1/27. Painful trigeminal neuropathy caused by severe mandibular resorption and nerve compression in a patient with systemic sclerosis: case report and literature review.Systemic sclerosis is a multi-system disorder characterized by abundant fibrosis of the skin, blood vessels, and visceral organs. Although resorption of the mandible has been commonly observed and reported, we found no report of resorption leading to a painful neuropathy of the inferior alveolar nerve. We report a case of a patient with systemic sclerosis, severe resorption of the angles, and inferior alveolar border of the mandible, resulting in a compression neuropathy of the inferior alveolar nerve. Diagnostic tests, medical treatment, and surgical treatment are discussed, and the relevant literature is reviewed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/27. Cerebral and oculorhinal manifestations of a limited form of Wegener's granulomatosis with c-ANCA-associated vasculitis.The authors report on cerebral and oculorhinal manifestations in a patient with a cytoplasmic pattern of antineutrophil cytoplasmic autoantibody (c-ANCA)-associated vasculitis. Recurrent tolosa-hunt syndrome, cavernous sinus syndrome, Raeder's paratrigeminal neuralgia, and seizures were the major clinical manifestations. brain MRI showed localized enhancing lesions initially in the cavernous sinus and later in the convexity pachymeninges. The lesions disappeared following 9 months of oral prednisolone (15 mg/day) and cyclophosphamide (100 mg/day) therapy. The presence of c-ANCA, demonstration of vasculitis, and depositions of immunoglobulin g (IgG) and fibrinogen in the vessel walls of pachymeninges of the patient confirmed an immune-mediated cause of the vasculitis. Cranial pathology without renal and pulmonary involvement suggests a variant of Wegener's granulomatosis, which is called the "limited" form of Wegener's granulomatosis. MRI, Raeder's paratrigeminal neuralgia, localized pachymeningitis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/27. Combined transhorizontal-supracerebellar approach for microvascular decompression of trigeminal neuralgia.A combined approach for microvascular decompression of trigeminal neuralgia is reported. Arachnoid dissection of the cerebellar horizontal fissure (transhorizontal approach) allowed easy identification of the root exit zone of the trigeminal nerve. The superior semilunar lobule was pulled back rostrally so that retraction of the acoustic nerve was minimal. After identification of the offending vessels, the supracerebellar artery was mobilized and dissected out through the supracerebellar route, which was also less invasive to the acoustic nerve than the standard approach. By combining these two approaches, the whole surface of the trigeminal nerve can be observed easily. Thus, the offending vessels can be readily identified, mobilized and moved away from the trigeminal nerve with minimal retraction of the acoustic nerve.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
4/27. 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.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
5/27. Fully endoscopic vascular decompression of the trigeminal nerve.Microvascular decompression of the trigeminal nerve is an accepted and effective means of treating patients with trigeminal neuralgia in whom compression of the nerve by a vascular structure is implicated in the pathogenesis of the disease. The current standard technique uses the binocular operating microscope for all intra-operative visualization. Posterior fossa endoscopy has demonstrated that the endoscope provides more comprehensive views of the anatomy of the cerebellopontine angle than does the operating microscope. To date, endoscopy has only been used to supplement microscopy in cranial nerve decompression surgery. In this report, we describe our completely endoscopic surgical technique as we present the case of a patient with trigeminal neuralgia who underwent successful vascular decompression by this approach. Using this technique the offending vessel was separated from the nerve with minimal brain retraction or dissection of surrounding structures. This report represents the first documented case where the endoscope was used as the exclusive imaging modality for decompression of the trigeminal nerve. From our experience we conclude that the endoscope's superior visualization more accurately identifies neurovascular conflicts, and provides a comprehensive evaluation of the completeness of the decompression. Additionally, this new method minimizes the risks of brain retraction and extensive dissection often required for microscopic exposure. From this study we conclude that completely endoscopic vascular decompression represents the next step forward in the safe and effective surgical treatment of trigeminal neuralgia.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/27. Snare technique of vascular transposition for microvascular decompression--technical note.recurrence of trigeminal neuralgia (TN) or hemifacial spasm (HFS) after microvascular decompression (MVD) is not rare. The prosthesis material eventually adheres to the neurovascular structures and again transmits arterial pulsation to the nerve. A snare ligature technique using a Gore-Tex tape can be used for the transposition of the offending artery. No prosthesis is necessary once the transposition is complete. This technique requires introduction of either Gore-Tex tape or thread around the artery and suture over the petrous dura, so an adequate working space as if operating in a shallow basin is essential. Therefore, the osteoplastic craniotomy is a little larger than usual with the scalp flap entirely reflected using a semicircular skin incision. The Gore-Tex tape can be directly snared around the artery and sutured over the petrous dura. If this procedure is difficult, a thread can be attached to both ends of the Gore-Tex tape to pass the tape around the vessel. Seven patients with TN and 13 patients with HFS have undergone this surgery. Although the follow-up period is not yet long enough, there has been no case of recurrence. The present technique for MVD can provide complete and permanent transposition of the offending artery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/27. Simultaneous virtual representation of both vascular and neural tissue within the subarachnoid space of the basal cistern--technical note.BACKGROUND: The representation of different anatomical structures requires varying imaging modalities and protocols. By mental composition of single-slice images, a three-dimensional (3D) impression can be achieved. However, this presupposes an outstanding imagination and is subject to inaccuracies. The use of an interactive and multi-modal planning system which represents different data sets in one single virtual environment holds promise to facilitate and improve neurosurgical decision-making. The authors report the clinical application of a self-developed virtual planning system in a case of trigeminal neuralgia due to an ectatic basilar artery. MATERIAL/methods: We modified our virtual planning system (VIVENDI), to achieve a virtual representation of the basal cistern illustrating both vascular and neuronal information. After conducting several experiments to determine an appropriate scanning protocol, we matched the data achieved by magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). RESULTS: The system provides the vascular topography combined with information on the anatomical structure of the subarachnoid space. To illustrate the clinical usefulness of this planning approach, the authors present a case of trigeminal neuralgia caused by an ectatic basilar artery. Pre-operatively, the virtual representation returned accurate information on the anatomical configuration of the cerebellopontine angle and the course of the ectatic vessel. This information was confirmed during surgery. CONCLUSIONS: The presented case demonstrates the clinical applicability of VIVENDI within the subarachnoid space of the basal cistern. The virtual representation enables pre-operative planning and simulation based on the patient's individual anatomy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/27. Preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia by use of three-dimensional reconstruction from two types of high-resolution magnetic resonance imaging.OBJECTIVE: To assess the value of three-dimensional (3-D) images reconstructed from 3-D constructive interference in steady state (3-D-CISS) and 3-D fast inflow with steady-state precession (3-D-FISP) images for the visualization of neurovascular compression in patients with trigeminal neuralgia. methods: Twenty-four consecutive patients with trigeminal neuralgia underwent preoperative 3-D-FISP and 3-D-CISS imaging. 3-D reconstruction of nerves and vessels was performed with the use of a volume-rendering method. We compared the 3-D reconstructed images with intraoperative findings. RESULTS: 3-D-CISS and 3-D-FISP images scanned from the same position clearly delineated the trigeminal nerve and vessels. 3-D reconstructed images showed the spatial relationship between the trigeminal nerve and causative vessels. The responsible arteries were identified from the 3-D reconstructed images, which closely simulated the microscopic operative view. CONCLUSION: 3-D reconstructions from two types of high-resolution magnetic resonance images (3-D-CISS and 3-D-FISP) are very useful for creating preoperative simulations and in deciding whether to perform surgery in patients with trigeminal neuralgia.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
9/27. Demonstration of neurovascular compression in trigeminal neuralgia and hemifacial spasm with magnetic resonance imaging: comparison with surgical findings in 60 consecutive cases.BACKGROUND: Until recently, it has been impossible to demonstrate vascular compression at the root entry or exit zone (REZ) of the trigeminal nerve and facial nerve in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS) preoperatively, although surgical findings have revealed apparent neurovascular compression and its correction has resulted in a good outcome in most cases. Revealing the anatomic correlation between nerves and vessels at the REZ preoperatively would be useful to predict operative findings. methods: To assess whether the vascular contact of the nerve at the REZ could be demonstrated preoperatively, high-resolution magnetic resonance tomographic angiography (MRTA) was performed in 21 patients with TN and 39 with HFS. Neuroradiological findings were compared with the operative findings in all patients. Contralateral asymptomatic nerves were evaluated as a control. RESULTS: MRTA correctly identified offending vessels in 14 (67%) of the 21 TN and 34 (87%) of the 39 HFS patients. Failure to identify neurovascular contact was noted in the cases with compression by veins or small arteries, thickened arachnoid, or distal compression. Neurovascular contact was also observed in 15% of the asymptomatic nerves. The deformity of the nerve seemed to be a more important factor for determining operative indication. CONCLUSIONS: MRTA could demonstrate offending vessels in TN and HFS at a high rate and was useful to predict operative findings. MRTA gave supportive evidence of surgical indications in patients with TN and HFS, although attention should be paid to the fact that MRTA did not necessarily detect all of the offending vessels.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
10/27. trigeminal neuralgia associated with a primitive trigeminal artery variant: case report.OBJECTIVE AND IMPORTANCE: A variant type of the primitive trigeminal artery (PTA) is a rare anomalous vessel that originates from the internal carotid artery and directly supplies the territory of the anteroinferior cerebellar artery and/or the superior cerebellar artery. We report a case of trigeminal neuralgia associated with this PTA variant, and we discuss the characteristics of this vessel. CLINICAL PRESENTATION: A 51-year-old woman presented with a 10-year history of left paroxysmal facial pain. magnetic resonance angiography and cerebral angiography demonstrated that an aberrant vessel originating from the left internal carotid artery directly supplied the cerebellum, without a basilar artery anastomosis. INTERVENTION: Surgical exploration was performed via a left retrosigmoid approach. A loop of the aberrant vessel, which entered the posterior fossa through the isolated dural foramen, was compressing the trigeminal nerve. This aberrant vessel was displaced medially from the nerve with a prosthesis, with care to avoid kinking and avulsion of the perforating arteries. The patient's neuralgia resolved postoperatively. CONCLUSION: Although the PTA variant is frequently associated with intracranial aneurysms, it is extremely rare for the variant to lead to trigeminal neuralgia. During microvascular decompression surgery, surgeons should be careful to prevent injury of the perforating arteries arising from the PTA variant.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
| | Next -> |