Department of Neurosurgery, NTT Medical Center Tokyo.
Neurol Med Chir (Tokyo). 2022 Feb 15;62(2):105-109. doi: 10.2176/nmc.tn.2021-0154. Epub 2021 Nov 3.
Trigeminal neuralgia (TN) is often caused by various vein forms. Herein, we report two cases of vein-related TN. In the first case, the vein of the cerebellopontine fissure (VCPF), along with the thickened surrounding arachnoid, clung to the trigeminal nerve. As the perfusion range of this vein was expected to be wide and its injury might cause extensive venous infarction, the anchor between the trigeminal nerve and the vein was carefully dissected and the vein was successfully transposed. In the second case, the involvement of the vein of the middle cerebellar peduncle (VMCP), which penetrates the nerve bundle of the trigeminal nerve, was suspected. Because vein transposition was impossible, the vein was transected at the nerve penetration site after confirming that there was sufficient collateral venous outflow. The superior petrosal vein and its tributaries are the primary causative veins of vein-related TN, and their contact patterns are infinite. Moreover, their perfusion range and the presence or absence of collateral venous outflow vary from case to case. Therefore, it is necessary to judge the perfusion range as well as collateral venous outflow based on preoperative images and intraoperative findings and to determine the appropriate treatment method for each case.
三叉神经痛（TN）常由各种静脉形式引起。在此，我们报告两例与静脉相关的 TN。在第一个病例中，桥小脑裂静脉（VCPF）与增厚的周围蛛网膜一起附着在三叉神经根上。由于这条静脉的灌注范围预计很广，其损伤可能导致广泛的静脉梗死，因此仔细解剖了三叉神经根和静脉之间的连接点，并成功地将静脉移位。在第二个病例中，怀疑中脑小脑脚静脉（VMCP）受累，该静脉穿过三叉神经神经束。由于无法进行静脉移位，在确认有足够的侧支静脉流出后，在神经穿透部位切断了静脉。岩上窦及其属支是与静脉相关的 TN 的主要致病静脉，其接触模式是无限的。此外，它们的灌注范围和侧支静脉流出的存在与否因病例而异。因此，有必要根据术前图像和术中发现来判断灌注范围和侧支静脉流出情况，并为每个病例确定合适的治疗方法。
