Papanastassiou Alexander M, Schwartz Richard B, Friedlander Robert M
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Neurosurgery. 2008 Sep;63(3):E614-5; discussion E615. doi: 10.1227/01.NEU.0000324726.93370.5C.
Trigeminal neuralgia (TN) is usually associated with vascular compression of the trigeminal nerve, but some cases are associated with central lesions such as tumors, aneurysms, or arteriovenous malformations. In this article, we report the 19th case of TN associated with Chiari I malformation and review clinical outcomes and pathophysiology.
A 63-year-old right-handed man initially presented in 1993 with left-sided lancinating facial pain in the V2 distribution of the trigeminal nerve; the pain was triggered by certain movements, tactile stimulation, or a hot shower. Magnetic resonance imaging revealed a Chiari I malformation associated with a syrinx from C1 to C3.
The patient underwent uncomplicated suboccipital craniectomy, C1 laminectomy, and duraplasty for Chiari decompression. Postoperatively, his pain resolved over a period of 1 year.
Chiari I malformation has been found to be associated with TN in 19 cases in the English-language literature. In patients refractory to medical treatment, suboccipital decompression leads to resolution of pain in about two-thirds of patients. Potential mechanisms for the pathogenesis of TN in the setting of Chiari I malformation are discussed. Chiari I malformation is important to consider as a rare cause of TN that responds to surgical therapy.
三叉神经痛（TN）通常与三叉神经的血管压迫有关，但有些病例与中枢性病变如肿瘤、动脉瘤或动静脉畸形有关。在本文中，我们报告第19例与Chiari I畸形相关的三叉神经痛病例，并回顾临床结果和病理生理学。
一名63岁右利手男性于1993年首次就诊，表现为左侧三叉神经V2分布区的刺痛性面部疼痛；疼痛由特定动作、触觉刺激或热水淋浴引发。磁共振成像显示Chiari I畸形伴C1至C3节段的脊髓空洞症。
患者接受了简单的枕下颅骨切除术、C1椎板切除术及硬脑膜成形术以进行Chiari减压。术后，其疼痛在1年内缓解。
在英文文献中，已发现19例Chiari I畸形与三叉神经痛相关。对于药物治疗无效的患者，枕下减压可使约三分之二的患者疼痛缓解。文中讨论了Chiari I畸形背景下三叉神经痛发病机制的潜在机制。Chiari I畸形作为三叉神经痛的一种罕见病因且对手术治疗有反应，是需要考虑的重要因素。
