Pure extradural approach for skull base lesions.
Lesions in the parasellar and paracavernous regions can be removed by various skull base approaches involving basal osteotomies. A major complication of intradural skull base approaches is CSF leak and associated meningitis. We have managed 5 patients with skull base lesions with a pure extradural approach using wide basal osteotomies. The operative techniques are described. (+info)
Cavernous sinus syndrome associated with nonsecretory myeloma.
The case of a 53-year-old man who developed cavernous sinus syndrome (CSS) four years after being diagnosed as having nonsecretory myeloma is described. He was admitted with diplopia and dull pain over the right infraorbital and zygomatic region in June 1997. The cause of CSS was the intracranial involvement of myeloma, which was diagnosed by fiberscopic biopsy. The results of endocrinologic evaluation were almost normal. The response to radiotherapy and chemotherapy was mild. CSS caused by nonsecretory myeloma is rare and its prognosis is poor. More aggressive chemotherapy with stem cell support may be indicated. (+info)
We report the clinical and imaging features of a patient with transient partial trigeminal sensory neuropathy thought to have been induced by thermal injury to the tongue. Abnormal thickening and enhancement of the mandibular division of the trigeminal nerve was revealed by MR imaging. The diagnostic considerations for mass-like enlargement of the trigeminal nerve should include transient/inflammatory processes, as well as more common and sinister conditions, such as tumor. (+info)
Trigeminal schwannoma associated with pathological laughter and crying.
A 46 year old man with trigeminal schwannoma displayed symptoms of ataxia with pathological laughter and crying. The tumour developed in the cerebellopontine angle, compressing the pontomesencephalic structures backward, extending in the posterior parasellar region and Meckel's cave. No recurrence of laughter and crying attacks were noted after total removal of the tumour. Theories of mechanism of pathological laughter and crying reported in the literature are reviewed. (+info)
Solitary metastasis from occult follicular carcinoma of the thyroid mimicking trigeminal neurinoma--case report.
A 50-year-old woman presented with an extremely uncommon case of solitary metastasis from follicular carcinoma of the thyroid, which presented clinically as trigeminal neurinoma. Neuroimaging detected a tumor in the right petrous apex, which was removed surgically. Histological examination showed metastatic follicular carcinoma of the thyroid. However, no primary tumor was detected by various investigations. The tumor recurred twice, and was treated surgically both times. The patient finally agreed to adjuvant therapy for the suspected primary. Radiotherapy was performed followed by complete thyroidectomy. Examination of the gross specimen found the tumor nodule. Clinically significant metastasis can arise from histologically benign and silent follicular thyroid neoplasms. (+info)
Surgical treatment of trigeminal neurinomas.
OBJECTIVE: To investigate the best surgical approach for the removal of trigeminal neurinomas (TNs). METHODS: A retrospective analysis of 75' patients with TNs in Huashan Hospital was carried out. RESULTS: In the early group (1978-1984), a series of conventional intradural approaches were used; in the late group (1985-1995), an epidural approach via the skull-base craniotomy was used. Total tumor removal was achieved in 58% (20/35) of patients in the early group and 80% (32/40) in the late group (P < 0.025). Temporary and permanent cranial nerve morbidity were 62.7% and 37% in the early group and 28.1% and 10% in the late group (P < 0.001). CONCLUSION: The best microsurgical approach for the removal of trigeminal neurinomas except those confined to the posterior fossa is epidural approach or epidurotransduro-transtentorial approach via the skull-base craniotomy. (+info)
Magnetic resonance angiography in facial and other pain: neurovascular mechanisms of trigeminal sensation.
For much of the twentieth century migraine and cluster headache have been considered as vascular headaches whose pathophysiology was determined by changes in cranial vascular diameter. To examine nociceptive neural influences on the cranial circulation, the authors studied healthy volunteers' responses to injection of the pain-producing compound capsaicin in terms of the caliber of the internal carotid artery. The study was conducted using magnetic resonance angiographic techniques. Injection of capsaicin into the skin innervated by the ophthalmic (first) division of the trigeminal nerve elicited 40% +/- 27% (mean +/- SD) increase in vascular cross-sectional area in the right (ipsilateral) internal carotid artery when compared with the mean baseline ( P < 0.001). Injection of capsaicin into the skin of the chin to stimulate the mandibular (third) division of the trigeminal nerve and into the leg led to a similar pain perception and failed to produce any significant change in vessel caliber. The data suggest that there is a highly functionally organized, somatotopically congruent trigeminal innervation of the cranial vessels, with a potent vasodilator effect of the ophthalmic division on the large intracranial vessels. The data are consistent with the notion that pain drives changes in vessel caliber in migraine and cluster headache, not vice versa. These conditions therefore should be regarded as primary neurovascular headaches not as vascular headaches. (+info)
Basilar artery aneurysm with autonomic features: an interesting pathophysiological problem.
Unruptured cerebral aneurysms often present with neuro-ophthalmological symptoms but ocular autonomic involvement from an aneurysm of the posterior circulation has not previously been reported. A patient is described with a basilar artery aneurysm presenting with headache and unilateral autonomic symptoms. After angiographic coiling of the aneurysm there was a near complete resolution of these features. The relevant anatomy and proposed mechanism of autonomic involvement of what may be considered--from a pathophysiological perspective as a secondary trigeminal-autonomic cephalgia--is discussed (+info)