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Kościołek D, Kobierecki M, Tokarski M, Szalbot K, Kościołek A, Malicki M, Wanibuchi S, Wiśniewski K, Piotrowski M, Bobeff EJ, Szmyd BM, Jaskólski DJ. The Anterior Inferior Cerebral Artery Variability in the Context of Neurovascular Compression Syndromes: A Narrative Review. Biomedicines 2024; 12:452. [PMID: 38398054 PMCID: PMC10887044 DOI: 10.3390/biomedicines12020452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
The anterior inferior cerebellar artery (AICA) is situated within the posterior cranial fossa and typically arises from the basilar artery, usually at the pontomedullary junction. AICA is implicated in various clinical conditions, encompassing the development of aneurysms, thrombus formation, and the manifestation of lateral pontine syndrome. Furthermore, owing to its close proximity to cranial nerves within the middle cerebellopontine angle, AICA's pulsatile compression at the root entry/exit zone of cranial nerves may give rise to specific neurovascular compression syndromes (NVCs), including hemifacial spasm (HFS) and geniculate neuralgia concurrent with HFS. In this narrative review, we undertake an examination of the influence of anatomical variations in AICA on the occurrence of NVCs. Significant methodological disparities between cadaveric and radiological studies (CTA, MRA, and DSA) were found, particularly in diagnosing AICA's absence, which was more common in radiological studies (up to 36.1%) compared to cadaver studies (less than 5%). Other observed variations included atypical origins from the vertebral artery and basilar-vertebral junction, as well as the AICA-and-PICA common trunk. Single cases of arterial triplication or fenestration have also been documented. Specifically, in relation to HFS, AICA variants that compress the facial nerve at its root entry/exit zone include parabola-shaped loops, dominant segments proximal to the REZ, and anchor-shaped bifurcations impacting the nerve's cisternal portion.
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Affiliation(s)
- Dawid Kościołek
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Mateusz Kobierecki
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Mikołaj Tokarski
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Konrad Szalbot
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Aleksandra Kościołek
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Mikołaj Malicki
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Sora Wanibuchi
- The Faculty of Medicine, Aichi Medical University, Nagakute 480-1195, Japan;
| | - Karol Wiśniewski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
| | - Michał Piotrowski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
| | - Ernest J. Bobeff
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowieka St. 6/8, 92-251 Lodz, Poland
| | - Bartosz M. Szmyd
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Sporna St. 36/50, 91-738 Lodz, Poland
| | - Dariusz J. Jaskólski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
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Houshi S, Tavallaei MJ, Barzegar M, Afshari-Safavi A, Vaheb S, Mirmosayyeb O, Shaygannejad V. Prevalence of trigeminal neuralgia in multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2022; 57:103472. [PMID: 34986455 DOI: 10.1016/j.msard.2021.103472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/30/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The prevalence of Trigeminal Neuralgia (TN) in patients diagnosed with multiple sclerosis (MS) is insufficiently understood and controversially reported. This study focused on providing a better understanding of the prevalence of TN in MS patients. METHOD We systematically searched PubMed, Scopus, EMBASE, Web of Science, and Google Scholar to identify studies published from January 1, 1990, to December 30, 2020. We included studies reporting the TN prevalence among MS patients and exclude case reports/series and editorial studies, review studies, and non-English written articles. We used pooled prevalence estimates to determine the TN prevalence among MS patients. RESULTS Pooled overall TN prevalence among 19 studies and 30,348 MS patients was estimated as 3.4% (95% CI: 1.5%-5.9%) with a high level of heterogeneity among studies (I2=98.92%; p<0.001). The pooled prevalence of TN in male and female patients across 9 surveys was 2.4% (95% CI: 0.5%-5.4%) and 3.8% (95% CI: 0.8%-8.7%), respectively. No heterogeneity between the two groups was observed (p = 0.558). A meta-regression was performed to explore the source of the heterogeneity. None of the candidate covariates, including the year of a study publication, the sample size, the average age of patients, and the disease duration, were significant in the model. CONCLUSION Our results showed that TN is a common problem among patients with MS, predominantly male patients. Future studies should target the general prevalence of pain in MS patients.
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Affiliation(s)
- Shakiba Houshi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mahdi Barzegar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Saeed Vaheb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Universal council of epidemiology (UCE), universal scientific education and research network (USERN), Tehran University of Medical Sciences, Tehran, Iran.
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Pipeline embolization device for treatment of atypical facial pain caused by a cavernous sinus aneurysm. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ros de San Pedro J. Superior Cerebellar Artery Aneurysms Causing Facial Pain: A Comprehensive Review. Oper Neurosurg (Hagerstown) 2020; 18:2-11. [PMID: 31144721 DOI: 10.1093/ons/opz092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 01/13/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Trigeminal neuralgia caused by superior cerebellar artery aneurysms (TGN-SCAAs) is a rare event without previous analysis. OBJECTIVE To describe the features of TGN-SCAA based on 8 cases (7 from literature +1 illustrative case). METHODS All cases were thoroughly studied with gathering of their epidemiological, radiological, clinical, therapeutic, and outcome data. RESULTS The mean age at diagnosis was 61 yr. Gender distribution showed a female predominance (M: F = 2:6). Side distribution had a left dominance (75%). The aneurysms mean size was 15.4 mm (range: 5-27). All 5 proximal SCAAs (SCA-Basilar junction) presented a lateral-posterior projection, while all 3 distal SCAAs (s2 segment) had variable projections but constant direct trigeminal nerve (TN) contact. No hemorrhage occurred. TGN was the clinical onset in all 8 cases. The most frequent pain distribution was V1-2-3 (n = 3), followed by V1-2 (n = 1) and V1 alone (n = 1). Proximal SCAAs caused TGN through direct TN compression (n = 1), third nerve compression (n = 1), cavernous sinus compression (n = 1), or a combination thereof (n = 2). However, all distal SCAAs caused TGN by direct TN compression (n = 3). Two different treatment options were used: clipping (n = 4) and coiling (n = 4). The post-treatment Barrow Neurological Institute score for pain control was I in all cases (100%). The mRS score was 0 in 75% of cases. CONCLUSION TGN-SCAAs are infrequent lesions, characterized by large size, variable TGN mechanisms depending on their anatomic location, and mostly affecting the first and second trigeminal divisions. Both SCAA clipping and coiling were used equally, providing good neurological and pain relief results.
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Affiliation(s)
- Javier Ros de San Pedro
- Regional Service of Neurosurgery, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
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Chicoine NH, Yaacoub AP, Jea A, Raskin JS. Surgical Management of Trigeminal Neuralgia in Children. World Neurosurg 2018; 121:217-221. [PMID: 30347302 DOI: 10.1016/j.wneu.2018.10.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a well-recognized facial pain syndrome. Discrete forms with disparate pain symptoms include classic and atypical. However, atypical facial pain includes neuralgiform pain along a spectrum. Most cases of TN are diagnosed in the adult population. Case reports and series of children have presented TN as a similar entity, with treatment similar to that for adults. We reviewed the pertinent data and present 2 pediatric TN cases successfully treated with microvascular decompression (MVD). CASE DESCRIPTION Two pediatric patients (age 12 and 15 years) with TN refractory to previous medical therapy were identified. Both patients were deemed appropriate surgical candidates and underwent MVD to manage their TN. TN compression was arterial in both cases and involved portions of the anterior inferior cerebellar artery. Patient 1 was pain free 6 months after the procedure. Patient 2 was pain free immediately after the procedure and had been weaned off preoperative symptomatic management at the latest follow-up visit. The most recent follow-up examination was 12 and 8 months for patients 1 and 2, respectively, with both experiencing continued freedom from pain. CONCLUSIONS Few studies have reported on the effectiveness of MVD in the pediatric population for the management of TN. The supporting data and our 2 cases have demonstrated that MVD is effective for pediatric patients to treat their TN. Furthermore, the side effects appear to be minimal, with excellent pain relief after MVD in this patient population.
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Affiliation(s)
- Nicole H Chicoine
- School of Medicine, Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA
| | - Alan P Yaacoub
- Section of Pediatric Neurosurgery, Riley Hospital for Children, Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew Jea
- Section of Pediatric Neurosurgery, Riley Hospital for Children, Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeffrey S Raskin
- Section of Pediatric Neurosurgery, Riley Hospital for Children, Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Sponton LES, Ayyad A, Archavlis E, Ringel FA. Unique case of trigeminal neuralgia due to Epstein-Barr-virus-associated B-cell lymphomatoid granulomatosis of the Meckel's cave and cavernous sinus: Important clinical and therapeutic implications. Surg Neurol Int 2018; 9:148. [PMID: 30105142 PMCID: PMC6080144 DOI: 10.4103/sni.sni_12_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/26/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Trigeminal neuralgia (TN) represents one of the most disabling pain syndromes. Several diseases have been described as etiological triggers of TN, vascular compression of the trigeminal nerve being the most frequent cause. Here, we describe for the first time a rare case of TN caused by an infiltration of an isolated Epstein–Barr virus (EBV) B-cell lymphomatoid granulomatosis (LYG) mass into the Meckel's cave and cavernous sinus. Case Description: A 51-year-old woman undergoing immunosuppressant treatment for Crohn's disease presented due to right-sided TN. Magnetic resonance imaging (MRI) scans revealed an isolated lesion affecting the right Meckel's cave and lateral wall of the cavernous sinus. We accomplished tumor resection through a subtemporal extradural approach and the patient recovered successfully from surgery. Histological examination revealed an LYG, and a blood test confirmed low but positive EBV counts. The immunosuppressant therapy was discontinued and we assumed a watchful waiting management. During a 41-months’ follow-up there was neither evidence of LYG recurrence nor an increase of EBV counts. Conclusions: LYG, an angiodestructive disease associated with EBV reactivation in the context of immune dysfunction and often associated with an aggressive behavior or even malignant transformation, should be considered as a rare differential diagnosis of TN associated with skull base lesions. The management of this rare disease is still controversial and varies from limiting the treatment to correcting immune dysfunction up to chemotherapy. In this case of an isolated mass, surgical excision and discontinuation of immunosuppressants were effective to prevent the relapse of the disease in a long-term follow-up.
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Affiliation(s)
| | - Ali Ayyad
- Department of Neurosurgery, Mainz University Hospital, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Eleftherios Archavlis
- Department of Neurosurgery, Mainz University Hospital, Langenbeckstraße 1, 55131 Mainz, Germany
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Ros de San Pedro J. Posterior communicating artery aneurysms causing facial pain: A comprehensive review. Clin Neurol Neurosurg 2017; 160:59-68. [PMID: 28686948 DOI: 10.1016/j.clineuro.2017.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/08/2017] [Accepted: 06/11/2017] [Indexed: 10/19/2022]
Abstract
Posterior communicating aneurysms are commonly associated with oculomotor nerve palsy. However, trigeminal nerve involvement among these aneurysms is a rare event with no previous analysis. In order to describe the main features of posterior communicating aneurysms causing trigeminal neuralgia (TGN-PComAAs) eight cases (six from the literature plus two more illustrative cases) were included in the present series. All cases were thoroughly studied in order to collect their epidemiological, radiological, clinical, therapeutic, pathogenic, and outcome data. The mean age at diagnosis was 57 years. Gender distribution showed a female predominance (M-to-F ratio 3:5), while side distribution showed a slight left dominance (62%). The aneurysms mean size was 24.7mm (range: 7-40mm). In 7 cases (87.5%) the PComAA was reported to project posteriorly, associated with cavernous sinus extension/compression in two of them and posterior fossa extension in three. No case presented with hemorrhage. Facial pain was the clinical onset in all eight cases, which was reported as an atypical TGN (continuous with exacerbating fits) in 87.5%. Trigger points were absent in all cases but one (87.5%). The most frequent anatomical distribution of the pain was V2 alone (n=3), followed by V1-2 (n=2) and V1-2-3 (n=2). Three different mechanisms for trigeminal neuralgia were observed, namely, cavernous sinus compression (n=4), direct trigeminal root compression (n=3), and oculomotor nerve compression (n=1). Three different treatment options were performed: surgery (n=6), trigeminal thermo-rhizotomy (n=1) and medical management (n=1). According to the Barrow Neurological Institute (BNI) score the pain control after main treatment was I (no pain with no medication) in 7 cases (87.5%). The average modified Rankin scale (mRS) score was 1. In sum, TGN-PComAAs are infrequent lesions characterized by large size and posterior-medial-inferior projection. They mainly cause atypical TGN, most commonly involving the first and second trigeminal distributions (V1-V2). Surgical aneurysmal clipping has been the most frequent treatment option for these aneurysms, providing good neurological results in a vast majority and complete trigeminal pain relief in all cases.
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Affiliation(s)
- Javier Ros de San Pedro
- Regional Service of Neurosurgery, Hospital Clínico Universitario Virgen de la Arrixaca, Crta. Madrid-Cartagena, sn, 30120, El Palmar, Murcia, Spain.
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Di Stefano G, Limbucci N, Cruccu G, Renieri L, Truini A, Mangiafico S. Trigeminal Neuralgia Completely Relieved After Stent-Assisted Coiling of a Superior Cerebellar Artery Aneurysm. World Neurosurg 2017; 101:812.e5-812.e9. [DOI: 10.1016/j.wneu.2017.03.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 12/20/2022]
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Lv X, Ge H, He H, Jiang C, Li Y. Anterior inferior cerebellar artery aneurysms: Segments and results of surgical and endovascular managements. Interv Neuroradiol 2016; 22:643-648. [PMID: 27485045 PMCID: PMC5564350 DOI: 10.1177/1591019916656474] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/02/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anterior inferior cerebellar artery (AICA) aneurysms are rare and published clinical experience with these aneurysms is limited. OBJECTIVE The objective of this article is to report angiographic characteristics and results associated with premeatal, meatal and postmeatal segments, surgical and endovascular therapies. METHODS A literature review was performed through PubMed using "anterior inferior cerebellar artery aneurysm" through January 2016. Clinical data, angiograms, management techniques, and patient outcomes were reviewed for 47 collected cases in 30 previous reports. RESULTS Of these aneurysms, 21 (44.7%) were associated with meatal segment, 10 (21.3%) were postmeatal and 16 (34.0%) were premeatal. Patients with meatal aneurysms are more likely to present with subarachnoid hemorrhage and hearing loss and facial palsy (77.8%). Patient outcomes of meatal aneurysms presented with more neuropathies (51.7%) and cerebellar symptoms (14.3%) (p = 0.049). Four cases of meatal aneurysm with preoperative cranial nerve deficits (two VII and two VIII) showed improvement after surgery. Endovascular treatment achieved outcomes similar to surgical treatment (p = 0.327). CONCLUSIONS AICA aneurysms have a predilection for meatal segment. Patients with meatal aneurysms are more likely to present with subarachnoid hemorrhage and hearing loss and facial palsy. Patient outcomes of meatal aneurysms presented with more neuropathies and cerebellar symptoms. Endovascular treatment achieved outcomes similar to surgical treatment.
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Affiliation(s)
- Xianli Lv
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huijian Ge
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongwei He
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuhan Jiang
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Chivukula S, Kim W, Zhuo X, Tenn S, Kaprealian T, DeSalles A, Pouratian N. Radiosurgery for Secondary Trigeminal Neuralgia: Revisiting the Treatment Paradigm. World Neurosurg 2016; 99:288-294. [PMID: 27702706 DOI: 10.1016/j.wneu.2016.09.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The mechanisms by which surgery and radiation elicit pain relief in trigeminal neuralgia (TN) secondary to mass lesions vary widely. We aimed to evaluate the outcomes of radiation to the nerve rather than to the lesion in the treatment of secondary TN. METHODS We retrospectively reviewed all patients who underwent radiation at the University of California, Los Angeles for TN secondary to tumors. The Barrow Neurological Institute (BNI) pain score was used to evaluate pain outcomes. RESULTS Twelve patients were identified; 4 were male and 8 were female. Their mean age at treatment was 59.8 years (range, 47.7-84.7 years). Tumor pathologies included meningioma (n = 8), squamous cell carcinoma (n = 2), vestibular schwannoma (n = 1), and hemangiopericytoma (n = 1). No patient suffered from multiple sclerosis. Ten patients underwent initial radiation targeting their tumors-radiosurgery in 3 and fractionated radiation therapy in 7 others. Only 6 among these 10 experienced at least partial relief, which lasted a mean 6 months. Radiosurgery targeting the trigeminal nerve was eventually performed. Overall, 10 of 12 (83.3%) patients experienced good initial pain relief, complete in 6 (50%) patients. Pain recurred in 6 (60%) patients, at a mean 41 months after radiosurgery to the trigeminal nerve. Three patients experienced facial sensory dysfunction postprocedurally at a mean follow-up duration of 57 months. CONCLUSION In contrast to tumor radiation, radiosurgery to the trigeminal nerve root resulted in reasonable and longer pain reduction, on par with the literature regarding surgical resection, with low risk of additional complications.
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Affiliation(s)
- Srinivas Chivukula
- Department of Neurological Surgery, University of California, Los Angeles, Los Angeles, California, USA.
| | - Won Kim
- Department of Neurological Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Xiaoyi Zhuo
- Department of Neurological Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Stephen Tenn
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California, USA
| | - Tania Kaprealian
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California, USA
| | - Antonio DeSalles
- Department of Neurological Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Nader Pouratian
- Department of Neurological Surgery, University of California, Los Angeles, Los Angeles, California, USA; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California, USA; Interdepartmental Program in Neuroscience, University of California, Los Angeles, Los Angeles, California, USA; Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, USA; Brain Research Institute, University of California, Los Angeles, Los Angeles, California, USA
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Takemoto Y, Kawano T, Nishi T, Kuratsu J. Formation of a pseudoaneurysm in the chronic phase at the site of a ruptured dissecting anterior inferior cerebellar artery aneurysm. Acta Neurochir (Wien) 2015; 157:1045-7. [PMID: 25894079 DOI: 10.1007/s00701-015-2397-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/09/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Yushin Takemoto
- Department of Neurosurgery, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
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A Successful Treatment of Coexistent Trigeminal Neuralgia and Ipsilateral Superior Cerebellar Artery Aneurysm. J Craniofac Surg 2015; 26:1270-2. [DOI: 10.1097/scs.0000000000001758] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mascitelli JR, McNeill IT, Mocco J, Berenstein A, DeMattia J, Fifi JT. Ruptured distal AICA pseudoaneurysm presenting years after vestibular schwannoma resection and radiation. J Neurointerv Surg 2015; 8:e19. [PMID: 25964373 DOI: 10.1136/neurintsurg-2015-011736.rep] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2015] [Indexed: 11/04/2022]
Abstract
Distal anterior inferior cerebellar artery (AICA) pseudoaneurysms are very rare lesions. Although cases have been previously reported, only a few have been reported as a result of vestibular schwannoma (VS) radiation, none have been reported as a result of VS resection, and only one has been reported as treated with parent vessel occlusion (PVO) with n-butyl cyanoacrylate (nBCA). We report a case of a 65-year-old man with a history of right-sided VS surgery and radiation who presented years later with a ruptured pseudoaneurysm of the distal right AICA and was treated with endovascular PVO using nBCA. The aneurysm was completely obliterated and the patient had no worsening of symptoms or neurological exam. The case illustrates a very rare complication of VS surgery and radiation as well as an effective treatment for distal AICA aneurysms.
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Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Ian T McNeill
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | | | - Joseph DeMattia
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
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Mascitelli JR, McNeill IT, Mocco J, Berenstein A, DeMattia J, Fifi JT. Ruptured distal AICA pseudoaneurysm presenting years after vestibular schwannoma resection and radiation. BMJ Case Rep 2015; 2015:bcr-2015-011736. [PMID: 25948851 DOI: 10.1136/bcr-2015-011736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Distal anterior inferior cerebellar artery (AICA) pseudoaneurysms are very rare lesions. Although cases have been previously reported, only a few have been reported as a result of vestibular schwannoma (VS) radiation, none have been reported as a result of VS resection, and only one has been reported as treated with parent vessel occlusion (PVO) with n-butyl cyanoacrylate (nBCA). We report a case of a 65-year-old man with a history of right-sided VS surgery and radiation who presented years later with a ruptured pseudoaneurysm of the distal right AICA and was treated with endovascular PVO using nBCA. The aneurysm was completely obliterated and the patient had no worsening of symptoms or neurological exam. The case illustrates a very rare complication of VS surgery and radiation as well as an effective treatment for distal AICA aneurysms.
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Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Ian T McNeill
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | | | - Joseph DeMattia
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
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16
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Ladner TR, Ehtesham M, Davis BJ, Khan IS, Ghiassi M, Ghiassi M, Singer RJ. Resolution of trigeminal neuralgia by coil embolization of a persistent primitive trigeminal artery aneurysm. J Neurointerv Surg 2013; 6:e22. [PMID: 24610143 DOI: 10.1136/neurintsurg-2013-010703.rep] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The persistent primitive trigeminal artery (PTA) is a rare anastomosis between the carotid artery and basilar artery. While most PTAs are asymptomatic, lateral variants can occasionally compress the trigeminal nerve and precipitate trigeminal neuralgia. Aneurysms of the PTA are exceptionally rare in the literature and have not previously been associated with trigeminal neuralgia. We present the first case of an aneurysm of the PTA causing trigeminal neuralgia. The patient underwent coil embolization of the aneurysm which relieved her symptoms. We propose embolization as a viable therapeutic option for the resolution of trigeminal neuralgia when the condition is secondary to irritation by the high velocity pulsatile flow of an aneurysm.
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Affiliation(s)
- Travis R Ladner
- Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA
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17
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Ladner TR, Ehtesham M, Davis BJ, Khan IS, Ghiassi M, Ghiassi M, Singer RJ. Resolution of trigeminal neuralgia by coil embolization of a persistent primitive trigeminal artery aneurysm. BMJ Case Rep 2013; 2013:bcr-2013-010703. [PMID: 23625680 DOI: 10.1136/bcr-2013-010703] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The persistent primitive trigeminal artery (PTA) is a rare anastomosis between the carotid artery and basilar artery. While most PTAs are asymptomatic, lateral variants can occasionally compress the trigeminal nerve and precipitate trigeminal neuralgia. Aneurysms of the PTA are exceptionally rare in the literature and have not previously been associated with trigeminal neuralgia. We present the first case of an aneurysm of the PTA causing trigeminal neuralgia. The patient underwent coil embolization of the aneurysm which relieved her symptoms. We propose embolization as a viable therapeutic option for the resolution of trigeminal neuralgia when the condition is secondary to irritation by the high velocity pulsatile flow of an aneurysm.
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Affiliation(s)
- Travis R Ladner
- Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA.
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18
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Sabalys G, Juodzbalys G, Wang HL. Aetiology and pathogenesis of trigeminal neuralgia: a comprehensive review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2013; 3:e2. [PMID: 24422020 PMCID: PMC3886096 DOI: 10.5037/jomr.2012.3402] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/29/2012] [Indexed: 11/29/2022]
Abstract
Objectives The aim of present paper was to discuss issues related to trigeminal
neuralgia with strong emphasis on the aetiology and pathogenesis of this
problem. Material and Methods An electronic search of 5 databases (1965 - Oct 2012) and a hand search of
peer-reviewed journals for relevant articles were performed. In addition,
experience acquired from treating 3263 patients in the Department of
Maxillofacial Surgery, Lithuanian University of Health Sciences, were also
summarized. Results Generally, aetiological factors can be classified into 3 most popular
theories that were based on: 1) Related to other disease, 2) Direct injury
to the trigeminal nerve, and 3) Propagates the polyetiologic origin of the
disease. In addition, two pathogenesis mechanisms of trigeminal neuralgia
were proposed. First: the peripheral pathogenetic mechanism that is often
induced by progressive dystrophy around the peripheral branches of the
trigeminal nerve. Second, central pathogenetic mechanism which often
triggered by peripheral pathogen that causes long-lasting afferent
impulsation and the formation of a stable pathologic paroxysmal type
irritation focus on the central nerve system (CNS). Conclusions Patients with susceptive trigeminal neuralgia should be examined carefully by
specialists who have expertise in assessing and diagnosing of possible
pathological processes and be able to eliminate the contributing factors so
the trigeminal neuralgia can be properly managed.
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Affiliation(s)
- Gintautas Sabalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences Kaunas Lithuania
| | - Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences Kaunas Lithuania
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan Ann Arbor, Michigan USA
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19
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Harsha KJ, Kesavadas C, Chinchure S, Thomas B, Jagtap S. Imaging of vascular causes of trigeminal neuralgia. J Neuroradiol 2012. [DOI: 10.1016/j.neurad.2012.08.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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20
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Anterior inferior cerebellar artery aneurysms: six cases and a review of the literature. Neurosurg Rev 2011; 35:111-9; discussion 119. [PMID: 21748288 DOI: 10.1007/s10143-011-0338-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Revised: 05/05/2011] [Accepted: 05/15/2011] [Indexed: 10/18/2022]
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21
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Balasundram S, Cotrufo S, Liew C. Case series: non vascular considerations in trigeminal neuralgia. Clin Oral Investig 2011; 16:63-8. [PMID: 21210165 DOI: 10.1007/s00784-010-0499-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 12/22/2010] [Indexed: 11/29/2022]
Abstract
An abnormal vascular course of the superior cerebellar artery is often cited as the cause for trigeminal neuralgia. However, among patients with TN-like symptoms, 6% to 16% are variously reported to have intracranial tumours. Aneurysms, tumours, or other lesions may impinge or irritate the trigeminal nerve along its course. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. We would like to present a series of unusual lesions, all of which initially presented with neuralgic-like symptoms and were refractory to treatment. Collated case series with photographs and imaging are reviewed in this paper. Discussion of case presentation and management are done for evaluation. A wide range of other compressive lesions can cause trigeminal neuralgia. This paper illustrates the clinical presentation of atypical trigeminal neuralgia and emphasises the value of diagnostic imaging in trigeminal neuralgia patient. Suggested algorithm for management of trigeminal neuralgia.
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Affiliation(s)
- Sathesh Balasundram
- Oral and Maxillofacial Surgery Unit, Eastman Dental Hospital, University College London Hospital, London, UK.
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22
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Oyama H, Kito A, Maki H, Hattori K, Tanahashi K. Compression of the medulla oblongata and acute respiratory failure caused by rupture of a thrombosed large aneurysm of the anterior inferior cerebellar artery. Neurol Med Chir (Tokyo) 2010; 50:571-3. [PMID: 20671383 DOI: 10.2176/nmc.50.571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 65-year-old female presented with an extremely rare case of a ruptured thrombosed large aneurysm of the anterior inferior cerebellar artery (AICA) in which a local hematoma compressed the medulla oblongata and caused acute respiratory failure. She first presented with dizziness, general fatigue, and nausea 2 months before admission. She was hospitalized for intense general fatigue, nausea, and occipitalgia. Computed tomography and T(1)-weighted magnetic resonance imaging showed a heterogeneous lesion around the right cerebello-medullary cistern. Angiography revealed a fusiform aneurysm of the right AICA. Asphyxia occurred 4 days after admission and the patient underwent an emergency operation. No subarachnoid hematoma was present, but a hematoma around the ruptured portion markedly compressed the medulla oblongata. The medulla oblongata was adequately decompressed after subtotal removal of the aneurysm. The patient's respiratory status and consciousness level recovered after the operation.
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Affiliation(s)
- Hirofumi Oyama
- Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
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23
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DATE I. Symptomatic Unruptured Cerebral Aneurysms: Features and Surgical Outcome. Neurol Med Chir (Tokyo) 2010; 50:788-99. [DOI: 10.2176/nmc.50.788] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Isao DATE
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
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24
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Figueiredo EG, Gomes MQT, Brito-Neto RV, Paiva WS, Teixeira MJ. A giant partially thrombosed AICA aneurysm. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:566-8. [PMID: 18813724 DOI: 10.1590/s0004-282x2008000400028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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25
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SAITO A, NISHINO A, SUZUKI I, SUZUKI H, UTSUNOMIYA A, SUZUKI S, UENOHARA H, SAKURAI Y. Subarachnoid Hemorrhage Caused by Rupture of a Distal Anterior Inferior Cerebellar Artery Aneurysm -Three Case Reports-. Neurol Med Chir (Tokyo) 2008; 48:506-11. [PMID: 19029778 DOI: 10.2176/nmc.48.506] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Atsushi SAITO
- Department of Neurosurgery, Stroke Center, Sendai Medical Center
| | - Akiko NISHINO
- Department of Neurosurgery, Stroke Center, Sendai Medical Center
| | - Ichiro SUZUKI
- Department of Neurosurgery, Stroke Center, Sendai Medical Center
| | | | | | - Shinsuke SUZUKI
- Department of Neurosurgery, Stroke Center, Sendai Medical Center
| | - Hiroshi UENOHARA
- Department of Neurosurgery, Stroke Center, Sendai Medical Center
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26
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Choi CH, Cho WH, Choi BK, Lee SW. Rerupture following endovascular treatment for dissecting aneurysm of distal anterior inferior cerebellar artery with parent artery preservation: retreatment by parent artery occlusion with Guglielmi detachable coils. Acta Neurochir (Wien) 2006; 148:363-6; discussion 366. [PMID: 16362175 DOI: 10.1007/s00701-005-0702-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Accepted: 10/26/2005] [Indexed: 11/24/2022]
Abstract
Distal anterior inferior cerebellar artery (AICA) aneurysms are rare and most cases have been treated surgically by clipping, wrapping or trapping. We recently treated this 20-year-old male patient by an endovascular technique. At first, he was treated by intra-aneurysmal embolisation with parent artery preservation. But he presented with rerupture 1 month after embolisation. Follow-up angiography revealed the regrowth of the aneurysm, which was considered as a dissecting aneurysm. We performed occlusion of the AICA just proximal to the aneurysm to prevent fatal rebleeding. He gradually improved and his level of consciousness fully recovered. At 2 year follow up, he had no neurological deficits. We suggest that embolisation of distal AICA aneurysm with parent artery occlusion may be safe and a simple method in the treatment of distal AICA aneurysms.
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Affiliation(s)
- C H Choi
- Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Republic of Korea
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27
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Sarkar A, Link MJ. Distal anterior inferior cerebellar artery aneurysm masquerading as a cerebellopontine angle tumor: case report and review of literature. Skull Base 2005; 14:101-6; discussion 106-7. [PMID: 16145591 PMCID: PMC1151678 DOI: 10.1055/s-2004-828703] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present the case of a distal anterior inferior cerebellar artery (AICA) aneurysm masquerading as a cerebellopontine angle tumor in a 60-year-old right-handed man with previously undiagnosed polyarteritis nodosa (PAN). The patient presented with a 2-month history of progressive right-sided hearing loss, intermittent severe headache, and sudden onset of complete facial paralysis 3 weeks before admission. Magnetic resonance imaging, including post-gadolinium images, showed a 1.2-cm heterogeneously enhancing mass that slightly enlarged the right internal auditory canal. A right suboccipital craniotomy was performed, and a partially thrombosed fusiform AICA aneurysm was discovered just anterior to the VII/VIII nerve complex. The aneurysm was trapped and opened, and a thrombectomy was performed. Postoperatively, the patient experienced abdominal pain; liver function tests were abnormal. Investigation revealed a small retroperitoneal hemorrhage and aneurysms of the celiac axis and gastroduodenal arteries. Further investigation revealed an increased erythrocyte sedimentation rate, and a diagnosis of PAN was made. PAN is a well-identified factor in the genesis of peripheral vascular aneurysms. Aneurysms involving the hepatic, renal, coronary, pancreatic, and tibial arteries have been described. PAN is an extremely rare cause of intracranial aneurysm. Patients who present with aneurysms in unusual locations (e.g., distal AICA) should be investigated for vasculopathy and collagen vascular disorders.
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Affiliation(s)
- Atom Sarkar
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J. Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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28
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Deshmukh VR, Hott JS, Tabrizi P, Nakaji P, Feiz-Erfan I, Spetzler RF. Cavernous Malformation of the Trigeminal Nerve Manifesting with Trigeminal Neuralgia: Case Report. Neurosurgery 2005; 56:E623. [DOI: 10.1227/01.neu.0000154063.05728.7e] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Accepted: 12/13/2004] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
We describe a patient with a cavernous malformation within the trigeminal nerve at the nerve root entry zone who presented with trigeminal neuralgia.
CLINICAL PRESENTATION:
A 52-year-old woman sought treatment after experiencing dizziness and lancinating left facial pain for almost a year. Neurological examination revealed diminished sensation in the distribution of the trigeminal nerve on the left. Magnetic resonance imaging demonstrated a minimally enhancing lesion affecting the trigeminal nerve.
INTERVENTION:
The patient underwent a retrosigmoid craniotomy. At the nerve root entry zone, the trigeminal nerve was edematous with hemosiderin staining. The lesion, which was resected with microsurgical technique, had the appearance of a cavernous malformation on gross and histological examination. The patient's pain improved significantly after resection.
CONCLUSION:
Cavernous malformations can afflict the trigeminal nerve and cause trigeminal neuralgia. Microsurgical excision can be performed safely and is associated with improvement in symptoms.
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Affiliation(s)
- Vivek R. Deshmukh
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jonathan S. Hott
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peyman Tabrizi
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Iman Feiz-Erfan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F. Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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29
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Gonzalez LF, Alexander MJ, McDougall CG, Spetzler RF. Anteroinferior Cerebellar Artery Aneurysms: Surgical Approaches and Outcomes—A Review of 34 Cases. Neurosurgery 2004; 55:1025-35. [PMID: 15509309 DOI: 10.1227/01.neu.0000141083.00866.82] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2004] [Accepted: 06/08/2004] [Indexed: 01/05/2023] Open
Abstract
Abstract
OBJECTIVE:
Anteroinferior cerebellar artery (AICA) aneurysms are rare lesions whose treatment requires expertise in vascular, endovascular, and cranial base surgery. This article presents the largest series treated at one center.
METHODS:
We retrospectively analyzed presenting symptoms, aneurysm characteristics, surgical approaches, postoperative outcomes, and the application of endovascular techniques.
RESULTS:
We found 32 patients with 34 AICA aneurysms (11 men and 21 women; age range, 6–77 yr; mean age, 51 yr). Twenty-one aneurysms had ruptured; 13 were unruptured. Seven of the unruptured aneurysms presented with brainstem compression, and six were found incidentally. Surgical approaches included the retrosigmoid, far-lateral transcochlear, translabyrinthine, and orbitozygomatic. Eighteen patients (56%) had neurological complications. Thirty aneurysms were at proximal locations, and four were distal. Intraoperative hypothermic cardiac arrest was used to clip eight giant aneurysms. Follow-up was available in 56% of the patients for a mean of 41 months. The mean Glasgow Outcome Scale scores at discharge were not significantly different from the patients' status at their initial assessment.
CONCLUSION:
We recommend the standard retrosigmoid approach for treating small to medium aneurysms involving the lower two-thirds of the clivus or distal AICA aneurysms. Cranial base approaches are recommended for large or giant aneurysms or for those proximal to the emergence of the AICA from the basilar trunk. Hypothermic cardiac arrest facilitates dissection of giant aneurysms. Endovascular treatment is a useful adjunct for treating residual aneurysms but did not provide definitive treatment in any of our patients.
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Affiliation(s)
- L Fernando Gonzalez
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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30
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Yamakawa H, Hattori T, Tanigawara T, Sahashi Y, Ohkuma A. Intracanalicular aneurysm at the meatal loop of the distal anterior inferior cerebellar artery: a case report and review of the literature. ACTA ACUST UNITED AC 2004; 61:82-8; discussion 88. [PMID: 14706388 DOI: 10.1016/s0090-3019(03)00270-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Distal aneurysms of the anterior inferior cerebellar artery (AICA) are rare. Most of the reported cases have been located near the internal auditory meatus. Among these cases, only six located in the internal auditory meatus have been reported in the literature. METHODS A 64-year-old female presented with sudden onset of severe headache. Computed tomography (CT) revealed moderate subarachnoid hemorrhage and Gd-DTPA enhanced magnetic resonance imaging (MRI) showed a small high-intensity mass at the right cerebellopontine angle. Although initial digital subtraction angiography (DSA) showed no vascular abnormalities, repeated DSA disclosed a saccular aneurysm at the top of the meatal loop of the right AICA. The patient underwent a suboccipital craniectomy on the 18th day after the hemorrhage RESULTS . In this case, the aneurysm was completely buried in the internal auditory meatus. After unroofing the meatus, the aneurysm was successfully clipped. After 3 months of hospitalization, the patient was discharged with right-sided deafness, partial facial palsy, and no other complications. CONCLUSIONS We discuss some of the clinical features and pitfalls in the surgical management of intracanalicular AICA aneurysms and review previous reports of similar cases.
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Affiliation(s)
- Haruki Yamakawa
- Department of Neurosurgery, Gifu University School of Medicine, Noishiki, Japan
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31
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Adorno JOA, de Andrade GC. [Aneurysm of the anterior inferior cerebellar artery: case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 2002; 60:1019-24. [PMID: 12563400 DOI: 10.1590/s0004-282x2002000600026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA) are considered rare, can cause cerebello pontine angle (CPA) syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.
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Affiliation(s)
- Juan Oscar Alarcón Adorno
- Serviço de Neurocirurgia do Hospital Municipal Dr Fernando Mauro Pires da Rocha, São Paulo, SP, Brasil
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32
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Zager EL, Shaver EG, Hurst RW, Flamm ES. Distal anterior inferior cerebellar artery aneurysms. Report of four cases. J Neurosurg 2002; 97:692-6. [PMID: 12296656 DOI: 10.3171/jns.2002.97.3.0692] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aneurysms of the distal anterior inferior cerebellar artery (AICA) are rare; fewer than 100 cases have been reported. The authors detail their experience with four cases and present endovascular as well as microsurgical management options. The medical records and neuroimaging studies obtained in four patients who were treated at a single institution were reviewed. Clinical presentations, neuroimaging and intraoperative findings, and clinical outcomes were analyzed. There were three men and one woman; their mean age was 43 years. Two patients presented with acute subarachnoid hemorrhage (SAH), and two presented with ataxia and vertigo (one with tinnitus, the other with hearing loss). Angiographic studies demonstrated aneurysms of the distal segment of the AICA. In one patient with von Hippel-Lindau syndrome and multiple cerebellar hemangioblastomas, a feeding artery aneurysm was found on a distal branch of the AICA. Three of the patients underwent successful surgical obliteration of their aneurysms, one by clipping, one by trapping, and one by resection along with the tumor. The fourth patient underwent coil embolization of the distal AICA and the aneurysm. All patients made an excellent neurological recovery. Patients with aneurysms in this location may present with typical features of an acute SAH or with symptoms referable to the cerebellopontine angle. Evaluation with computerized tomography, magnetic resonance (MR) imaging, MR angiography, and digital subtraction angiography should be performed. For lesions distal to branches coursing to the brainstem, trapping and aneurysm resection are viable options that do not require bypass. Endovascular obliteration is also a reasonable option, although the possibility of retrograde thrombosis of the AICA is a concern.
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Affiliation(s)
- Eric L Zager
- Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia 19104-6380, USA.
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33
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Bonneville F, Sarrazin JL, Marsot-Dupuch K, Iffenecker C, Cordoliani YS, Doyon D, Bonneville JF. Unusual lesions of the cerebellopontine angle: a segmental approach. Radiographics 2001; 21:419-38. [PMID: 11259705 DOI: 10.1148/radiographics.21.2.g01mr13419] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tumors of the cerebellopontine angle (CPA) are frequent; acoustic neuromas and meningiomas represent the great majority of such tumors. However, a large variety of unusual lesions can also be encountered in the CPA. The site of origin is the main factor in making a preoperative diagnosis for an unusual lesion of the CPA. In addition, it is essential to analyze attenuation at computed tomography (CT), signal intensity at magnetic resonance (MR) imaging, enhancement, shape and margins, extent, mass effect, and adjacent bone reaction. CPA masses can primarily arise from the cerebellopontine cistern and other CPA structures (arachnoid cyst, nonacoustic schwannoma, aneurysm, melanoma, miscellaneous meningeal lesions) or from embryologic remnants (epidermoid cyst, dermoid cyst, lipoma). Tumors can also invade the CPA by extension from the petrous bone or skull base (cholesterol granuloma, paraganglioma, chondromatous tumors, chordoma, endolymphatic sac tumor, pituitary adenoma, apex petrositis). Finally, CPA lesions can be secondary to an exophytic brainstem or ventricular tumor (glioma, choroid plexus papilloma, lymphoma, hemangioblastoma, ependymoma, medulloblastoma, dysembryoplastic neuroepithelial tumor). A close association between CT and MR imaging findings is very helpful in establishing the preoperative diagnosis for unusual lesions of the CPA.
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Affiliation(s)
- F Bonneville
- Department of Neuroradiology, Hôpital J. Minjoz, Boulevard Fleming, 25000 Besançon, France.
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34
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Mizushima H, Kobayashi N, Yoshiharu S, Kazuo H, Dohi K, Sasaki K, Matsumoto K. Aneurysm of the distal anterior inferior cerebellar artery at the medial branch: a case report and review of the literature. SURGICAL NEUROLOGY 1999; 52:137-42. [PMID: 10447279 DOI: 10.1016/s0090-3019(99)00042-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Distal aneurysms of the anterior inferior cerebellar artery (AICA) are rare. Most have been located at the cerebellopontine angle. Only three cases, including ours, located in the medial branch of the AICA have been reported in the literature. METHODS A 55-year-old female presented with epilepsy that she experienced for the first time. Computed tomography and magnetic resonance imaging revealed no abnormality. Digital subtraction angiography (DSA) disclosed a rare aneurysm at the medial branch of the distal anterior inferior cerebellar artery. In the blood workup on her admission, a mild inflammatory sign was found, and bacterial aneurysm was suggested as the presumptive differential diagnosis. Repeated DSA was performed 3 months after admission, but the aneurysm did not disappear. She then underwent a suboccipital craniotomy in the prone position. RESULTS The aneurysm was clipped and partially resected for the pathological examination. Histologic examination revealed a true aneurysm. She was discharged without neurological deficit. CONCLUSIONS In this report, we summarize the previous cases and discuss the location and clinical manifestations of aneurysms of the AICA through a review of the literature.
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Affiliation(s)
- H Mizushima
- Department of Neurosurgery, Shioda Hospital, Chiba, Japan
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