1/8. Differential diagnosis of idiopathic inflammatory trigeminal sensory neuropathy from neuroma with a biopsy: case report.OBJECTIVE AND IMPORTANCE: Idiopathic inflammatory trigeminal sensory neuropathy (IITSN) is a disorder with the dominant clinical features of trigeminal sensory disturbance; this idiopathic condition follows a benign course in most cases. Recent reports have shown that transient abnormalities, which may mimic those of trigeminal neuromas, can be observed in magnetic resonance imaging scans. Presented here is a case of IITSN that was diagnosed, with cytological and histopathological verification, during the active inflammatory phase of the disease (the first such attempt, to our knowledge). CLINICAL PRESENTATION: A 20-year-old female patient was referred to our hospital with a 2-month history of numbness of the left side of her face, headache, and hemifacial pain attacks. Cranial magnetic resonance imaging scans revealed a mass above and below the foramen ovale, extending into the cavernous sinus. INTERVENTION: A percutaneous biopsy procedure through the foramen ovale was performed; the pathological examination revealed lymphocytes, macrophages, and endothelial cells but no evidence of neoplastic cells. A few days later, the patient was surgically treated using a cranial base approach, the gasserian ganglion was exposed, and the lesion was removed. Pathological examination of the specimens revealed inflammatory changes and fibrosis of the nerve fibers and ganglion cells. Disruption of the myelin around the nerve bundles was detected. Therefore, IITSN was pathologically confirmed during the early stage of the disease. During 3 months of follow-up monitoring, the patient experienced no serious clinical problems. CONCLUSION: IITSN should be suspected in cases of tumors involving the cavernous sinus, and a percutaneous biopsy through the foramen ovale should be performed as part of the differential diagnosis in such cases. This procedure might obviate unnecessary aggressive surgery. In the current case, no neoplastic cells were observed during the examination; only lymphocytes, macrophages, and endothelial cells were observed, on a background of erythrocytes. Lymphocyte-dominant inflammatory infiltration, fibrotic changes, and demyelinization are cardinal histopathological findings observed during the active phase of IITSN.- - - - - - - - - - ranking = 1keywords = ganglion (Clic here for more details about this article) |
2/8. Amyloidoma in the gasserian ganglion: case report.BACKGROUND: Amyloidoma in the central nervous system is extremely rare. We describe a rare case of amyloidoma in the gasserian ganglion manifesting as trigeminal neuropathy. methods: A 41-year-old woman was admitted to our hospital with progressive numbness and hypalgesia in the distribution of the second and third divisions of the left trigeminal nerve. There was no evidence of chronic inflammatory disorder or immunological abnormalities. Magnetic resonance images showed a mass in the left Meckel's cave that was brightly enhanced with gadolinium. RESULTS: A reddish, firm mass was successfully removed via a left temporal craniotomy. Histologically, the tumor was composed of larger acellular deposits of eosinophilic material. The acellular deposits were positive for potassium permanganate-resistant congo red staining, showing apple-green birefringence under polarized light and expression of immunoglobulin lambda light chain-derived proteins (A lambda) immunohistochemically. CONCLUSION: The present case revealed an A lambda amyloidoma in the left gasserian ganglion. Although the incidence is rare, amyloidoma should be suspected in patients who complain of progressive trigeminal neuropathies and show an enhanced lesion in the gasserian ganglion on MR images.- - - - - - - - - - ranking = 3.5keywords = ganglion (Clic here for more details about this article) |
3/8. abducens nerve paresis as first symptom of trigeminal neurinoma. Report of two cases and review of the literature.Two cases of neurinoma of the Gasserian ganglion with abducens nerve paresis as the first symptom are described and 27 cases culled from the literature are reviewed. The anatomo-surgical and clinical-radiological features of this pathology were re-assessed in an attempt to identify the pathogenetic mechanism responsible for a trigeminal neurinoma manifesting with VI cranial nerve palsy.- - - - - - - - - - ranking = 0.5keywords = ganglion (Clic here for more details about this article) |
4/8. Bilateral neurotrophic keratopathy complicating Vidian neurectomy.PURPOSE: To present a case of bilateral neurotrophic keratopathy with miosis after bilateral Vidian neurectomy for vasomotor rhinitis. methods: Observational case report. RESULTS: A 68 year-old man presented with irritation and blurred vision in both eyes 2 weeks after bilateral Vidian neurectomy. Slit-lamp examination revealed a large epithelial defect, typical of neurotrophic keratopathy, in the inferior two-thirds of cornea in both eyes. Corneal sensitivity test with a Cochet-Bonnet anesthesiometer and electrical study of the blink reflex indicated bilateral trigeminal dysfunction. Both pupils were miotic, and tests with hydroxyamphetamine 1% and epinephrine 0.1% showed postganglionic sympathetic nerve damage. The corneal epithelial defects healed after 2 months of treatment with systemic prednisolone, vitamin B(12) and tarsorrhaphy. CONCLUSION: Neurotrophic keratopathy associated with dry eye syndrome may be a serious complication of Vidian neurectomy.- - - - - - - - - - ranking = 0.5keywords = ganglion (Clic here for more details about this article) |
5/8. Chronic granulomatous neuritis in idiopathic trigeminal sensory neuropathy. Report of two cases.Idiopathic trigeminal sensory neuropathy is a clinically benign disorder in which the main feature is facial numbness limited to the territory of one or more divisions of the trigeminal nerve; the disorder persists for a few weeks to several years. and no underlying disease can be identified. Magnetic resonance (MR) imaging findings are occasionally consistent with a small trigeminal neuroma of the left gasserian ganglion associated with idiopathic trigeminal sensory neuropathy. The authors report on two patients who were treated using a skull base approach in which the gasserian ganglion was exposed and the lesion was removed. The pathological diagnosis was chronic granulomatous neuritis. The authors conclude that, in patients with MR findings suggestive of a small trigeminal neuroma, benign idiopathic trigeminal sensory neuropathy should also be considered in the differential diagnosis. A conservative approach featuring sequential MR imaging studies may avoid an unnecessary surgical exploration.- - - - - - - - - - ranking = 1keywords = ganglion (Clic here for more details about this article) |
6/8. Neuromuscular hamartoma of the trigeminal nerve in an adult.A 36-year-old female presented with a long-standing history of headache. Computed tomography scan and magnetic resonance imaging revealed an enhancing lesion occupying the right Meckel's cave, enlarging the trigeminal ganglion and extending through the foramen ovale into the infratemporal fossa. A right frontotemporal extradural approach to the cavernous sinus was performed and a firm, pinkish lesion intermingled with nerve fibers enlarging the trigeminal ganglion and V3 branch was identified. Frozen section was suggestive of a neuromuscular hamartoma. The lesion was sub-totally resected to avoid injury to the motor branch.Neuromuscular hamartoma should be included in the differential diagnosis of cavernous sinus and cranial nerve lesions in adults.- - - - - - - - - - ranking = 1keywords = ganglion (Clic here for more details about this article) |
7/8. magnetic resonance imaging of third cranial nerve palsy and trigeminal sensory loss caused by herpes zoster.A 44-year-old man with right-sided herpes zoster ophthalmicus (HZO) developed ipsilateral third and sixth cranial nerve palsies and first-division trigeminal (fifth cranial nerve) sensory loss. MRI revealed contrast enhancement of the cisternal and cavernous portions of the third cranial nerve and high signal on a FLAIR sequence within the ipsilateral medulla at the presumed location of the trigeminal nucleus and tract. To our knowledge, this is the first report of the combination of these imaging findings in HZO.- - - - - - - - - - ranking = 0.0065431046390009keywords = nucleus (Clic here for more details about this article) |
8/8. Cavernous malformation of the trigeminal nerve.A cavernous malformation involving the Gasserian ganglion, 2nd and 3rd divisions of the trigeminal nerve on the left side was resected via an extradural route in a 54 year old male. Cavernous malformations of the cranial nerves are rare. Specific origin from the trigeminal nerve has not been previously reported.- - - - - - - - - - ranking = 0.5keywords = ganglion (Clic here for more details about this article) |