Surgical Treatment of Trigeminal Neuralgia：Rare Trigeminal Neuralgia

Abstract

　The purpose of this article is to report the characteristics and treatment of a special type of trigeminal neuralgia that is difficult to diagnose.
　The purpose of this report is to describe the characteristics and treatment of trigeminal neuralgia.
　1. Trigeminal neuralgia due to vertebra-basilar artery vertebrobasilar ectasia.
　2. Trigeminal neuralgia due to venous compression alone.
　3. Trigeminal neuralgia due to arachnoid thickening.
　4. Trigeminal neuralgia caused by compression of the trigeminal nerve by multiple blood vessels.
　5. Trigeminal neuralgia of young onset (age 15) .
　6. Trigeminal neuralgia caused by trigeminocerebellar artery (TCA) . The TCA, a malformation of the superior cerebellar artery, compresses the REZ of the trigeminal nerve as it penetrates the nerve.
　7. Trigeminal neuralgia caused by cerebral arteriovenous malformation. Cerebral arteriovenous malformation compresses the REZ of the trigeminal nerve; AVMs may be small lesions and may be missed in the preoperative diagnosis. Cerebral arteriovenous malformations can be treated with MVD without removal of the lesion, which may result in pain relief.
　8. Trigeminal neuralgia due to venous hemangioma. The outflowing vein of a venous hemangioma may directly contact the trigeminal nerve, or the outflowing vein may dilate and the pyramidal vein may compress the trigeminal nerve, or the superior cerebellar artery and anterior inferior cerebellar artery may simultaneously compress the trigeminal nerve. Treatment includes coagulation and disconnection of the outflow vein, or coagulation and reduction of the outflow vein and MVD.
　9. Trigeminal neuralgia due to supratentorial tubercle.
　10. Trigeminal neuralgia due to brain tumor. The main tumors associated with trigeminal neuralgia symptoms are epithelioma, vestibular schwannoma, and meningioma, each of which has a different surgical approach. Some tumors cause further compression of the trigeminal nerve REZ by the superior cerebellar artery in addition to tumor compression. Trigeminal neuralgia caused by pyriform plateau meningioma should be treated with MVD at an early stage, because even if the tumor is small, the pathology of compression of the superior cerebellar artery and compression of the trigeminal nerve REZ should be recognized.
　11. Postoperative recurrence due to interposition material, transverse pontine. V. Even if paroxysmal pain of trigeminal neuralgia disappears after reoperation, neuropathic pain, which is persistent pain, is likely to remain.
　12. Trigeminal neuralgia after gamma knife therapy. paroxysmal pain of trigeminal neuralgia after MVD may disappear, but persistent neuropathic pain is likely to remain.
　13. Some SUNCT syndromes can be cured by microvascular decompression.
　In cases with typical symptoms of trigeminal neuralgia, trigeminal neuralgia due to rare causes, such as the one presented here, should be taken into consideration.