Impressão basilar como causa de neuralgia do trigêmeo: registro de um caso

Abstract

A case of basilar impression associated with Arnold-Chiari malformation and with trigeminal neuralgia is reported. The radiological examination of the skull showed marked asymmetry of the petrous bone with the tip of the odontoid apophysis located 30 mm above the McGregor line. Treatment consisted of craiectomy of the posterior fossa and cervical laminetomy (C1 to C3). The postoperative course was uneventful with total disappearance of the trigeminal neuralgia.

Trigeminal neuralgia secondary to basilar impression: A case report

“…This may cause narrowing of the posterior fossa and may compress its contents, like neurovascular structures, resulting in many kinds of neurological symptoms. [ 3 6 ]…”

“…[ 2 4 5 8 9 ] Sensory symptoms of the trigeminal nerve were reported in 30-50% of patients with basilar impression[ 2 ] but incidence of TN was less than 1% in 200 reported cases of basilar impression and other occipitocervical malformations in the cases of Obrador et al .,[ 5 ] and 0.7% in 139 cases of basilar impression operated on the da Silva and Silvas casuistry. [ 3 9 ] The same author reported a 46-year-old man with a history of TN associated with skull base deformity, and attributed the TN was secondary to asymmetry of the petrous bone. [ 3 ] There is also a single report of TN and ipsilateral hemifacial spasm secondary to Chiari's I malformation with hydrocephalus.…”

“…[ 3 9 ] The same author reported a 46-year-old man with a history of TN associated with skull base deformity, and attributed the TN was secondary to asymmetry of the petrous bone. [ 3 ] There is also a single report of TN and ipsilateral hemifacial spasm secondary to Chiari's I malformation with hydrocephalus. [ 10 ]…”

“…[ 1 ] In spite of being the most common cause, some data demonstrated that craniocervical abnormalities, like basilar impression and platybasia, affect the bony walls of the posterior fossa, and even Chiari malformation may play an important role in the pathogenesis of vascular abnormalities causing TN. [ 2 3 4 5 ] Our research, which was carried out from 1995 to 2014, presents 60 cases of basilar impression, enabling us to observe only one case (1,7%) with TN. The deformity of the skull base was the noteworthy aspect that influenced the development of the trigeminal neuralgia resulting in the publication of the present case.…”