1/131. Intraoperative loss of auditory function relieved by microvascular decompression of the cochlear nerve.BACKGROUND: Brainstem auditory evoked potentials (BAEP) are useful indicators of auditory function during posterior fossa surgery. Several potential mechanisms of injury may affect the cochlear nerve, and complete loss of BAEP is often associated with postoperative hearing loss. We report two cases of intraoperative auditory loss related to vascular compression upon the cochlear nerve. methods: Intra-operative BAEP were monitored in a consecutive series of over 300 microvascular decompressions (MVD) performed in a recent twelve-month period. In two patients undergoing treatment for trigeminal neuralgia, BAEP waveforms suddenly disappeared completely during closure of the dura. RESULTS: The cerebello-pontine angle was immediately re-explored and there was no evidence of hemorrhage or cerebellar swelling. The cochlear nerve and brainstem were inspected, and prominent vascular compression was identified in both patients. A cochlear nerve MVD resulted in immediate restoration of BAEP, and both patients recovered without hearing loss. CONCLUSION: These cases illustrate that vascular compression upon the cochlear nerve may disrupt function, and is reversible with MVD. awareness of this event and recognition of BAEP changes alert the neurosurgeon to a potential reversible cause of hearing loss during posterior fossa surgery.- - - - - - - - - - ranking = 1keywords = neuralgia (Clic here for more details about this article) |
2/131. Removal of petrous apex meningioma and microvascular decompression for trigeminal neuralgia through the anterior petrosal approach. Case report.A 64-year-old female presented with right trigeminal neuralgia. Computed tomography and magnetic resonance (MR) imaging demonstrated a tumor attached to the right petrous apex. MR imaging also revealed that the trigeminal nerve was compressed and distorted by the tumor. Tumor removal and microvascular decompression (MVD) were performed via the anterior petrosal approach. The trigeminal nerve was distorted by the tumor and the superior cerebellar artery compressed the medial part of the root entry zone of the trigeminal nerve. The surgery resulted in complete relief of the trigeminal neuralgia. Posterior fossa tumors causing ipsilateral trigeminal neuralgia are not rare, and are often removed via the suboccipital retromastoid approach, as MVD for trigeminal neuralgia is usually performed through the retromastoid approach. The advantages of the anterior petrosal approach are shorter access to the lesion and direct exposure without interference from the cranial nerves, and that bleeding from the tumors is easily controlled as the feeding arteries can be managed in the early stage of the surgery. We conclude that the anterior petrosal approach is safe and advantageous for the removal of petrous apex tumor associated with trigeminal neuralgia.- - - - - - - - - - ranking = 9keywords = neuralgia (Clic here for more details about this article) |
3/131. Aseptic meningitis caused by Teflon implantation for microvascular decompression. Case report.The authors present the case of a 47-year-old man who, after undergoing microvascular decompression for trigeminal neuralgia, experienced symptomatic pain relief but developed prolonged aseptic meningitis. This case is unusual in that the patient remained dependent on steroid medications for nearly 5 months following the initial surgery and the aseptic meningitis did not resolve until after surgical removal of the Teflon used to pad the trigeminal nerve. The pathophysiological characteristics of the body's reaction to implanted Teflon are discussed along with the rationale for removing this substance in cases of prolonged intractable aseptic meningitis.- - - - - - - - - - ranking = 1keywords = neuralgia (Clic here for more details about this article) |
4/131. Frontal intraosseous cryptic hemangioma presenting with supraorbital neuralgia.Primary intraosseous cranial hemangiomas are rare benign tumors comprising 0.2% of all osseous neoplasms. Symptomatic cranial cryptic hemangiomas are extremely rare. We report the case of a 43-year-old man with a cryptic hemangioma of the superior orbital rim. Radiological investigations revealed it to be an intraosseous cryptic mass which was totally excised and the supraorbital nerve was decompressed, relieving the patient of his symptoms. Histopathology showed features of an intraosseous hemangioma.- - - - - - - - - - ranking = 4keywords = neuralgia (Clic here for more details about this article) |
5/131. Possible role of an endovascular provocative test in the diagnosis of glossopharyngeal neuralgia as a vascular compression syndrome.We utilized endovascular provocative techniques to identify the indications for microvascular decompression surgery in a serious case of glossopharyngeal neuralgia. This is the first reported case in which an endovascular provocative test was applied for diagnosis of glossopharyngeal neuralgia as a vascular compression syndrome. A 68-year-old woman presented with severe paroxysmal facial pain which could not be controlled by medical therapy. Partial effectiveness to carbamazepine led us to wonder whether or not the selection of microvascular decompression surgery would be appropriate. Pre-operative angiography was performed. During the examination a microcatheter was inserted into the right posterior inferior cerebellar artery (pica), and an attack of typical glossopharyngeal neuralgia occurred. The patient thus underwent microvascular decompression surgery. The pica was verified to compress the glossopharyngeal nerve and therefore was moved to induce decompression. The patient has since experienced no further pain for one year postoperatively. The diagnosis of glossopharyngeal neuralgia is sometimes complex and it is difficult to select the most appropriate surgical modality. In such cases this endovascular provocative technique may thus be useful for making a definitive decision or microvascular decompression surgery.- - - - - - - - - - ranking = 8keywords = neuralgia (Clic here for more details about this article) |
6/131. sciatica in the community--not always disc herniation.Three cases of sciatica seen in general practice are described. The clinical features were consistent with pyriformis syndrome, a condition of compression of the sciatic nerve at the pelvic outlet. The literature on causes and clinical features is briefly reviewed. The prevalence of the condition in the community and the accuracy of clinical diagnosis are unknown. It is suggested that pelvic outlet syndrome, comparable to carpal tunnel syndrome, is a more appropriate name for the condition.- - - - - - - - - - ranking = 0.34321369831604keywords = sciatica (Clic here for more details about this article) |
7/131. Neurovascular compression of the trigeminal and glossopharyngeal nerve: three case reports.trigeminal neuralgia (TN) is a frequent cause of paroxysmal facial pain and headache in adults. Glossopharyngeal neuralgia (GPN) is less common, but can cause severe episodic pain in the ear and throat. Neurovascular compression of the appropriate cranial nerve as it leaves the brain stem is responsible for the symptoms in many patients, and neurosurgical decompression of the nerve is now a well accepted treatment in adults with both TN and GPN who fail to respond to drug therapy. Neither TN nor GPN are routinely considered in the differential diagnosis when assessing children with paroxysmal facial or head pain, as they are not reported to occur in childhood. case reports of three children with documented neurovascular compression causing severe neuralgic pain and disability are presented. The fact that these conditions do occur in the paediatric population, albeit rarely, is highlighted, and appropriate investigation and management are discussed.- - - - - - - - - - ranking = 2keywords = neuralgia (Clic here for more details about this article) |
8/131. Microvascular decompression for trigeminal neuralgia in charcot-marie-tooth disease.The authors report on three patients suffering from coexistent trigeminal neuralgia (TGN) and charcot-marie-tooth disease who, based on preoperative magnetic resonance tomographic angiography findings, underwent microvascular decompression. All patients had demonstrable neural compression and all experienced immediate postoperative pain relief. Symptoms recurred in one patient and required a second procedure in the form of a neurotomy. Two patients suffered from bilateral TGN. When a patient with TGN suffers coexistent neurological disease and experiences bilateral symptoms, preoperative imaging and subsequent decompressive surgery may avoid the unacceptable risk of morbidity associated with bilateral ablative procedures.- - - - - - - - - - ranking = 5keywords = neuralgia (Clic here for more details about this article) |
9/131. trigeminal neuralgia associated with tentorial agenesis and temporal lobe herniation--case report.A 22-year-old female presented with an extremely rare case of trigeminal neuralgia associated with tentorial agenesis. The pulsating pain in her left maxillary region persisted for an abnormally long time and had no trigger zone. The pain later spread to the periorbital region. Coronal magnetic resonance imaging revealed left medial temporal lobe herniation caused by tentorial agenesis. The herniated temporal lobe, which had distorted the superior cerebellar artery, was causing compression of the trigeminal nerve. Her condition improved following microvascular decompression surgery. Tentorial agenesis should be considered as a cause of atypical pulsating facial pain, especially in younger patients.- - - - - - - - - - ranking = 5keywords = neuralgia (Clic here for more details about this article) |
10/131. Multiple peripheral nerve compressions related to malignantly transformed hereditary multiple exostoses.Autosomal dominantly transmitted hereditary multiple exostoses is an uncommon disorder consisting of multiple projections of bone capped by cartilage. The lesions are most numerous in the metaphyses of long bones but may appear on flat bones. Sarcomatous transformation occurs in 1-25% of patients. We report a 33-year-old man with sciatica, previously diagnosed as hereditary multiple exostoses, presenting with multiple peripheral nerve compressions. Electrodiagnostic studies showed profound axon-loss multiple neuropathies involving the sciatic, superior gluteal, and inferior gluteal nerves. magnetic resonance imaging of the left pelvis showed a large mass in the sacral area that was suggestive of a chondrosarcoma. An open intralesional excision biopsy confirmed chondrosarcoma transformed from chondromatosis. Excision of the lesion was effective in eliminating the impingement of nerves and retarding progressive osseous growth. We suggest that malignant transformation be suspected in cases with focal compression neuropathy of patients known to have multiple exostoses. osteochondroma as a possible cause for compression neuropathy is discussed.- - - - - - - - - - ranking = 0.34321369831604keywords = sciatica (Clic here for more details about this article) |
| | Next -> |