TY - JOUR
T1 - Right Retrosigmoid Craniotomy for Microvascular Decompression and Glioneuronal Hamartoma Resection for Trigeminal Neuralgia
T2 - 2-Dimensional Operative Video
AU - Omoba, Oluwaseun
AU - Tavakoli, Samon G.
AU - Mascitelli, Justin
N1 - Publisher Copyright:
© 2023 Oxford University Press. All rights reserved.
PY - 2023/8/24
Y1 - 2023/8/24
N2 - Trigeminal neuralgia (TN) is a disabling facial pain syndrome characterized as unilateral, sharp, and lancinating in the trigeminal distribution aggravated by touching the face and chewing. First-line treatment includes anticonvulsants, with more invasive procedures indicated with failure of conservative therapy.1,2 Classical TN is caused by neurovascular contact seen on MRI or intraoperatively. Secondary TN is caused by an identifiable lesion on MRI such a tumors, arteriovenous malformations, and multiple sclerosis. Tumors can be extrinsic or intrinsic to the trigeminal nerve. Common intrinsic trigeminal nerve tumors include schwannomas, epidermoids, and lipomas.3 TN without an identifiable cause is termed idiopathic TN. We present a case of a 50-year-old man with 1 year of facial pain in the V2/3 distribution without improvement with conservative management. MRI demonstrated a prominent vascular loop compressing the right trigeminal nerve along the dorsal root entry zone without an enhancing mass. Retrosigmoid craniotomy was offered given the failure of conservative management.4 Intraoperatively, there was noted to be an expansion of neuronalappearing tissue within the trigeminal nerve or which subtotal resection was performed. Multiple vessels were dissected from the trigeminal nerve and padded with Teflon. Postoperatively, the patient denied facial pain and endorsed stable facial sensation.5 Pathologic evaluation identified the mass as a glioneuronal hamartoma. Notably, Peris-Celda et al6 showed images of a similar case with glioneuronal hamartoma. We believe our report adds to the literature by including a high-definition surgical video not included in the previous report. The patient provided informed consent for the operation depicted in this video.
AB - Trigeminal neuralgia (TN) is a disabling facial pain syndrome characterized as unilateral, sharp, and lancinating in the trigeminal distribution aggravated by touching the face and chewing. First-line treatment includes anticonvulsants, with more invasive procedures indicated with failure of conservative therapy.1,2 Classical TN is caused by neurovascular contact seen on MRI or intraoperatively. Secondary TN is caused by an identifiable lesion on MRI such a tumors, arteriovenous malformations, and multiple sclerosis. Tumors can be extrinsic or intrinsic to the trigeminal nerve. Common intrinsic trigeminal nerve tumors include schwannomas, epidermoids, and lipomas.3 TN without an identifiable cause is termed idiopathic TN. We present a case of a 50-year-old man with 1 year of facial pain in the V2/3 distribution without improvement with conservative management. MRI demonstrated a prominent vascular loop compressing the right trigeminal nerve along the dorsal root entry zone without an enhancing mass. Retrosigmoid craniotomy was offered given the failure of conservative management.4 Intraoperatively, there was noted to be an expansion of neuronalappearing tissue within the trigeminal nerve or which subtotal resection was performed. Multiple vessels were dissected from the trigeminal nerve and padded with Teflon. Postoperatively, the patient denied facial pain and endorsed stable facial sensation.5 Pathologic evaluation identified the mass as a glioneuronal hamartoma. Notably, Peris-Celda et al6 showed images of a similar case with glioneuronal hamartoma. We believe our report adds to the literature by including a high-definition surgical video not included in the previous report. The patient provided informed consent for the operation depicted in this video.
KW - Glioneuronal
KW - Hamartoma
KW - Neuralgia
KW - Retrosigmoid
KW - Trigeminal
UR - http://www.scopus.com/inward/record.url?scp=85165222901&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85165222901&partnerID=8YFLogxK
U2 - 10.1227/ons.0000000000000751
DO - 10.1227/ons.0000000000000751
M3 - Article
C2 - 37222524
AN - SCOPUS:85165222901
SN - 2332-4252
VL - 25
SP - E106
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 2
ER -