Moosa Shayan, Wang Tony R, Mastorakos Panagiotis, Sheehan Jason P, Elias W Jeffrey
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA,
Stereotact Funct Neurosurg. 2019;97(3):202-206. doi: 10.1159/000501624. Epub 2019 Sep 5.
Trigeminal neuralgia (TN) is a rare and debilitating craniofacial pain syndrome often caused by vascular compression of the trigeminal nerve. Gamma Knife radiosurgery (GKRS) has been shown to offer a less invasive yet effective treatment method for pain reduction in TN. In this case report, we observed radiological evidence of resolved neurovascular compression after 11 years for a patient with recur-rent TN and prior GKRS.
A 72-year-old -female presented with TN and radiological evidence of neurovas-cular compression on the affected side. She had complete resolution of her pain for 7 years after treatment with GKRS. The patient experienced recurrence and underwent repeat GKRS, this time resulting in another 3 years of pain relief. After the second recurrence, repeat intracranial imaging demonstrated resolution of neurovascular compression.
GKRS is an important treatment option for TN, although the mechanisms behind pain relief from this procedure still remain unclear. While prior histological and radiological studies point to ablative mechanisms for pain relief, this case report suggests that GKRS may result in a decompressive effect in TN due to changes in neurovascular architecture. Despite this finding, TN is known to occur and recur in the absence of neurovascular compression; thus, further work is necessary to understand the etiology of TN and its treatments.
In this case, we demonstrate that vessel-nerve relationships may change over time in TN patients treated with GKRS, which raises the possibility that GKRS could ease a neurovascular compression.
三叉神经痛（TN）是一种罕见且使人衰弱的颅面疼痛综合征，常由三叉神经的血管压迫引起。伽玛刀放射外科手术（GKRS）已被证明为TN患者减轻疼痛提供了一种侵入性较小但有效的治疗方法。在本病例报告中，我们观察到一名复发性TN且曾接受过GKRS治疗的患者在11年后神经血管压迫解除的影像学证据。
一名72岁女性因TN就诊，影像学显示患侧存在神经血管压迫。她在接受GKRS治疗后疼痛完全缓解了7年。患者复发后接受了再次GKRS治疗，此次又缓解了3年疼痛。第二次复发后，重复颅内成像显示神经血管压迫解除。
GKRS是TN的一种重要治疗选择，尽管该手术缓解疼痛的机制仍不清楚。虽然先前的组织学和影像学研究指出疼痛缓解的机制是消融性的，但本病例报告表明，由于神经血管结构的改变，GKRS可能对TN产生减压作用。尽管有这一发现，但已知TN在没有神经血管压迫的情况下也会发生和复发；因此，有必要进一步开展工作以了解TN的病因及其治疗方法。
在本病例中，我们证明了接受GKRS治疗的TN患者的血管与神经关系可能随时间发生变化，这增加了GKRS能够缓解神经血管压迫的可能性。
