The Tethered Effect of Vestibular Schwannoma Tumor Shrinkage Following Stereotactic Radiosurgery in Secondary Trigeminal Neuralgia
| Autor: | Iwao Yamakami, Maidinamu Yakufujiang, Yoshinori Higuchi, Takayuki Motoshima, Toru Serizawa, Osamu Nagano, Yasuo Iwadate, Masaki Izumi, Kentaro Horiguchi, Kyoko Aoyagi |
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| Rok vydání: | 2019 |
| Předmět: |
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medicine.medical_specialty Nerve root medicine.medical_treatment Schwannoma Radiosurgery 03 medical and health sciences 0302 clinical medicine Trigeminal neuralgia medicine Tumor Expansion Humans Trigeminal Nerve Aged Trigeminal nerve Dysesthesia business.industry Neuroma Acoustic Middle Aged Trigeminal Neuralgia medicine.disease Magnetic Resonance Imaging nervous system diseases body regions Treatment Outcome 030220 oncology & carcinogenesis Neuralgia Female Surgery Neurology (clinical) Radiology medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 123:136-141 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2018.12.002 |
| Popis: | Background Compression of the trigeminal nerve by vessels and tumors causes trigeminal neuralgia. However, a tethering effect, provoking an abnormal root-stretching force, has been previously reported to play a role in trigeminal nerve hyperexcitability. We report 2 patients with vestibular schwannomas treated by stereotactic radiosurgery (SRS) who presented with typical manifestations of trigeminal neuralgia after tumor shrinkage. Furthermore, we discuss the mechanisms of trigeminal neuralgia. Case Description Two patients without a history of trigeminal dysfunction, including trigeminal neuralgia, underwent SRS for vestibular schwannomas. Both patients demonstrated tumor shrinkage after transient tumor expansion following SRS. Neither patient presented with facial pain or dysesthesia at the time of peak tumor volume. However, trigeminal neuralgia occurred after tumor shrinkage. One patient underwent surgery, as the neuralgia was refractory to medical treatment; although the trigeminal nerve was adhered and tethered to the tumor, no neurovascular conflict was identified between the tumor and the nerve. We removed the tumor partially, dissecting between the nerve and the tumor, and relieved the tethered effect. Trigeminal neuralgia was relieved without medication after surgery. Conclusions The present cases demonstrate a tethered effect of tumor shrinkage after SRS, which was considered to play a role in trigeminal neuralgia. Surgical dissection surrounding the nerve root is effective for medically resistant neuralgia, even if the tumor shrinks. Partial tumor removal is adequate in such cases, as the tumor has been controlled by radiosurgery. |
| Databáze: | OpenAIRE |
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