Primary brain stem tethering: a rare cause of geniculate neuralgia

Abstract

This rare case of brain stem tethering presented with chronic and progressive geniculate neuralgia. In view of the fact that an occipital subcutaneous lipoma had been resected in childhood, it probably concerned a primary tethering, fitting in with an occult occipital dysraphism.Magnetic resonance imaging (MRI) clearly demonstrated an underlying tethering, causing a distortion of the brain stem. Consequently, this led to the hypothesis that the geniculate neuralgia could be explained by traction on the lower cranial nerves secondary to the brain stem displacement. Untethering resulted in a considerable decrease of the neuralgia.MRI proved to be essential in the diagnosis and treatment of this unusual case.

A pain in the ear: Two case reports of nervus intermedius neuralgia and narrative review

“…Note that the included cases are diagnosed as NIN, but this diagnosis may not have been confirmed and may not have even formally met ICHD‐3 criteria. As a result of this review, 61 papers were reviewed in full for inclusion, from which data on 127 cases were compiled from 33 publications, 2,6,8–38 with 30 of these publications discussing treatments 6,8–13,15–37,39 …”

“…The most common effective treatments reported in the literature were surgical procedures, 6,[8][9][10][11][12][13]15,16,18,[20][21][22]24,27,28,[30][31][32][33][34][35][36] including microvascular decompression, nerve sectioning, rhizotomy, and tractotomy. None of the surgical cases reported a poor response, although some did report requiring two to three procedures for a good response.…”

“…Given the preponderance of surgical reports, focused information on medical treatment was vague and often limited. [8][9][10]13,[15][16][17][19][20][21][22][23][24][25][26][27]29,30,32,33,[35][36][37]…”

“…A summary of the patient and clinical characteristics of the 127 NIN cases reviewed is shown in Table 1 2,6,8–38 . Cases were reported in all age groups (range 1–89 years, n = 102), with the mean age of occurrence being 45 years.…”

“…None of the surgical cases reported a poor response, although some did report requiring two to three procedures for a good response. Given the preponderance of surgical reports, focused information on medical treatment was vague and often limited 8–10,13,15–17,19–27,29,30,32,33,35–37 . Carbamazepine was the most commonly reported medication, with 18/30 responding and 12/30 having incomplete or no response.…”