English
Arabic
Chinese (Simplified)
Dutch
French
German
Hebrew
Italian
Japanese
Portuguese
Russian
Spanish
- Department of Neurosurgery, Air Force Galeão Hospital, Rio de Janeiro, Brazil,
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- Department of Neurosurgery, Hospital Padilla de Tucuman, Tucuman, Argentina.
Correspondence Address:
Dan Zimelewicz Oberman, Department of Neurosurgery, Air Force Galeão Hospital, Rio de Janeiro, Brazil.
DOI:10.25259/SNI_632_2022
Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Dan Zimelewicz Oberman1, Pedro Plou2, Alvaro Campero3, Pablo Marcelo Ajler2. Surgical management of atypical trigeminal neuralgia secondary to tentorial meningioma: 2D video. 25-Nov-2022;13:554
How to cite this URL: Dan Zimelewicz Oberman1, Pedro Plou2, Alvaro Campero3, Pablo Marcelo Ajler2. Surgical management of atypical trigeminal neuralgia secondary to tentorial meningioma: 2D video. 25-Nov-2022;13:554. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=12030
Date of Submission
15-Jul-2022
Date of Acceptance
10-Nov-2022
Date of Web Publication
25-Nov-2022
Abstract
Background: Tentorial meningiomas (TM) are complex entities with distinguished clinical, radiological and surgical considerations. They comprise approximately 3 - 6% of all intracranial meningiomas1. TM have been classified in 5 subgroups according to the modified Yasargil’s classification, based on their location 2 and 3. Those located at the free margin of the tentorium are still challenging for neurosurgeons, with high morbidity and mortality. Atypical trigeminal neuralgia (ATN) is a type of trigeminal neuralgia that is identified by the constancy of symptoms. They experience less intense pain, but a constant dull aching or burning pain, and it is frequently misdiagnosed. Although it is well known that typical trigeminal (TN) neuralgia responds very well to medical treatment and are related with posterior fossa tumors, ATN is less likely. In this video we demonstrate the microsurgical resection of group 1 tentorial meningioma in the treatment of atypical trigeminal neuralgia.
Case Description: A previously healthy 63-year-old female came to our service complaining of long lasting, intermittent, right facial pain for two years. On neurological examination, the patient had hypoesthesia in the territory of maxillae (V2) branch of the right trigeminal nerve. She had no other complaints on the physical examination. Initial treatment with carbamazepine and pregabalin was performed, however, it could not be further increased because of the maximal doses and side effects. Radiological investigation was carried out with cranial computed tomography (CT) and magnetic resonance image (MRI), which showed a high signal density mass lesion in the free margin of the tentorium, with extension to the right cerebello pontine angle (CPA), compressing the trigeminal nerve, that exhibited homogeneous contrast enhancement, suggestive of tentorial meningioma. Given the size, the location of the mass, and no response to the medical treatment, microsurgical resection was performed.
Conclusion: The postoperative period was excellent, without any neurological deficit. The patient consented with publication of her images and videos.
Keywords: Microsurgical resection, Skull base, Tentorium meningioma, Trigeminal neuralgia
Video 1
Annotations[1-5]
0:07 – Clinical presentation and Neurological examination. 0:28 – Neuroimaging findings. 0:49 – Rationale for the procedure, risks of the procedure and potential benefits, and alternatives and why they were not chosen. 1:44 – Description of the setup. 1:59 – Positioning. 2:09 – Key surgical steps. 3:39 – Surgical video. 6:46 – Brief review of clinical and imaging background. 7:45 – Post-operative course.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Publication of this article was made possible by the James I. and Carolyn R. Ausman Educational Foundation.
Conflicts of interest
There are no conflicts of interest.
Videos available on:
References
1. Bassiouni H, Asgari S, König HJ, Stolke D. Meningiomas of the falcotentorial junction: Selection of the surgical approach according to the tumor type. Surg Neurol. 2008. 69: 339-49
2. Bret P, Guyotat J, Madarassy G, Ricci AC, Signorelli F. Tentorial meningiomas. Report on twenty-seven cases. Acta Neurochir (Wien). 2000. 142: 513-26
3. Burchiel KJ. A new classification for facial pain. Neurosurgery. 2003. 53: 1164-6
4. Qin C, Wang J, Long W, Xiao K, Wu C, Yuan J. Surgical management of tentorial notch meningioma guided by further classification: A consecutive study of 53 clinical cases. Front Oncol. 2020. 10: 609056
5. Sindou M, Leston J, Decullier E, Chapuis F. Microvascular decompression for primary trigeminal neuralgia: Long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg. 2007. 107: 1144-53
