Samadian Mohammad, Bakhtevari Mehrdad Hosseinzadeh, Nosari Masood Asghari, Babadi Armin Jahangiri, Razaei Omidvar
Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
World Neurosurg. 2015 Sep;84(3):860-4. doi: 10.1016/j.wneu.2015.04.063. Epub 2015 May 9.
Trigeminal neuralgia typically occurs in the middle-aged to elderly population, is believed to be related to abnormal conduction within the trigeminal nerve, and is possibly is attributable to changes in myelin induced by pulsatile mechanical trauma from an adjacent vessel. At the point just before it enters the brainstem, there is a short segment at which nerve axons are still ensheathed in central myelin (produced by oligodendrocytes), but after a few millimeters, there is a transition to peripheral myelin (produced by Schwann cells). The region of this transition is called the Obersteiner-Redlich zone. It is thought that the area of the nerve containing the central form of myelin is especially susceptible to pathologic changes from vascular contact that result in demyelination and altered conduction. When associated with a venous angioma at the root entry zone, trigeminal neuralgia usually presents at a younger age.
We report a 34-year-old man with a complaint of left hemifacial stabbing pain in maxillomandibular area that was triggered by chewing and speaking. On examination, no neurologic deficit was detected. The pain was not relieved significantly, even with the administration of carbamazepine. Magnetic resonance imaging demonstrated venous angioma in the left cerebello-pontine region.
Microvascular decompression was performed uneventfully. The patient's pain was completely relieved without neurologic deficits.
It seems that the trigeminal neuralgia caused by venous angioma may occur in the younger population. In most cases, the vessel that caused compression can be identified with magnetic resonance imaging without the need for intensive conventional angiography.
三叉神经痛通常发生于中老年人，被认为与三叉神经内的异常传导有关，可能归因于相邻血管搏动性机械创伤引起的髓鞘变化。在三叉神经进入脑干之前的部位，有一小段神经轴突仍被中枢髓鞘（由少突胶质细胞产生）包裹，但几毫米后，会过渡到外周髓鞘（由施万细胞产生）。这个过渡区域称为奥伯施泰纳 - 雷德利希区。据认为，含有中枢形式髓鞘的神经区域特别容易受到血管接触导致的病理变化影响，从而导致脱髓鞘和传导改变。当与神经根入区的静脉血管瘤相关时，三叉神经痛通常在较年轻的年龄出现。
我们报告一名34岁男性，主诉咀嚼和说话时左侧上颌下颌区域出现半侧面部刺痛。检查时未发现神经功能缺损。即使服用卡马西平，疼痛也未明显缓解。磁共振成像显示左侧小脑脑桥区域有静脉血管瘤。
微血管减压手术顺利进行。患者的疼痛完全缓解，无神经功能缺损。
由静脉血管瘤引起的三叉神经痛似乎可能发生在较年轻人群中。在大多数情况下，通过磁共振成像可以识别出造成压迫的血管，无需进行强化的传统血管造影。
