Morikawa Masayuki, Tokimura Hiroshi, Hosoyama Hiroshi, Yamanaka Sae, Inoue Eri, Sato Masanori, Ishigami Takashi, Niiro Tadaaki, Nishimuta Yosuke, Hanaya Ryosuke
Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan.
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan.
NMC Case Rep J. 2024 Oct 24;11:285-290. doi: 10.2176/jns-nmc.2024-0143. eCollection 2024.
Trigeminal neuralgia (TN) associated with a primitive trigeminal artery variant (PTAV) is a rare condition that causes severe facial pain. We report the case of an 81-year-old woman presenting with right facial pain. Brain magnetic resonance imaging revealed an aberrant artery originating from the cavernous portion of the right internal carotid artery (ICA), coursing laterally around the posterior clinoid process and running toward the anterior inferior cerebellar artery (AICA) territory, suggesting a PTAV. Although the pain subsided with carbamazepine, liver dysfunction developed; microvascular decompression was performed. Transposition of the PTAV in a lateral direction revealed a marked indentation at the root of the right trigeminal nerve. The PTAV was surgically transposed laterally and fixed to the pyramidal bone surface using a Teflon sling, whereas the proximal part was fixed downward to the brainstem. There was immediate facial pain relief, following surgery. We reviewed 27 cases of TN associated with PTA or PTAV reported in the literature, which showed that the average age of onset was similar to our case, at 56.5 years, with a male-to-female ratio of 1:2.85. The proportion of patients with PTAV with V2 region affected was highest (91.3%), with PTAV (AICA) being the most common aberrant blood vessel (40.7%). In cases of TN associated with PTA or PTAV, it is crucial to identify blood vessels that are compressing or contacting the nerve and transpose these arteries from the nerve. It is also critical to plan movement direction in order to prevent ischemia of perforators to the brainstem or internal auditory artery.
与原始三叉动脉变异（PTAV）相关的三叉神经痛（TN）是一种导致严重面部疼痛的罕见病症。我们报告了一例81岁女性出现右侧面部疼痛的病例。脑部磁共振成像显示一条异常动脉起源于右侧颈内动脉（ICA）海绵窦段，向外侧绕过后床突并朝向前下小脑动脉（AICA）区域走行，提示为PTAV。尽管疼痛通过卡马西平缓解，但出现了肝功能障碍；遂进行了微血管减压术。将PTAV向外侧移位时发现右侧三叉神经根处有明显压痕。PTAV通过手术向外侧移位，并用特氟龙吊带固定于锥骨表面，而近端部分向下固定于脑干。术后面部疼痛立即缓解。我们回顾了文献中报道的27例与PTA或PTAV相关的TN病例，结果显示平均发病年龄与我们的病例相似，为56.5岁，男女比例为1:2.85。V2区域受累的PTAV患者比例最高（91.3%），PTAV（AICA）是最常见的异常血管（40.7%）。在与PTA或PTAV相关的TN病例中，识别压迫或接触神经的血管并将这些动脉从神经上移位至关重要。规划移位方向以防止脑干或内听动脉穿支缺血也很关键。
