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Tiril Sandell, Jostein Holmen and Per Kristian Eide

. Compression of this center might yield a heightened sympathetic tone, leading to AH. 2 , 7 , 12 , 25 , 29 , 35 Jannetta et al. 17–19 demonstrated that microvascular decompression (MVD) of the RVLM could normalize or improve a raised blood pressure. Because the RVLM is close to the origin of the facial nerve, vessel loops originating from the vertebral/basilar arteries might be responsible for multiple neurovascular compressions (NCs), inducing both hemifacial spasms (HFSs) and AH. The aim of this work was to further explore the hypothesis that vascular compression of

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Matthew S. Willsey, Kelly L. Collins, Erin C. Conrad, Heather A. Chubb and Parag G. Patil

, episodic, severe pain), TN type 2 (TN2) (> 50% constant pain), neuropathic (due to injury), deafferentation, symptomatic (secondary to multiple sclerosis), postherpetic, and atypical. 2 Large cross-sectional studies of patients with trigeminal pain support the existence of at least 2 subtypes of the disease (TN1 and TN2) based on the absence (TN1) or presence (TN2) of concomitant persistent pain. 28 , 29 TN1 is associated with neurovascular compression at the trigeminal root entry zone (REZ). 15 , 34 Histopathological studies demonstrate focal demyelination in TN

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Lawrence D. Dickinson, Stephen M. Papadopoulos and Julian T. Hoff

following surgery. 16 However, in a postmortem study, Naraghi, et al. , 21 demonstrated neurovascular compression and hypertension in individuals without neurological deficit. An alternative explanation for rostral ventrolateral medullary excitation in our patient would be that the odontoid acted as a mass that indirectly stimulated neurons of the rostral ventrolateral medulla. Conclusions To our knowledge, this is the first reported case with resolution of chronic essential hypertension following resection of the odontoid process for basilar impression

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Dennis L. Johnson

questioned the pathophysiological basis of microvascular decompression and have not been convinced by the electrophysiological data in support of the procedure. 1 In a study of 50 trigeminal nerve roots and their vascular relationships, Hardy and Rhoton 10 found that 60% of the nerves were in contact with a vessel; 20 of the cadavers had bilateral vascular contacts. None of the individuals studied had suffered trigeminal neuralgia during their lifetime. In patients with hyperactive dysfunction syndromes, neurovascular compression is not always found. Among 526 patients

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Péter Banczerowski, Gábor Czigléczki and István Nyáry

M egadolichoectatic basilar artery (BA) anomaly represents an enlarged, elongated, ectatic, often sclerotic aberration of the vertebrobasilar system, also known as vertebrobasilar dolichoectasia or tortuous vertebrobasilar system. 8 By neurovascular compression of the trigeminal nerve root and/or pontine entry zone, this anomaly may contribute to the development of trigeminal neuralgia (TN). 3 , 4 However, smaller vessels (e.g., the superior cerebellar artery [SCA] or the anterior inferior cerebellar artery [AICA]) are more often involved in mechanical

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Makoto Ideguchi, Koji Kajiwara, Koichi Yoshikawa, Shoichi Kato, Hideyuki Ishihara, Masami Fujii, Hirosuke Fujisawa and Michiyasu Suzuki

radiological follow-up is still considered essential to assess the most appropriate antihypertensive therapy. Disclaimer The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. References 1 Akimura T , Furutani Y , Jimi Y , Saito K , Kashiwagi S , Kato S , : Essential hypertension and neurovascular compression at the ventrolateral medulla oblongata: MR evaluation . AJNR Am J Neuroradiol 16 : 401 – 405 , 1995 2 Andresen MC , Doyle MW , Jin YH

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Roger L. Melvill and Belinda L. Baxter

Bederson JB, Wilson CB: Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 71: 359–367, 1989 2. Hamlyn PJ , King TT : Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg 76 : 948 – 954 , 1992 Hamlyn PJ, King TT: Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg 76: 948–954, 1992 3. Jannetta PJ : Treatment of trigeminal neuralgia by suboccipital and

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Susanne Guhl, Michael Kirsch, Heinz Lauffer, Michael Fritsch and Henry W. S. Schroeder

complications caused by compression of cerebral and neural structures, typically by the draining collector, are seen. In the majority of cases, however, flow-related complications due to an imbalance between in- and outflow in the DVA system have been described. 11 In most symptomatic DVAs, an association with other vascular malformations such as cavernous malformations was found. 12 Rare mechanical complications are as follows: 1) hydrocephalus by compression of the aqueduct; 9 , 13 or 2) neurovascular compression of cranial nerves inducing trigeminal neuralgia, facial

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Indra Yousry, Bernhard Moriggl, Markus Holtmannspoetter, Urs D. Schmid, Thomas P. Naidich and Tarek A. Yousry

CISS and 3D TOF sequences now make that evaluation possible. References 1. Adams CBT : Microvascular compression: an alternative view and hypothesis. J Neurosurg 70 : 1 – 12 , 1989 Adams CBT: Microvascular compression: an alternative view and hypothesis. J Neurosurg 70: 1–12, 1989 2. Akimoto H , Nagaoka T , Nariai T , et al : Preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia by use of three-dimensional reconstruction from two types of high resolution

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Toshikazu Kimura, Tetsuro Sameshima and Akio Morita

. Discussion Trigeminal neuralgia is a neurovascular compression syndrome and can be caused by tumors 1 , 4 that compress the nerve along its course. There are also reports of venous compression 2 , 6 , 7 and still other cases without any obvious offending vessels. 3 In the latter cases, several causes are suggested, such as distortion of the axis of the trigeminal nerve and tension caused by the arachnoid membrane and the anchored artery. 5 However, no cases of trigeminal neuralgia caused by a fibrous ring, as in our case, have been reported. The origin of the