小2.0 cm×1.5 cm,面、听神经及三叉神经位于肿瘤前下方。病理检查大体所见:淡黄色可漂浮小…     

Cerebellopontine angle lipoma in a teenager

Lipomas of the cerebellopontine angle are very rare lesions. To date, 18 patients have been reported, 17 of whom were adults. A second child is described with cerebellopontine angle lipoma.     

Arteriovenous malformation in the cerebellopontine angle presenting as trigeminal neuralgia

A case of arteriovenous malformation of the left cerebellopontine angle causing symptoms of ipsilateral trigeminal neuralgia is reported. Pain relief followed microsurgical removal of the malformation. The authors review the literature on the subject.     

Cerebellopontine angle enterogenous cyst: case report.

The case of a cerebellopontine angle enterogenous cyst is presented in a 30 year old patient. This very rare tumour and its highly unusual localisation raises questions in relation to its embryogenesis. The literature is reviewed and 3 previously reported cases of endodermal cysts located in the posterior fossa and away from the midline are discussed.     

Comparison of percutaneous trigeminal ganglion compression and microvascular decompression for the management of trigeminal neuralgia

This investigation evaluates the results of percutaneous trigeminal ganglion compression (PTGC) and compares them those for microvascular decompression (MVD) in treating trigeminal neuralgia. The authors report 127 cases of trigeminal neuralgia treated by PTGC and comparing the results with those of 114 patients whom underwent MVD from 1985 to 2000. The following parameters were compared: technical success, pain relief and recurrence, complications, perioperative morbidity, and perioperative mortality. PTGC and MVD initially had similar initial success rates. However, MVD had a higher rate of pain recurrence at the first 2 years follow-up, as well as higher rates of major complications and perioperative morbidity. Meanwhile, PTGC had higher rates of facial numbness, dysesthesia and minor complications.     

神经内窥镜血管减压术治疗原发性三叉神经痛

一、对象与方法 1. 一般资料:男7例,女3例;年龄30～57岁,平均41岁.病史2月～6年;均为单侧三叉神经痛,其中第一支1例,第二支1例,第二、三支8例.所有患者均为非手术治疗无效者.术前均行CT或MRI检查以明确诊断.     

Dyna-CT引导下经皮穿刺三叉神经半月节微球囊压迫术治疗三叉神经痛

目的 探讨Dyna-CT引导下经皮穿刺三叉神经节微球囊压迫术（PBC）治疗三叉神经痛的临床效果。方法 对2017年9月至2018年11月采用Dyna-CT 引导下PBC治疗的17例三叉神经痛的临床资料进行回顾性分析。在Dyna-CT引导下穿刺，颅底3D-CT重建证实穿刺针抵达卵圆孔。通过穿刺针将带导丝CTZ-14球囊导入Meckel腔，球囊压迫三叉神经半月节。结果 住院时间3~9 d，平均5.6 d。术后随访6~12个月。术后症状完全消失14例，明显缓解2例，无缓解1例；总有效率为94.2%（16/17）。术后出现面部麻木15例、咀嚼略乏力9例、眼角干涩2例、口角疱疹5例，均经治疗后痊愈。结论 Dyna-CT 引导下PBC，是针对复发三叉神经痛、高龄、不愿或不能耐受开颅手术的三叉神经痛的有效微创手术方法，具有良好的临床应用价值。