Dzhafarov Vidzhai, Rzaev Jamil, Moysak Galina, Voronina Eugenia
Department of Functional Neurosurgery, Federal Center of Neurosurgery, Nemirovich-Danchenko 132/1.
Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Pirogova.
Surg Neurol Int. 2020 Jul 4;11:173. doi: 10.25259/SNI_546_2019. eCollection 2020.
Facial pain resembling trigeminal neuralgia is not a common clinical feature of cervical spinal cord tumor. Depending on nature of the facial pain, differential diagnosis tends to include neurovascular conflict, multiple sclerosis, cerebellopontine angle tumors, herpes zoster, facial injuries, and other conditions involving trigeminal nerve, ganglion, and root. Here, we present a unique case of pain in trigeminal distribution due to an intramedullary tumor in the upper cervical spinal cord.
A 27-year-old male was admitted with complaints of intense facial pain on the right side lasting for several years. MRI revealed an intramedullary lesion at the C1 level and no signs of a neurovascular conflict or a demyelination. This lesion was removed microsurgically, with the subtotal resection immediately abolishing the pain and causing no additional neurological deficit. Histological analysis revealed ganglioglioma, Grade 1. After 5-day hospital stay, the patient was discharged home; 2-year follow-up showed no tumor recurrence on MRI and persistent relief of facial pain.
Secondary trigeminal neuralgia may be explained by a pathological process in vicinity of the spinal trigeminal nuclei. Removing the tumor may be expected to provide complete and lasting pain relief.
类似三叉神经痛的面部疼痛并非颈髓肿瘤常见的临床特征。根据面部疼痛的性质，鉴别诊断往往包括神经血管冲突、多发性硬化症、桥小脑角肿瘤、带状疱疹、面部损伤以及其他涉及三叉神经、神经节和神经根的病症。在此，我们报告一例因上颈髓髓内肿瘤导致三叉神经分布区疼痛的独特病例。
一名27岁男性因右侧剧烈面部疼痛数年入院。磁共振成像（MRI）显示C1水平存在髓内病变，未发现神经血管冲突或脱髓鞘迹象。该病变经显微手术切除，次全切除后疼痛立即消失，且未造成额外的神经功能缺损。组织学分析显示为1级节细胞胶质瘤。住院5天后，患者出院；2年随访显示MRI未见肿瘤复发，面部疼痛持续缓解。
继发性三叉神经痛可能由三叉神经脊束核附近的病理过程所致。切除肿瘤有望实现完全且持久的疼痛缓解。
