Revuelta-Gutiérrez Rogelio, Contreras-Vázquez Oscar Rubén, Piñón-Jiménez Fernando, Martínez-Anda Jaime Jesús
Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
Surg Neurol Int. 2024 Feb 9;15:36. doi: 10.25259/SNI_925_2023. eCollection 2024.
Trigeminal neuralgia (TN) is a highly disabling facial pain syndrome, historically known as the suicide disease, in which most cases can be cured with appropriate surgical treatment.
We present the case of a 43-year-old male farmer with acute, self-limiting episodes of shock-like pain on the left side of the face that started in June of 2021. He was diagnosed with TN and was treated with carbamazepine. Magnetic resonance imaging was performed, which revealed an epidermoid cyst (EC) at the prepontine cistern with an extension to the left cerebellopontine angle. The neurosurgery department at our institution was consulted, which performed surgical tumor resection and V cranial nerve decompression. During the resection, a neurovascular conflict (NVC) was identified at the root entry zone. After the resection around the nerve and its whole tract was completed, a microvascular decompression (MVD) was performed.
TN secondary to EC in association with a NVC is a rare phenomenon, due to the growth pattern of the EC. TN may remit if an appropriate treatment is carried out. In cases of NVC, an MVD is required apart from an appropriate resection to achieve pain relief.
三叉神经痛（TN）是一种严重致残的面部疼痛综合征，历史上被称为“自杀性疾病”，大多数病例可通过适当的手术治疗治愈。
我们报告一例43岁男性农民的病例，他于2021年6月开始出现左侧面部急性、自限性的电击样疼痛发作。他被诊断为三叉神经痛，并接受了卡马西平治疗。进行了磁共振成像检查，结果显示脑桥前池有一个表皮样囊肿（EC），并延伸至左侧小脑脑桥角。我们机构的神经外科进行了会诊，实施了肿瘤切除术和第五颅神经减压术。在切除过程中，在神经根入区发现了神经血管冲突（NVC）。在完成神经及其整个走行的周围切除后，进行了微血管减压术（MVD）。
由于表皮样囊肿的生长方式，继发于表皮样囊肿并伴有神经血管冲突的三叉神经痛是一种罕见现象。如果进行适当治疗，三叉神经痛可能会缓解。在存在神经血管冲突的情况下，除了进行适当的切除外，还需要进行微血管减压术以缓解疼痛。
