RESUMEN
BACKGROUND: Trigeminal schwannoma is a rare type of tumor that arises from the Schwann cells of the trigeminal nerve. METHOD: We present a case of a patient with a giant V2 trigeminal schwannoma with painful swelling in the left maxilla. A complete resection using a combined open maxillectomy and endoscopic endonasal approach was performed. CONCLUSION: This case highlights the importance of a multidisciplinary approach to perform a combined open and endoscopic approach for safe resection while preserving adequate speech and swallowing.
Asunto(s)
Neoplasias de los Nervios Craneales , Neurilemoma , Humanos , Neoplasias de los Nervios Craneales/cirugía , Neoplasias de los Nervios Craneales/patología , Neoplasias de los Nervios Craneales/diagnóstico por imagen , Endoscopía/métodos , Maxilar/cirugía , Maxilar/diagnóstico por imagen , Cirugía Endoscópica por Orificios Naturales/métodos , Neurilemoma/cirugía , Neurilemoma/diagnóstico por imagen , Neurilemoma/patología , Resultado del Tratamiento , Nervio Trigémino/cirugía , Nervio Trigémino/patología , Enfermedades del Nervio Trigémino/cirugía , Enfermedades del Nervio Trigémino/patologíaRESUMEN
INTRODUCTION: The most frequent pathology of the fifth cranial nerve is trigeminal neuralgia (TN), characterized by unilateral orofacial pain, of a paroxysmal nature, with distribution in one or more divisions of the trigeminal nerve. The main objective of this work is to demonstrate the efficacy and safety of neurovascular decompressive surgery (NVD). METHODS: Retrospective analytical study, patients operated on for NVD by TN (n: 155), from January 2006 - 2022, using a retrosigmoid approach and clinicalradiological follow-up, whose intraoperative recording was in 3D system (n: 42). RESULTS: 83.3% (n=35) presented classic NT and 16.7% (n = 7) idiopathic. The right side prevailed with 59.5% (n = 25) and paroxysmal pain with 81% (n=34) of representation in the entire series. Compression of arterial origin represented 76.2% (n: 32) of the cases, the superior cerebellar artery represented the first cause of neurovascular compression (NVC) in 52.4% (n: 22) in the exit zone of the trigeminal nerve. The validity of the magnetic resonance imaging (MRI) protocol selected for this series was analyzed; evidencing a high sensitivity of MRI with 97%, and a specificity of 86%. CONCLUSION: The sensitivity and specificity of highdefinition MRI studies and with special protocols for the evaluation of TN, as gold standard paraclinical, were presented. The DNV offered safe results, a high percentage of the patients were described as successful. The 3D recording allowed retrospective analysis with a vision identical to that of the surgeon during the intraoperative period, the type of NVC.
Introducción: La afección más frecuente del V nervio craneal es la neuralgia del trigémino (NT), se caracteriza por dolor orofacial unilateral, paroxístico, distribuyéndose en una o más divisiones del nervio trigémino. El objetivo de presente trabajo es demostrar la eficacia y seguridad de la cirugía descompresiva neurovascular (DNV). Métodos: Estudio analítico retrospectivo, pacientes intervenidos para DNV por NT (n: 155), desde enero de 2006 - 2022, mediante un abordaje retrosigmoideo y seguimiento clínico-radiológico, cuyo registro intraoperatorio fue en sistema 3D (n: 42). Resultados: 83.3% (n=35) presentó NT clásica y 16.7% (n = 7) idiopática. La mayoría con afectación del lado derecho 59.5% (n = 25) y el dolor paroxístico con 81% (n = 34). La compresión de origen arterial representó 76.2% (n: 32) de los casos, la arteria cerebelosa superior representó la primera causa de compresión neurovascular (CNV) en un 52.4% (n:22) en la zona de salida del nervio trigémino. Se analizó la validez del protocolo de resonancia magnética (RM) seleccionado para esta serie; evidenciando una alta sensibilidad de la RM con 97%, y una especificidad del 86%. Conclusión: Se demostró la sensibilidad y especificidad de los estudios de resonancia magnética (RM) de alta definición y con protocolos especiales para la evaluación de la NT, como paraclínico estándar de oro. La DNV ofreció resultados seguros, un alto porcentaje de los pacientes se calificaron como exitosos. El registro 3D permitió analizar en retrospectiva con una visión idéntica a la del cirujano durante el intraoperatorio, el tipo de CNV.
Asunto(s)
Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/diagnóstico por imagen , Neuralgia del Trigémino/cirugía , Neuralgia del Trigémino/etiología , Estudios Retrospectivos , Nervio Trigémino/cirugía , Nervio Trigémino/patología , Imagen por Resonancia Magnética/métodos , Descompresión/efectos adversosAsunto(s)
Lipomatosis , Neuralgia del Trigémino , Humanos , Lipomatosis/complicaciones , Lipomatosis/diagnóstico por imagen , Lipomatosis/cirugía , Imagen por Resonancia Magnética/métodos , Nervio Trigémino/cirugía , Neuralgia del Trigémino/diagnóstico por imagen , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/cirugíaRESUMEN
ABSTRACT INTRODUCTION: Idiopathic trigeminal neuralgia (ITN) is a common pain disease in elderly people. Many methods have been used to alleviate the pain of patients, but few studies in the literature have compared the effect of nerve combing and percutaneous radiofrequency thermocoagulation. OBJECTIVE: The purpose of this study was to describe and evaluate the clinical outcome of idiopathic trigeminal neuralgia after nerve combing (NC) and compare them with those obtained using percutaneous radiofrequency thermocoagulation (RF). METHODS: The study included 105 idiopathic trigeminal neuralgia patients with similar symptom, age and underlying disease, which were divided into two groups. One group was treated by nerve combing (50 patients), the other by RF (55 cases). All patients were considered medical failures prior to the surgeries. A questionnaire was used to assess the long-term outcomes: pain relief, recurrence, complication and need for additional treatment. RESULTS: The median duration of follow-up in both groups was 90 months. Satisfactory relief was noted in 41 patients (82%), 5 patients (10%) initially experienced pain relief, then recurred, and four patients (8%) were designated poor among the group NC. In the group RF, satisfactory relief was noted in 42 patients (76.4%). There were eight "pain free with recurrence patients (14.5%) and 5 poor cases (9.1%). No statistically significant differences existed in the outcomes between both groups (p > 0.05). Postoperative morbidity included dysesthesia, diplopia, partial facial nerve palsy, hearing loss, tinnitus, cerebrospinal fluid leak, meningitis and mortality. CONCLUSION: Nerve combing and RF are both satisfactory treatment strategies for patients with ITN. Because of the higher risk of sensory morbidity and surgical risk as open surgery, RF is preferred as the recommended procedure for patients with ITN.
Resumo Introdução: A neuralgia idiopática do trigêmeo (NIT) é uma condição dolorosa comum em idosos. Muitos métodos têm sido usados para aliviar a dor dos pacientes, mas poucos estudos na literatura compararam o efeito de neurólise interna e termocoagulação percutânea por radiofrequência. Objetivo: O objetivo desse estudo foi descrever e avaliar o desfecho clínico de pacientes com neuralgia idiopática do trigêmeo após neurólise interna (NI) e compará-los com os obtidos usando termocoagulação percutânea por radiofrequência (RF). Método: O estudo incluiu 105 pacientes com NIT com sintomas, idade e doenças de base semelhantes, que foram divididos em dois grupos. Um grupo foi tratado por neurólise interna (50 pacientes) e o outro por RF (55 casos). Todos os pacientes haviam sido considerados fracassos terapêuticos antes das cirurgias. Um questionário foi utilizado para avaliar os resultados a longo prazo: alívio da dor, recorrência, complicações e necessidade de tratamento adicional. Resultados: A duração média do acompanhamento foi de 90 meses em ambos os grupos. Alívio satisfatório foi observado em 41 pacientes (82%); cinco pacientes (10%) experimentaram alívio inicial da dor, porém seguido de recrudescimento, e quatro pacientes (8%) apresentaram desfecho desfavorável no grupo NI. No grupo de RF, alívio satisfatório foi observado em 42 pacientes (76,4%). Houve oito pacientes livres de dor, com recorrência ''LDR'' (14,5%) e cinco casos com desfecho desfavorável (9,1%). Não houve diferenças significantes nos resultados entre os dois grupos (p > 0,05). Morbidade pós-operatória incluiu disestesia, diplopia, paralisia parcial do nervo facial, perda auditiva, tinnitus, fístula liquórica, meningite e óbito. Conclusão: Neurólise interna e RF são estratégias satisfatórias de tratamento para os pacientes com NIT. Em decorrência da maior morbidade sensorial e maior risco cirúrgico em uma cirurgia aberta, a RF é o procedimento mais indicado para pacientes com NIT.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Nervio Trigémino/cirugía , Neuralgia del Trigémino/terapia , Electrocoagulación , Tratamiento de Radiofrecuencia Pulsada , Neuralgia del Trigémino/cirugía , Dimensión del Dolor , Estudios Retrospectivos , Estudios de Seguimiento , Resultado del Tratamiento , Descompresión Quirúrgica , CraneotomíaRESUMEN
OBJECTIVE: Trigeminal neuralgia is a debilitating facial pain disorder, frequently caused by vascular compression of the trigeminal nerve. Vascular compression that results in trigeminal neuralgia occurs along the cisternal segment of the nerve. CONCLUSION: Imaging combined with clinical information is critical to correctly identify patients who are candidates for microvascular decompression. The purpose of this article is to review trigeminal nerve anatomy and to provide strategies for radiologists to recognize important MRI findings in patients with trigeminal neuralgia.
Asunto(s)
Imagen por Resonancia Magnética , Síndromes de Compresión Nerviosa/etiología , Nervio Trigémino/anatomía & histología , Neuralgia del Trigémino/diagnóstico , Enfermedades Vasculares/complicaciones , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/cirugía , Nervio Trigémino/patología , Nervio Trigémino/cirugía , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/cirugía , Enfermedades Vasculares/cirugíaRESUMEN
INTRODUCTION: Idiopathic trigeminal neuralgia (ITN) is a common pain disease in elderly people. Many methods have been used to alleviate the pain of patients, but few studies in the literature have compared the effect of nerve combing and percutaneous radiofrequency thermocoagulation. OBJECTIVE: The purpose of this study was to describe and evaluate the clinical outcome of idiopathic trigeminal neuralgia after nerve combing (NC) and compare them with those obtained using percutaneous radiofrequency thermocoagulation (RF). METHODS: The study included 105 idiopathic trigeminal neuralgia patients with similar symptom, age and underlying disease, which were divided into two groups. One group was treated by nerve combing (50 patients), the other by RF (55 cases). All patients were considered medical failures prior to the surgeries. A questionnaire was used to assess the long-term outcomes: pain relief, recurrence, complication and need for additional treatment. RESULTS: The median duration of follow-up in both groups was 90 months. Satisfactory relief was noted in 41 patients (82%), 5 patients (10%) initially experienced pain relief, then recurred, and four patients (8%) were designated poor among the group NC. In the group RF, satisfactory relief was noted in 42 patients (76.4%). There were eight "pain free with recurrence patients (14.5%) and 5 poor cases (9.1%). No statistically significant differences existed in the outcomes between both groups (p>0.05). Postoperative morbidity included dysesthesia, diplopia, partial facial nerve palsy, hearing loss, tinnitus, cerebrospinal fluid leak, meningitis and mortality. CONCLUSION: Nerve combing and RF are both satisfactory treatment strategies for patients with ITN. Because of the higher risk of sensory morbidity and surgical risk as open surgery, RF is preferred as the recommended procedure for patients with ITN.
Asunto(s)
Electrocoagulación , Tratamiento de Radiofrecuencia Pulsada , Nervio Trigémino/cirugía , Neuralgia del Trigémino/terapia , Adulto , Anciano , Anciano de 80 o más Años , Craneotomía , Descompresión Quirúrgica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Retrospectivos , Resultado del Tratamiento , Neuralgia del Trigémino/cirugíaRESUMEN
INTRODUÇÃO: A ritidoplastia se tornou uma das cirurgias estéticas mais realizadas por cirurgiões plásticos ao redor do mundo. Junto com o aumento do número de cirurgias, a quantidade de complicações associadas ao procedimento também aumentou, sendo que as alterações nervosas são uma das que despertam maiores preocupações. O presente estudo visa a identificar, por meio de uma revisão sistemática, as principais estruturas nervosas lesadas durante uma ritidoplastia, tanto por técnicas convencionais como endoscópicas. MÉTODOS: Uma revisão sistemática da literatura foi realizada nas principais bases de dados utilizadas atualmente. Artigos que preencheram os critérios de inclusão foram analisados na íntegra e suas referências, verificadas. Ao final, 20 estudos foram incluídos. RESULTADOS: Nestes 20 artigos, no total, foram avaliados 3.347 pacientes, sendo encontradas 142 lesões nervosas: 79 do nervo facial; 55 do nervo trigêmeo, e oito do nervo auricular magno. Destas, apenas duas foram definitivas. As lesões, proporcionalmente, foram mais comuns nas técnicas videoassistidas (81%), quando comparadas com as convencionais (19%). CONCLUSÃO: Encontramos que as lesões dos ramos temporal e bucal são mais frequentes no facelift e as do nervo auricular magno, na ritidoplastia cervical. Apesar de as lesões nervosas serem pouco frequentes na literatura, faltam estudos bem desenhados que busquem conhecer melhor estas complicações.
INTRODUCTION: Rhytidoplasty has become one of the most common aesthetic surgeries performed by plastic surgeons worldwide. Along with the increase in the number of surgeries performed, the number of procedure-related complications has also increased. In particular, nerve injuries are the major concern. By conducting a systematic review, the present study aimed to identify the main nerve structures injured during rhytidoplasty, by either the conventional or endoscopic technique. METHODS: A systematic literature review was performed in the main databases currently used. Articles that met the inclusion criteria were analyzed in their entirety, and their references were checked. Finally, 20 studies were included. RESULTS: In these 20 articles, 3,347 patients were evaluated and 142 nerve injuries found, of which 79 were of the facial nerve, 55 were of the trigeminal nerve, and eight were of the great auricular nerve. Of these, only two were definitive. The lesions were more prevalent (81%) with the video-assisted techniques than with the conventional techniques (19%). CONCLUSION: We found that the injuries of the temporal and buccal branches were more frequent during facelifts; and those of the great auricular nerve, during cervical rhytidoplasty. Although nerve injuries are infrequent in the literature, well-designed studies that aim to better understand these complications are lacking.
Asunto(s)
Humanos , Historia del Siglo XXI , Complicaciones Posoperatorias , Cirugía Plástica , Nervio Trigémino , Ritidoplastia , Estudio de Evaluación , Nervio Facial , Revisiones Sistemáticas como Asunto , Complicaciones Posoperatorias/cirugía , Cirugía Plástica/métodos , Nervio Trigémino/cirugía , Nervio Trigémino/patología , Ritidoplastia/efectos adversos , Ritidoplastia/métodos , Nervio Facial/cirugíaRESUMEN
OBJECTIVE: Trigeminal neuralgia (TN) surgical treatment with microvascular decompression is highly effective and safe, but for a percentage of patients who undergo this procedure, no vascular compression is found. The purpose of this study was to evaluate the long-term efficacy with trigeminal root compression of the trigeminal nerve in patients with TN refractory to medical treatment who underwent neurosurgical management by a retrosigmoid approach of the cerebellopontine angle and were found to be negative for vascular compression. METHODS: A prospective collection of clinical data on all patients with a diagnosis of idiopathic TN was conducted at our institution. A total of 277 patients with TN were treated by a keyhole retrosigmoid approach for exploration of the cerebellopontine angle between January of 2000 and August of 2010. A total of 44 patients were found to be negative for vascular compression of the trigeminal nerve; all of these patients underwent trigeminal root compression. RESULTS: We found that all patients were pain free after the procedure. There was a 27% relapse in a mean time of 10 months, but 83% of these patients were adequately controlled by medical treatment, and only 17% needed a complementary procedure for pain relief. We also found that 63% of the patients complained of a partial loss of facial sensitivity, but only 1 patient presented with a corneal ulcer. There was a 6.7% rate of significant complications. CONCLUSIONS: We concluded that trigeminal root compression is a safe and effective option for patients with primary TN without vascular compression.
Asunto(s)
Cirugía para Descompresión Microvascular/efectos adversos , Cirugía para Descompresión Microvascular/métodos , Radiculopatía/cirugía , Nervio Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Vasos Sanguíneos/lesiones , Traumatismos del Nervio Facial/etiología , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: The aim of this prospective study was to evaluate whether the cerebellopontine angle (CPA) cistern area and trigeminal nerve cisternal length play a role in the pathogenesis of trigeminal neuralgia (TN). METHODS: High-resolution 1.5 T magnetic resonance imaging of the posterior fossa was performed in 26 patients with TN and 18 age-matched healthy controls. Axial T2-weighted, three-dimensional constructive interference in steady-state (3D-CISS) was used to measure bilaterally the cross-sectional area of the CPA cistern and trigeminal nerve cisternal length. RESULTS: In patients, the cross-sectional area of the CPA cistern and trigeminal nerve cisternal length was smaller on the affected side (p = 0.04). Healthy controls tended to have larger cisternal areas and longer trigeminal nerve lengths than patients (p = 0.059, p = 0.071, respectively). Larger CPA cisternal areas tended to be seen in older patients. There was a strong correlation between the cross-sectional area of the CPA cistern and the length of the trigeminal nerve (p = 0.000). CONCLUSIONS: Smaller CPA cisterns and short cisternal trigeminal nerves impact the pathogenesis of essential TN by facilitating the neurovascular conflict, especially in younger patients. Trigeminal nerve cisternal measurement provides an easy and direct estimation of the CPA area. This information can be used for surgical planning and potentially for outcome prediction.
Asunto(s)
Ángulo Pontocerebeloso/patología , Nervio Trigémino/patología , Neuralgia del Trigémino/patología , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Nervio Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Adulto JovenRESUMEN
BACKGROUND: The foramen of Vesalius (FV) is located in the greater wing of the sphenoid bone between the foramen ovale (FO) and the foramen rotundum in an intracranial view. The FO allows the passage of the mandibular branch of trigeminal nerve, which is the target of the trigeminal radiofrequency rhizotomy. OBJECTIVE: We analyzed its location, morphology, morphometry and interrelation among other foramina. MATERIALS AND METHODS: 400 macerated adult human skulls were examined. A digital microscope (Dino-Lite plus) was used to capture images from the FV. A digital caliper was used to perform the measurements of the distance between the FV and other foramina (FO, foramen spinosum and the carotid canal) in an extracranial view of the skull base. RESULTS: In the 400 analyzed skulls, the FV was identified in 135 skulls (33.75%) and absent on both sides in 265 skulls (66.25%). The FV was observed present bilaterally in 15.5% of the skulls. The incidence of unilateral foramen was 18.25% of the skulls of which 7.75% on right side and 10.5% on left side. The diameter of the FV was measured and we found an average value of 0.65 mm, on right side 0.63 mm and on the left side 0.67 mm. We verified that positive correlations were statistically significant among the three analyzed distances. CONCLUSIONS: This study intends to offer specific anatomical data with morphological patterns (macroscopic and mesoscopic) to increase the understanding of the FV features as frequency, incidence and important distances among adjacent foramina.
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Hueso Esfenoides/anatomía & histología , Humanos , Rizotomía , Nervio Trigémino/cirugíaRESUMEN
Debido a su localización anatómica en la base del cráneo, los meningiomas esfeno-petro-clivales continúan siendo un reto para el cirujano, asociándose con múltiples estructuras neurovasculares. A través de los años han sido descritos muchos abordajes con el fin de mejorar los resultados en la resección de este tipo de tumores. La selección apropiada del abordaje se basa en la evaluación minuciosa de factores clínicos y radiológicos. En este artículo se describen dos diferentes abordajes para los meningiomas esfero-petro-clivales.
Asunto(s)
Humanos , Seno Cavernoso , Fosa Craneal Posterior , Meningioma , Microcirugia , Nervio Trigémino/cirugía , Seno Esfenoidal , MétodosRESUMEN
BACKGROUND: We describe our experience of the MVD in the typical trigeminal neuralgia and identify the prognostic factors. METHOD: A retrospective studio of 89 cases between 1995-2005 was used. The prognostic significant data evaluated were demographics data; duration of neuralgia; the affected divisions involved; surgical findings; used material for the decompression. The data analysis was made with the chi(2) test. RESULTS: We have found an excellent outcome in 77% one year later. The age and the antecedent of hypertension disease were not statistically significant. A poor outcome was observed for: female sex, neuralgia lasting longer than two years, the three divisions involved, venous compression and the muscle used as surgical material. CONCLUSIONS: The MVD is an effective and reliable technique. The use of muscle is not recommended. When the three trigeminal divisions are involved we should choose another technique.
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Descompresión Quirúrgica/métodos , Neuralgia del Trigémino/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Nervio Trigémino/anatomía & histología , Nervio Trigémino/cirugíaRESUMEN
BACKGROUND: We present the experience in the treatment of trigeminal neuralgia (TN) during 15 years in one institute, evaluating epidemiological variables and clinical presentation, and comparing the results obtained with different treatments available. METHODS: A retrospective, descriptive study was carried out by reviewing cases diagnosed by the Neurology Service, such as TN, and treated by the Pain Medicine and Palliative Care Unit of the Insituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubíran," from January 1, 1998 to December 31, 2003. Age, sex, type of neuralgia, anatomical site affected and intensity of pain were evaluated by means of the Analogue Visual Scale (AVS). The following treatments were evaluated (pharmacologic, surgical, and blockade of Gasser ganglion). Descriptive statistics, linear regression and bivariate correlation were used (statistical package SPSS). RESULTS: Fifty two cases were studied with a female predominance (2:1). Average age was 60 years. Clinical presentation most frequently was typical neuralgia (51.9%), right predominance (59.6%) and affected branch V2 (50%). In 88%, pharmacological treatment was used. The reduction of pain was 74% in all cases, with r-.765 for the pharmacological treatment, r-.715 in the blockade of the Gasser ganglion, and r-.901 for surgical treatment (p < 0.01). CONCLUSIONS: In the experience of the INCMNSZ, treatment of choice in most cases of TN is pharmacological, with surgical treatment useful in cases where vascular alterations were identified.
Asunto(s)
Neuralgia del Trigémino/terapia , Analgésicos/uso terapéutico , Descompresión Quirúrgica/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/métodos , Clínicas de Dolor , Dimensión del Dolor , Estudios Retrospectivos , Resultado del Tratamiento , Ganglio del Trigémino/cirugía , Nervio Trigémino/patología , Nervio Trigémino/cirugíaRESUMEN
BACKGROUND: Trigeminal neuralgia is a common cause of facial pain, characterized by shock-like pain affecting one or more branches of the trigeminal nerve. When conservative treatment fails and microdecompression is not indicated, percutaneous procedures are helpful. This percutaneous approach is done by a puncture up to the Gasserian ganglion, through the foramen ovale. Although simple and safe, this puncture demands some expertise from neurosurgeons. For that, a partnership between neurosurgeons and bio-engineers has developed a model for foramen ovale puncture, allowing practice for residents and young neurosurgeons. METHOD: A model for foramen ovale puncture has been created by interposition of synthetic materials over a skull, simulating the human face. FINDINGS: This model has shown great similarity with that found in conventional surgeries, even upon repeated testing by experienced functional neurosurgeons and young residents. CONCLUSION: This model for foramen ovale puncture training has demonstrated valuable help for initial practicing of this common neurosurgical procedure, particularly in centers where there are not many cadavers available for training.
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Fosa Craneal Media/cirugía , Modelos Anatómicos , Procedimientos Neuroquirúrgicos/educación , Base del Cráneo/cirugía , Ganglio del Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Ablación por Catéter/métodos , Fosa Craneal Media/anatomía & histología , Desnervación/métodos , Cara/anatomía & histología , Humanos , Internado y Residencia/métodos , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/fisiopatología , Complicaciones Intraoperatorias/prevención & control , Neurocirugia/educación , Procedimientos Neuroquirúrgicos/métodos , Elastómeros de Silicona , Base del Cráneo/anatomía & histología , Enseñanza/métodos , Ganglio del Trigémino/anatomía & histología , Ganglio del Trigémino/fisiopatología , Nervio Trigémino/anatomía & histología , Nervio Trigémino/fisiopatología , Nervio Trigémino/cirugía , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/fisiopatologíaRESUMEN
BACKGROUND: There are few reports on the outcome of surgical treatment of TGN without vascular compression. METHODS: Between 1984 and 2004, 668 patients underwent MVD for TGN. In 21 patients (3.1%), vascular compression was absent. The surgical strategy in these cases involved the following: (1) dissection and exposure of the entire trigeminal nerve root; (2) slight neurapraxia with bipolar tips at the trigeminal nerve root; and (3) isolation of trigeminal nerve with Teflon sponge fragments. RESULTS: The patients' (female/male, 20:1) ages ranged from 33 to 77 years. Their right side was the most frequently involved (61.9%). Their mean duration of pain before treatment was 7.6 years (range = 1-20 years). At surgical exploration, vascular compression or anatomical abnormalities were absent in 15 patients (71.4%), arachnoidal thickening was present in 5 (23.8%), and fiber dissociation of the trigeminal nerve was present in 1 (4.8%). Mean follow-up after surgery was 17.7 months (range = 4-65 months). Immediate relief from pain occurred in all 21 patients. On Kaplan-Meier analysis, recurrence was maintained at 14.8% for 12, 24, and 36 months, increasing to 43.2% at 48 months. Permanent hypoesthesia was present in 6 patients (28.6%), whereas loss of corneal reflex was observed transiently in 1 (4.8%). Motor function of the trigeminal nerve was intact in all patients. No other complication was found. CONCLUSION: The proposed surgical plan of standard MVD plus slight trigeminal nerve root neurapraxia is a safe and effective management option for TGN without vascular compression.
Asunto(s)
Descompresión Quirúrgica/métodos , Procedimientos Neuroquirúrgicos/métodos , Nervio Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Adulto , Anciano , Aracnoides/patología , Aracnoides/fisiopatología , Arteria Basilar/patología , Arteria Basilar/fisiopatología , Fosa Craneal Media/anatomía & histología , Fosa Craneal Media/patología , Fosa Craneal Media/cirugía , Descompresión Quirúrgica/instrumentación , Descompresión Quirúrgica/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Estudios Prospectivos , Resultado del Tratamiento , Nervio Trigémino/patología , Nervio Trigémino/fisiopatología , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/fisiopatología , Insuficiencia Vertebrobasilar/complicaciones , Insuficiencia Vertebrobasilar/patología , Insuficiencia Vertebrobasilar/fisiopatologíaRESUMEN
Our purpose is to report a case of trigeminal neuralgia caused by vertebrobasilar dolichoectasia treated with microvascular decompression. A 63-year-old man sought treatment for a recurrent lancinating left facial pain in V2 and V3 trigeminal territories. The computed tomography angiography revealed a mechanical compression of the left trigeminal nerve due to vertebrobasilar dolichoectasia. The patient was submitted to a left suboccipital craniotomy. Shredded Teflon was introduced in the conflicting neurovascular area, achieving a satisfactory decompression. The patients pain resolved immediately. Vertebrobasilar dolichoectasia is a rare cause of trigeminal neuralgia and a successful outcome can be achieved with microvascular decompression.
Asunto(s)
Descompresión Quirúrgica/métodos , Nervio Trigémino , Neuralgia del Trigémino/etiología , Insuficiencia Vertebrobasilar/complicaciones , Insuficiencia Vertebrobasilar/cirugía , Angiografía Coronaria , Humanos , Masculino , Persona de Mediana Edad , Politetrafluoroetileno/uso terapéutico , Recurrencia , Tomografía Computarizada por Rayos X , Nervio Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Insuficiencia Vertebrobasilar/diagnóstico por imagenRESUMEN
O objetivo desse estudo é relatar um caso de neuralgia trigeminal causado por dolicoectasia vertebrobasilar tratado com descompressão microvascular. Um homem (63 anos) consultou por neuralgia trigeminal recorrente na hemiface esquerda (territórios V2 e V3). A angiotomografia cerebral revelou compressão mecânica do nervo trigêmio esquerdo devido à dolicoectasia vertebrobasilar. O paciente foi submetido à craniotomia suboccipital esquerda. Introduziu-se Teflon® na área de conflito neurovascular, obtendo-se uma descompressão satisfatória. O paciente apresentou remissão da dor imediatamente. A dolicoectasia vertebrobasilar é uma causa rara de neuralgia trigeminal e uma excelente evolução pode ser alcançada com a descompressão microvascular.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Descompresión Quirúrgica/métodos , Nervio Trigémino , Neuralgia del Trigémino/etiología , Insuficiencia Vertebrobasilar/complicaciones , Insuficiencia Vertebrobasilar/cirugía , Angiografía Coronaria , Politetrafluoroetileno/uso terapéutico , Recurrencia , Tomografía Computarizada por Rayos X , Nervio Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Insuficiencia VertebrobasilarRESUMEN
Schwannomas reach 8 to 10% of all intracranial tumors. Most originate at the vestibular root of VIII cranial nerve, but trigeminal tumors are infrequent. We present the case of a patient admitted at the National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez" (Mexico City) with a mass occupying the infratemporal fossa with involvement of nearby structures. Schwannomas with extension to the infratemporal fossa are rare. We review the anatomy of this region, the surgical approaches, which have been used and propose a different approach.
Asunto(s)
Neoplasias de los Nervios Craneales/patología , Seno Maxilar/patología , Neurilemoma/patología , Nervio Trigémino/patología , Adulto , Encéfalo/patología , Encéfalo/cirugía , Neoplasias de los Nervios Craneales/cirugía , Femenino , Humanos , Seno Maxilar/cirugía , Cavidad Nasal/patología , Cavidad Nasal/cirugía , Invasividad Neoplásica , Neurilemoma/cirugía , Órbita/patología , Órbita/cirugía , Faringe/patología , Faringe/cirugía , Nervio Trigémino/cirugíaRESUMEN
We treated 50 patients at the Hospital de Especialidades, Centro Médico Nacional La Raza, IMSS, in Mexico City, with trigeminal neuralgia by two procedures: a) microvascular decompression of the trigeminal nerve with asterional craniectomy, or b) compression of Gasser's nodule by percutaneous puncture. Each patient was allowed to choose one of the procedures after informed consent. Twenty two patients underwent percutaneous puncture, while 28 patients underwent microvascular decompression. Our study group comprised 35 females and 15 males between the ages of 38 and 80 years. After 3 months, we achieved good-to-excellent results in 25 patients with microvascular decompression and in 15 patients, with compression of Gasser's nodule. At 2 years follow-up, our results remained the same for microvascular decompression group while in the other group we observed only satisfactory results in 59% of cases. In craniectomy group, we found vascular compression in 96% of cases. Five patients presented hypoacusia after decompressive procedure and eight patients had facial dysesthesia after percutaneous procedure. In percutaneous group, procedures were cancelled due to technical difficulties in two cases. We conclude that both procedures are safe, with zero mortality. The microvascular procedure affords better results at 2 years follow-up.
Asunto(s)
Nervio Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Descompresión Quirúrgica/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias , Resultado del Tratamiento , Nervio Trigémino/patología , Neuralgia del Trigémino/patologíaRESUMEN
Se trataron 50 pacientes en el Hospital de Especialidades Centro Médico Nacional La Raza con neuralgia del trigémino, mediante dos procedimientos: a) microdescompresión vascular del trigémino mediante craniectomia asterional y b) compresión del ganglio de Gasser por punción per cutánea. El paciente eligió el procedimiento quirúrgico previa información detallada. A 22 pacientes se les realizó punción y a 28 microdescompresión. Las edades variaron de 38 a 80 años, 35 mujeres y 15 hombres. Los resultados a tres meses fueron buenos o excelentes en 25 pacientes con la microdescompresión y en 15pacientes con la compresión. A dos años los resultados seguían iguales a quienes se les realizó microdescompresión y en los pacientes tratados con compresión los resultados satisfactorios habían disminuido 59% de los casos. Se encontró compresión vascular en 96% de los casos de los pacientes que se realizó craniectomía. Tuvimos cinco pacientes con hipoacusia después de la microdescompresión y ocho con disestesia facial después de la compresión, y en dos casos de compresión el procedimiento no se pudo llevar a cabo por dificultades técnicas. Uno y otro procedimientos son seguros, con nula mortalidad, pero con mejores resultados a dos años con la microdescompresión vascular.
We treated 50 patients at the Hospital de Especialidades, Centro Médico Nacional La Raza, LMSS, in Mexico City, with trigeminal neuralgia by two procedures: a) microvascular decompression of the trigeminal nerve with asterional craniectomy, or b) compression of Gasser's nodule by percutaneous puncture. Each patient was allowed to choose one of the procedures after informed consent. Twenty two patients underwent percutaneous puncture, while 28 patients underwent microvascular decompression. Our study group comprised 35 females and 15 males between the ages of 38 and 80 years. After 3 months, we achieved good-to-excellent results in 25 patients with microvascular decompression and in 15 patients, with compression of Gasser's nodule. At 2 years follow-up, our results remained the same for microvascular decompression group while in the other group we observed only satisfactory results in 59% of cases. In craniectomy group, we found vascular compression in 96% of cases. Five patients presented hypoacusia after decompressive procedure and eight patients had facial dysesthesia after percutaneous procedure. In percutaneous group, procedures were cancelled due to technical difficulties in two cases. We conclude that both procedures are safe, with zero mortality. The microvascular procedure affords better results at 2 years follow-up.