Trigeminal neuralgia caused by compression from arteries transfixing the nerve

Abstract

The authors present three patients with trigeminal neuralgia due to compression by an artery that transfixed the sensory root of the fifth cranial nerve. These cases represented 0.8% of 384 patients with trigeminal neuralgia treated by microvascular decompression at the authors' clinic during the past 12 years. In the remaining 381 cases, the compressing vessels were successfully removed from the trigeminal nerve without much difficulty, for an initial cure rate of 94.3%. In the three cases reported, however, the compressing artery penetrating the nerve could not easily be maneuvered away from the nerve. In the first two cases, partial rhizotomy perpendicular to the axis of the nerve at the site of arterial transfixion made it possible to separate the artery from the nerve. However, these two patients developed postoperative facial sensory impairment. In the third case, rhizotomy was performed longitudinal to the axis of the nerve at the site of arterial transfixion, making it possible to reposition the artery peripherally beyond the root entry zone of the nerve without causing any postoperative sensory deficits of the face. No recurrent pain has developed in more than 2 1/2 years since surgery in any of these three cases. When performing microvascular decompression surgery on patients in whom the compressing artery penetrates the nerve, the technique used in our third patient is the procedure of choice.

Arteriovenous Malformation Surrounding the Trigeminal Nerve-Case Report-

“…This is probably why the patient did not complain of previous symptoms. 8,20) In a recent very similar case to ours, the reason for the missing trigeminal neuralgia was possibly the aberrant formation in the sprouting meshwork of primordial vessels in the trigeminal root during embryogenesis (weeks 5 to 6 of gestation). 11) As an alternative treatment modality, radiosurgery was primarily offered to our patient, who nevertheless preferred surgical therapy.…”

Anatomical Observations During Microvascular Decompression for Idiopathic Trigeminal Neuralgia (with Correlations Between Topography of Pain and Site of the Neurovascular Conflict). Prospective Study in a Series of 579 Patients

“…An o¤ending vessel at this point seems to be the most logic etiological mechanism responsible for trigeminal neuralgia [14]. Even more so, mindful of Kondo's Japanese group [43,71], if nerve compression by a blood vessel occurs at a site remote from the entry zone, no symptoms develop.…”

“…Various degrees of severity of the NVC have been noticed by several authors [8,53,65], qualified from mere contact with the nerve, to marked distortion or even severe indentation of the root. Besides, some authors reported a form of vascular conflict where the conflicting vessel whether artery [22,71] or vein [17] transfixed the sensory root of the nerve. We have quantified degrees: from I to III, and in a study in progress, we have correlated outcome with the degree of severity (manuscript in preparation).…”

Trigeminal neuralgia and other neuropathic pain syndromes of the head and face

“…Microvascular decompression is the only surgical modality that directly addresses the presumed etiology of TN [1,10,11,[48][49][50][51][52] and provides the longest lasting pain relief. It is a major surgical procedure, with a reported mortality rate of 1% and associated morbidity rate consisting of 1% hearing loss [53•], 1% to 2% rate of cerebrospinal fluid leakage [54], and uncommon transient or permanent cranial nerve deficits [3,55,56].…”