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Unusual recurrence of trigeminal neuralgia after microvascular decompression by muscle interposal.

Grasso G, Meli F, Maugeri R, Certo F, Costantino G, Giambartino F, Iacopino DG - Med. Sci. Monit. (2011)

Bottom Line: The fifth cranial nerve was carefully separated from the muscle.Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura.Our findings, along with similar cases reported in the literature, support the development of new inert materials and alternative surgical strategies that can limit TN recurrence.

View Article: PubMed Central - PubMed

Affiliation: Neurosurgical Clinic, Department of Clinic Neurosciences, University of Palermo, Palermo, Italy. ggrasso@unipa.it

ABSTRACT

Background: Patients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression (MVD) typically undergo less invasive procedures in the hope of providing pain relief. However, re-operation should be considered in selected patients.

Case report: A 48-year-old woman presented with recurrent trigeminal neuralgia (TN) 3 years following microvascular decompression (MVD). The patient underwent brain magnetic resonance angiography (MRA), which did not reveal neurovascular compression; therefore surgical re-exploration was carried out. During the operation, the fifth cranial nerve was seen without impingement from any blood vessels; however, a very firm tissue was observed and identified as the muscle fragment from the previous MVD procedure. The fifth cranial nerve was carefully separated from the muscle. Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura.

Conclusions: Our findings, along with similar cases reported in the literature, support the development of new inert materials and alternative surgical strategies that can limit TN recurrence.

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Related in: MedlinePlus

Intraoperative photograph at re-operation. (A) The image showing the right trigeminal nerve (asterisk) compressed by a firm tissue (arrow) that was identified as the muscle fragment from the previous MVD procedure. Such a tissue, was distorting and stretching the nerve and, at the same time, encasing the right SCA; (B) After careful partial dissection the right SCA was visualized (arrow).
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f1-medscimonit-17-4-cs43: Intraoperative photograph at re-operation. (A) The image showing the right trigeminal nerve (asterisk) compressed by a firm tissue (arrow) that was identified as the muscle fragment from the previous MVD procedure. Such a tissue, was distorting and stretching the nerve and, at the same time, encasing the right SCA; (B) After careful partial dissection the right SCA was visualized (arrow).

Mentions: During the operation, the fifth cranial nerve was seen without impingement from any blood vessels. However, inferiorly to the nerve and directly against it, a solid tissue was observed that was identified as the muscle fragment from the previous MVD procedure. This tissue was distorting and stretching the nerve and encasing the right SCA (Figure 1). The fifth cranial nerve was carefully separated from the muscle. Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura.


Unusual recurrence of trigeminal neuralgia after microvascular decompression by muscle interposal.

Grasso G, Meli F, Maugeri R, Certo F, Costantino G, Giambartino F, Iacopino DG - Med. Sci. Monit. (2011)

Intraoperative photograph at re-operation. (A) The image showing the right trigeminal nerve (asterisk) compressed by a firm tissue (arrow) that was identified as the muscle fragment from the previous MVD procedure. Such a tissue, was distorting and stretching the nerve and, at the same time, encasing the right SCA; (B) After careful partial dissection the right SCA was visualized (arrow).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539511&req=5

f1-medscimonit-17-4-cs43: Intraoperative photograph at re-operation. (A) The image showing the right trigeminal nerve (asterisk) compressed by a firm tissue (arrow) that was identified as the muscle fragment from the previous MVD procedure. Such a tissue, was distorting and stretching the nerve and, at the same time, encasing the right SCA; (B) After careful partial dissection the right SCA was visualized (arrow).
Mentions: During the operation, the fifth cranial nerve was seen without impingement from any blood vessels. However, inferiorly to the nerve and directly against it, a solid tissue was observed that was identified as the muscle fragment from the previous MVD procedure. This tissue was distorting and stretching the nerve and encasing the right SCA (Figure 1). The fifth cranial nerve was carefully separated from the muscle. Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura.

Bottom Line: The fifth cranial nerve was carefully separated from the muscle.Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura.Our findings, along with similar cases reported in the literature, support the development of new inert materials and alternative surgical strategies that can limit TN recurrence.

View Article: PubMed Central - PubMed

Affiliation: Neurosurgical Clinic, Department of Clinic Neurosciences, University of Palermo, Palermo, Italy. ggrasso@unipa.it

ABSTRACT

Background: Patients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression (MVD) typically undergo less invasive procedures in the hope of providing pain relief. However, re-operation should be considered in selected patients.

Case report: A 48-year-old woman presented with recurrent trigeminal neuralgia (TN) 3 years following microvascular decompression (MVD). The patient underwent brain magnetic resonance angiography (MRA), which did not reveal neurovascular compression; therefore surgical re-exploration was carried out. During the operation, the fifth cranial nerve was seen without impingement from any blood vessels; however, a very firm tissue was observed and identified as the muscle fragment from the previous MVD procedure. The fifth cranial nerve was carefully separated from the muscle. Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura.

Conclusions: Our findings, along with similar cases reported in the literature, support the development of new inert materials and alternative surgical strategies that can limit TN recurrence.

Show MeSH
Related in: MedlinePlus