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Trigeminal neuralgia induced by brainstem infarction treated with pontine descending tractotomy: illustrative case

Rachyl M. Shanker, Miri Kim, Chloe Verducci, Elhaum G. Rezaii, Kerry Steed, Atul K. Mallik, and Douglas E. Anderson

Trigeminal neuralgia (TN) most commonly presents as neuropathic pain secondary to neurovascular compression (NVC) at the nerve root entry zone (NREZ) 1 , 2 or as a result of a space-occupying lesion impacting the trigeminal nerve. 3 However, there exists a subset of patients in whom trigeminal pain is induced by brainstem ischemia, interrupting the NREZ, spinal trigeminal nucleus, or descending spinal trigeminal tract (SpTV). While cases of TN induced by a brainstem infarct have been reported, there are no clear treatment recommendations for this

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Anesthesia-induced Takotsubo cardiomyopathy in trigeminal neuralgia: illustrative case

Guido Mazzaglia, Giulio Bonomo, Emanuele Rubiu, Paolo Murabito, Alessia Amato, Paolo Ferroli, and Marco Gemma

, trigeminal neuralgia is linked with sudden pain and prolonged suffering that may provoke a physical and psychological stress response. In this paper, we present a case of TS that manifested during induction of anesthesia to perform a surgical microvascular decompression (MVD) of the left trigeminal nerve in a patient with trigeminal neuralgia. We expose the peculiar clinical picture and discuss the possible underlying pathophysiological mechanisms. Illustrative Case We present a case of a 50-year-old female patient scheduled for an MVD who presented immediately

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Simultaneous microvascular decompression for trigeminal neuralgia and hemifacial spasm involving a dolichoectatic vertebral artery in an elderly patient: illustrative case

Neelan J. Marianayagam, Hanya M. Qureshi, Sagar Vasandani, Shaurey Vetsa, Muhammad Jalal, Kun Wu, and Jennifer Moliterno

Trigeminal neuralgia (TN) and hemifacial spasm (HFS) refractory to medical management can commonly be the result of direct contact by an aberrant vessel compressing the root entry zone (REZ) of the trigeminal and facial nerves, respectively. Microvascular decompression (MVD) has been shown to provide lasting relief. 1 In TN, the offending vessel is usually the superior cerebellar artery, whereas in HFS, it is usually the anterior inferior cerebellar artery. There are instances, however, in which an enlarged or dolichoectatic vertebral artery (DVA) can be the

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Middle meningeal artery pseudoaneurysm and pterygoid plexus fistula following percutaneous radiofrequency rhizotomy: illustrative case

Rahim Ismail, Derrek Schartz, Timothy Hoang, and Alexander Kessler

The percutaneous approach to the trigeminal nerve via the foramen ovale originated in the early 20th century from Taptas and Hartel in 1911 and 1913, 1 respectively, with electrocoagulation developed by Rethi in 1913. 2 Over the subsequent century, much advancement in the percutaneous techniques has occurred including chemodenervation, radiofrequency ablation, cryoablation, nerve blocks, Botox injections, nerve stimulation, and balloon decompression. 2 Percutaneous treatment for trigeminal neuralgia is generally considered a well-tolerated procedure, with

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Microvascular decompression for developmental venous anomaly causing hemifacial spasm: illustrative case

Margaret Tugend and Raymond F Sekula Jr.

DVA or a decrease in outflow from the DVA. Symptoms from flow-related causes include headache, neurological deficit, seizures, and coma secondary to hemorrhage or infarction. Mechanical causes include obstructive hydrocephalus and nerve compression, causing trigeminal neuralgia and HFS. Cases with symptoms attributed to DVA, such as headache, but with no identifiable patho-mechanism, are classified as idiopathic. 5 Here, we present an example of mechanical compression of the facial nerve by a pontine DVA ostensibly causing HFS. Although the patient ultimately had a

Open access

Microvascular decompression of a vertebral artery loop causing cervical radiculopathy: illustrative case

Alexa Semonche, Lorenzo Rinaldo, Young Lee, Todd Dubnicoff, Harlan Matles, Dean Chou, Adib Abla, and Edward F Chang

adapted techniques specific to MVD for trigeminal neuralgia, including Teflon felt and sling transposition. 15–17 Rare cases of vertebral artery transection with end-to-end anastomosis or sacrifice have also been described. 18 , 19 Illustrative Case A 49-year-old man presented with a decades-long history of left-sided neck pain and migraines, which had acutely worsened over the past few years. The pain was exacerbated by neck extension and head turn to the contralateral side. On physical examination, the patient had full strength in all extremities with a