Identification of a persistent primitive trigeminal artery following the transposition technique for trigeminal neuralgia: a case report.
(2/11)
A patient who presented with trigeminal neuralgia associated with a persistent primitive trigeminal artery (PPTA) is presented. A 62-year-old woman suffering from right orbital pain was admitted to the hospital. Medical treatment for three months was ineffective, and her neuralgia had deteriorated and gradually spread in the maxillary division. Magnetic resonance imaging demonstrated the flow void signal attached to the right trigeminal nerve. Thus, microvascular decompression was performed. The superior cerebellar artery was the responsible artery, and it was transposed to decompress the trigeminal nerve. After this manoeuvre, an artery was identified running parallel to the trigeminal nerve toward Meckel's cave. The artery, which turned out to be a PPTA, communicated with the basilar artery. The PPTA was carefully observed, and it was found not to be the artery causing the neuralgia because it did not compress the nerve at surgical observation. No additional procedure between the PPTA and the trigeminal nerve was performed. The patient's symptom improved dramatically following surgery, and her postoperative course was uneventful. Postoperative three-dimensional computed tomography showed the PPTA. The findings in the present case suggest that transposition of the responsible artery effectively decompresses the root entry zone and assists in determining whether the PPTA is affecting the trigeminal nerve. (+info)
Vagoglossopharyngeal neuralgia treated by microvascular decompression and glossopharyngeal rhizotomy: clinical results of 21 cases.
(3/11)
Radiofrequency thermocoagulation rhizotomy for recurrent trigeminal neuralgia after microvascular decompression.
(4/11)
BACKGROUND: Microvascular decompression (MVD) is a well accepted surgical treatment strategy for trigeminal neuralgia (TN) with satisfying long-term outcome. However, considerable recurrent patients need more effective management. The purpose of this study was to evaluate the effectiveness of radiofrequency thermocoagulation rhizotomy (RTR) on patients with recurrent TN after MVD. METHODS: Totally 62 cases of recurrent TN after MVD undergoing RTR from January 2000 to January 2010 were retrospectively evaluated. Based on surgical procedures undertaken, these 62 cases were classified into two subgroups: group A consisted of 23 cases that underwent traditional RTR by free-hand; group B consisted of 39 cases that underwent RTR under the guidance of virtual reality imaging technique or neuronavigation system. The patients in group A were followed up for 14 to 70 months (mean, 40 +/- 4), and those in group B were followed up for 13 to 65 months (mean, 46 +/- 7). Kaplan-Meier analyses of the pain-free survival curves were used for the censored survival data, and the log-rank test was used to compare survival curves of the two groups. RESULTS: All patients in both groups A and B attained immediate pain relief after RTR. Both groups attained good pain relief rate within the first two years of follow-up: 92.3%, 84.6% and 82.6%, 69.6% respectively (P > 0.05). After 2 years, the virtual reality or neuronavigation assisted RTR group (group B) demonstrated higher pain relief rates of 82.5%, 76.2% and 68.8% at 3, 4 and 5 years after operation respectively, while those in group A was 57.2%, 49.6%, and 36.4% (P < 0.05). Low levels of minor complications were recorded, while neither mortalities nor significant morbidity was documented. CONCLUSIONS: RTR was effective in alleviating the pain of TN cases suffering from unsuccessful MVD management. With the help of virtual reality imaging technique or neuronavigation system, the patients could attain better long-term pain relief. (+info)
A comparison of three induction regimens using succinylcholine, vecuronium, or no muscle relaxant: impact on the intraoperative monitoring of the lateral spread response in hemifacial spasm surgery: study protocol for a randomised controlled trial.
(5/11)
Recurrent trigeminal neuralgia at 20 years after surgery: case report.
(8/11)
Microvascular decompression (MVD) is now the most feasible method of treatment for trigeminal neuralgia (TN). The recurrence of symptoms is rarely encountered postoperatively. A female patient with typical right V3 distribution TN had been successfully treated by MVD at age 56 years by transposing the offending superior cerebellar artery, and she became completely pain-free postoperatively without sequelae. Twenty years after the first MVD, pain recurred on the right V2 distribution at age 76 years and she was operated on a second time to resolve the pain. Re-exploration surgery revealed that the trigeminal nerve was compressed mediocranially by the anterior inferior and posterior inferior cerebellar artery complex, which had not been close to the neural structure during the first surgery. The artery complex was successfully transpositioned to decompress the root exit zone (REZ) of the nerve and she became pain-free again. Although various causal factors likely contribute to recurrence of TN, the present case of recompression of a REZ occurred due to a newly developed offending artery which caused TN a long time after the first surgery. (+info)