Intermedius neuralgia

We report 2 cases of microvascular decompression of the nervus intermedius. The current views of aetiology of neuralgia and spasm of the cranial nerves are discussed based on intraoperative observations and electro-optical investigation reported in the literature. The complex anatomy within the sensory system of the facial nerve, and the intersection of its area of supply with that of the glossopharyngeal and vagus nerves are discussed. Surgical treatment is proposed with emphasis on the current preoperative difficulties of interpretation and the intraoperative constant variations in the course of the anterior inferior cerebellar artery.     

三叉神经痛和舌咽神经痛外科治疗

目的探讨三叉神经痛、半面痉挛和舌咽神经痛的显微手术方法及疗效。方法回顾分析桥小脑角Ⅴ、Ⅶ、Ⅸ颅神经手术211例,其中原发性三叉神经痛178例,半面痉挛27例,舌咽神经痛6例。对桥小脑角探查有血管压迫神经的三叉神经痛、半面痉挛患者,以显微血管减压术为主,辅以神经梳理术;无血管压迫神经的三叉神经痛、半面痉挛患者,只作神经梳理术;对显微血管减压和/或神经根梳理术后无效或复发的三叉神经痛患者,作三叉神经感觉根部分切断术;舌咽神经痛患者,均作舌咽神经切断术。结果术后随访6～24个月,三叉神经痛、半面痉挛和舌咽神经痛的治愈率分别是94.3%、92.6%和100%。结论神经梳理术是显微血管减压术治疗三叉神经痛、半面痉挛的必要补充,神经切断术仍为治疗神经痛的有效方法。     

Keyhole microsurgery for trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia

The aim of the study was to describe and evaluate the efficacy of the keyhole microsurgery to manage patients with trigeminal neuralgia (TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GPN). Two hundred and seven patients underwent microvascular decompression (MVD) and neurotomy via retrosigmoid keyhole approach in our department clinic: MVD for trigeminal neuralgia 169 cases, hemifacial spasm 31 cases, glossopharyngeal neuralgia 4 cases and neurotomy for glossopharyngeal neuralgia 3 cases. There was no serious complication such as deaths or infarction in the cerebellum or the brainstem. Complete and partial symptoms relief was obtained in 160 (94.7%) cases and failure 9 (5.3%) cases with MVD for trigeminal neuralgia, postoperatively. Meanwhile, complications occurred in one case with cerebellar hematoma only. The postoperative results of MVD for hemifacial spasm with symptoms relief was noted in 29 (93.5%) cases and failure 2 (6.5%) cases. Postoperative complications occurred in one case with moderate hearing loss, another three cases complained of transient facial paralysis. Symptoms relief achieved in all 7 (100%) cases undergone MVD or neurotomy for glosspharyngeal neuralgia. Postoperative complications occurred in one case with moderate vocal paralysis. We think that microsurgery via retrosigmoid keyhole approach is safe and effective for CPA hyperactive cranial nerve dysfunction syndromes.     

三叉神经痛治疗的探讨

目的 探讨三叉神经痛的病因，比较三叉神经痛的内科治疗及不同手术方法治疗的疗效。方法 60例病人均分别采用过药物、封闭、射频治疗。在内科治疗的基础上，对其中50例病人行颅内三叉神经感觉根部分切断术，8例行三叉神经感觉根梳理术。结果 经内科治疗复发的60例病人中，58例采用手术治疗术后止痛效果好，术后随访42例，3-6年均未复发。结论 内科治疗的方法疗效不肯定。对不同的病人要选择不同的手术方法以达到最佳疗效。     

桥小脑角内镜下神经减压术

目的：探讨内镜在治疗三叉神经痛、面肌痉挛、舌咽神经痛及部分桥小脑角肿瘤手术中应用的相关问题。方法：回顾性分析采用经内镜下耳后小切口乙状窦后入路桥小脑角神经减压术或肿瘤切除术进行治疗的973例患者的临床资料,其中420例三叉神经痛（含28例桥小脑角肿瘤）、487例面肌痉挛和66例舌咽神经痛。结果：420例三叉神经痛中,发现责任血管390例（92.9%）,用Teflon隔离;蛛网膜粘连但未发现责任血管2例（0.5%）;桥小脑角肿瘤继发三叉神经痛28例。487例面肌痉挛中486例有责任血管,用Teflon隔离。66例舌咽神经痛均采用舌咽神经切断加迷走神经减压术治疗。出现脑脊液耳鼻漏3例,小脑梗塞1例,小脑出血2例,颅内积气3例;均治愈。无其他并发症及死亡病例。随访1~5年,三叉神经痛复发4例,面肌痉挛复发4例,舌咽神经痛无复发。结论：内镜用于耳后小切口乙状窦后入路桥小脑角神经减压术治疗三叉神经痛、面肌痉挛、舌咽神经痛手术中可获得满意疗效,提高了责任血管的发现率,有助于脑组织和神经功能的保护,有临床推广应用价值。     

Glossopharyngeal neuralgia with syncope.

Thirty-two cases of glossopharyngeal neuralgia complicated by syncope, cardiac arrhythmias or convulsions, singly or together, have been reported in the world literature. A further case is described and the clinical features of these thirty-three are reviewed. It is recommended that treatment should be undertaken as a matter of urgency. In the first place, Carbamezapine, with often the addition of Atropine, may prove effective. However, surgical intervention appears to give a better chance of permanent relief. Four alternative methods of surgery are discussed and the cervical or the intracranial approach recommended. Surgery should not be delayed in patients who fail to respond to medical treatment or in whom recurrence of symptoms occurs.     

Coincidental supraorbital neuralgia and sinusitis

Headache interpreted as treatment failure may be encountered after FESS or pharmacological treatment for chronic sinusitis. This persistent symptom may lead, even in the presence of minimal sinus disease, to frequent office visits, medical treatment, primary surgery, and revision procedures. A prospective study of patients with a documented history and imaging-verified sinus disease with persistent atypical refractory headache were evaluated. Diagnostic measures included injection of local anesthetic and response to carbamazepine. Severe neuralgia of the supraorbital nerve was identified in 11 patients with chronic sinusitis, treated either medically or surgically before inclusion in the study. Eight of the patients underwent surgery for sinus disease, and five of them had revision surgery because of persisting complaints. All patients responded favorably to the local injection, and eight were treated with carbamazepine. In certain cases, headache in sinusitis patients may be caused or aggravated by supraorbital neuralgia. Sinus disease is possibly a causative factor but conceivably plays the role of a "red herring." This readily diagnosed and treated coexistence may be more prevalent than recognized formerly.     

功能性三叉神经痛手术

目的:探讨既能根治三叉神经痛,又能保留其神经生理功能的功能性三叉神经痛手术方案.方法:采用耳后小切口乙状窦后入路行三叉神经血管减压松解梳理术,治疗三叉神经痛112例,包括桥小脑角区域肿瘤继发三叉神经痛15例.结果:全部病例均一次手术治愈,保全了三叉神经生理功能,随访3个月～3年,近期治愈率100%,无1例复发,仅部分病例留有面部麻木(此组病例因术前均做过无水酒精封闭等治疗).术中发现责任血管91例,神经受压106例,占94.6%.结论:血管减压松解梳理术是治疗三叉神经痛理想的功能性术式.应用冷光源导光束直视手术,有利于责任血管的发现.处理好岩静脉能提高手术成功率.责任血管是指压迫三叉神经感觉根入根区敏感区的血管.     

Trigeminal neuralgia associated with sinusitis

When a patient presents with trigeminal neuralgia, one usually thinks of a vascular loop at the root entry zone of the nerve and consequently of vascular decompression. An image of sinusitis on the MRI may be considered an incidental finding. We present a case of an elderly woman who experienced severe neuralgic pain in the distribution of the trigeminal nerve on the left side following a mild upper respiratory tract infection. Routine MRI revealed severe sinusitis with no pathology in the brain. Following antibiotic treatment for the sinusitis, the symptoms of the neuralgia resolved completely and no other therapy was necessary. A review of the literature reveals a wide variety of etiologies for trigeminal neuralgia. A vascular loop compressing the nerve may be the most frequent cause of trigeminal neuralgia. Nevertheless, other etiologies must be considered prior to decompressive surgery since some can be treated medically.     

Intraoral nerve block for glossopharyngeal neuralgia

Summary Glossopharyngeal neuralgia was treated by a new method of intraoral block. The procedure consists of block for the tonsillar branch and block of the lingual branch by the injection of 5% Phenol in Glycerin. This can be applied for neuralgia with a trigger zone around the tonsil. The result is quite satisfactory. This is extremely safe and simple, and can be performed repetitively when recurrences occur. Also, this procedure does not preclude later operations as a final step.     

Mandibular neuralgia due to anatomical variations

In our large collection of macerated human adult skulls and disarticulated skulls of young individuals we found cases with an extremely large lateral lamina of the pterygoid process. The medial wall of the infratemporal fossa was defined as its formation by the lateral lamina of the pterygoid process and the medial pterygoid muscle. The muscular part formed two-thirds and the lateral lamina one-third of this wall. In cases of a very large lateral lamina in our specimens nearly the whole medial wall was osseous. The third portion of the trigeminal nerve gives off the lingual nerve and alveolar mandibular nerve in the region of the infratemporal fossa. These two nerves generally passed between the lateral and medial pterygoid muscles to their terminal sites. In cases of extremely large lateral laminae the nerves had to make a curve in their course, following the shape of the enlarged lamina. During contraction of the pterygoid muscles both nerves can be compressed. Since the lingual nerve runs between muscular elements, tension and compression is probably avoided. In contrast, the mandibular nerve fixed between the oval and mandibular foramina cannot avoid tension and compression. The result is possible pain, especially during chewing, and may finally create a trigeminal neuralgia. Similar symptoms could be provoked by a foramen pterygospinale or ovalis canal replacing the foramen ovale. Received: 7 July 1998 / Accepted: 16 July 1998     

Use of gabapentin in glossopharyngeal neuralgia

Anticonvulsant drugs, especially carbamazepine, are the treatment of choice for glossopharyngeal neuralgia. If no clinical response is obtained, surgical treatment, including nerve section or decompression, may be required. We report the results obtained with a new anticonvulsant, gabapentin, as an alternative for cases of carbamazepine failure. In 7 patients with bouts of glosso-pharyngeal neuralgia refractory to the usual medical treatment, gabapentin produced improvement in 5 patients. Response was poor in patients who had undergone surgical nerve decompression. Gabapentin was concluded to be an effective therapeutic option for neuralgia of the IXth cranial nerve before surgery.     

Intraoral nerve block for glossopharyngeal neuralgia

Glossopharyngeal neuralgia was treated by a new method of intraoral block. The procedure consists of block for the tonsillar branch and block of the lingual branch by the injection of 5% Phenol in Glycerin. This can be applied for neuralgia with a trigger zone around the tonsil. The result is quite satisfactory. This is extremely safe and simple, and can be performed repetitively when recurrences occur. Also, this procedure does not preclude later operations as a final step.     

乙状窦后锁孔手术治疗三叉神经痛、半面痉挛和舌咽神经痛

目的 评价锁孔术治疗三叉神经痛（TN）,半面痉挛（HFS）和舌咽神经痛（GPN）的疗效。方法 对207例患者实施乙状窦后锁孔入路微血管减压术（MVD）和神经切断术,其中三叉神经痛169例,半面痉挛31例,舌咽神经痛7例。结果 三叉神经痛治愈和好转160例（94.7％）,失败9（5.3％）;半面痉挛患者症状治愈29例（93.5％）,失败2例（6.5％）;舌咽神经痛患者症状治愈7例（100％）。术后未发生严重并发症,如死亡或小脑或脑干梗死等。其它并发症包括有小脑血肿1例,中度听力损失3例,暂时性面瘫3例,一侧声带不完全性麻痹1例。结论 经乙状窦后锁孔入路微血管减压和神经切断术安全有效。