Microvascular decompression for trigeminal neuralgia caused by vascular compression on the trigeminal sensory nucleus and descending trigeminal tract.
microvascular decompression
retrosigmoid approach
root entry zone
trigeminal neuralgia
trigeminal tract and nucleus
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
22 Dec 2023
22 Dec 2023
Historique:
received:
19
10
2023
revised:
14
12
2023
accepted:
15
12
2023
medline:
25
12
2023
pubmed:
25
12
2023
entrez:
24
12
2023
Statut:
aheadofprint
Résumé
Trigeminal neuralgia (TN) is characterized by paroxysmal episodes of severe shock-like orofacial pain typically resulting from arterial compression on the trigeminal root entry zone (REZ). However, neurovascular conflict in more proximal parts of the trigeminal pathway within the pons is extremely rare. The authors present a case of microvascular decompression (MVD) for TN caused by dual arterial compression on the dorsolateral pons, along with a brief literature review. Our patient was a 74-year-old male with episodic left-sided facial stabbing pain. Brain MRI revealed a dual arterial compression on dorsolateral pons, the known site of the trigeminal sensory nucleus (TSN) and descending trigeminal tract (DTT). A MVD was performed via a retrosigmoid approach. Complete pain relief and partial improvement of the facial hypesthesia were achieved immediately after surgery and the BNI pain intensity score improved from V to I, and the BNI hypesthesia score decreased from III to II within a month following surgery. The literature review identified one case of TN secondary to an arteriovenous malformation in REZ with lateral pontine extension. One month following partial coagulation of the draining vein, the patient was reportedly able to reduce medication dosage by half to achieve an improvement of BNI pain intensity score from V to IIIa. Neurovascular compression in the trigeminal tract and nucleus is a rare, but potential cause of TN. A thorough investigation of the trigeminal pathway should be considered during preoperative evaluation and intraoperative inspection - particularly if no clear offending vessel is identified.
Sections du résumé
BACKGROUND
BACKGROUND
Trigeminal neuralgia (TN) is characterized by paroxysmal episodes of severe shock-like orofacial pain typically resulting from arterial compression on the trigeminal root entry zone (REZ). However, neurovascular conflict in more proximal parts of the trigeminal pathway within the pons is extremely rare.
METHODS
METHODS
The authors present a case of microvascular decompression (MVD) for TN caused by dual arterial compression on the dorsolateral pons, along with a brief literature review.
RESULTS
RESULTS
Our patient was a 74-year-old male with episodic left-sided facial stabbing pain. Brain MRI revealed a dual arterial compression on dorsolateral pons, the known site of the trigeminal sensory nucleus (TSN) and descending trigeminal tract (DTT). A MVD was performed via a retrosigmoid approach. Complete pain relief and partial improvement of the facial hypesthesia were achieved immediately after surgery and the BNI pain intensity score improved from V to I, and the BNI hypesthesia score decreased from III to II within a month following surgery. The literature review identified one case of TN secondary to an arteriovenous malformation in REZ with lateral pontine extension. One month following partial coagulation of the draining vein, the patient was reportedly able to reduce medication dosage by half to achieve an improvement of BNI pain intensity score from V to IIIa.
CONCLUSIONS
CONCLUSIONS
Neurovascular compression in the trigeminal tract and nucleus is a rare, but potential cause of TN. A thorough investigation of the trigeminal pathway should be considered during preoperative evaluation and intraoperative inspection - particularly if no clear offending vessel is identified.
Identifiants
pubmed: 38143032
pii: S1878-8750(23)01820-X
doi: 10.1016/j.wneu.2023.12.087
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Elsevier Inc. All rights reserved.