Department of Neurosurgery, University of Brescia, at Spedali Civili, Brescia, Italy.
World Neurosurg. 2010 Oct-Nov;74(4-5):544-6. doi: 10.1016/j.wneu.2010.03.035. Epub 2011 Jan 12.
Trigeminal neuralgia is usually caused by microvascular conflict with the fifth cranial nerve in the pontocerebellar angle. Rarely is it secondary to other extra-axial or intra-axial lesions. Few cases of trigeminal neuralgia due to cavernous angiomas have been reported in the literature. This is the first report of surgical decompression of the intra-axial trigeminal nerve tract from a deep pontine cavernous angioma.
A 45-year-old man came to our attention for frequent and intense left facial pain episodes compatible with trigeminal neuralgia in the V1 and V2 branches, poorly responsive to carbamazepine treatment. Magnetic resonance imaging revealed a left posterolateral pontine cavernous angioma. No neurovascular conflict was found.
The cavernous angioma was surgically excised. No new neurological deficit arose and the pain episodes completely disappeared.
Trigeminal neuralgia can occur occasionally secondary to the compressive effect of a pontine cavernous angioma. In this patient surgical removal of the cavernous angioma can be considered a successful and relatively safe treatment.
三叉神经痛通常由桥小脑角处第五颅神经与微血管的冲突引起。很少由其他颅外或颅内病变引起。文献中报道了少数由海绵状血管瘤引起的三叉神经痛病例。这是首例报道的从深部桥脑海绵状血管瘤行颅内三叉神经束减压的手术。
一位 45 岁男性因左侧面部频繁且剧烈的疼痛发作就诊，符合三叉神经痛 V1 和 V2 分支的表现，卡马西平治疗效果不佳。磁共振成像显示左侧桥脑后外侧海绵状血管瘤。未发现神经血管冲突。
海绵状血管瘤被手术切除。无新的神经功能缺损出现，疼痛发作完全消失。
三叉神经痛偶尔可继发于桥脑海绵状血管瘤的压迫效应。在该患者中，海绵状血管瘤的手术切除可被视为一种成功且相对安全的治疗方法。
