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At least 19 recordsLinked to original sources

[Oculomotor nerve and trigeminal nerve involvement demonstrated by Gd-DTPA-enhanced MRI in acute lymphoblastic leukemia: a case report].

Magnetic Resonance Imaging (MRI) is considered a useful procedure for evaluating the intracranial diseases. Leukemic infiltration in either the oculomotor or trigeminal nerve is rarely seen by MRI. We herein describe the diagnostic assessment and outcome of an adult patient suffering from acute lymphoblastic leukemia (L2, FAB). An 18-year-old female was suspected to have ALL. She complained of nausea, vomiting, and double vision for a month, and further examination was required. Fiber gastroscope examination revealed no abnormal lesions in the upper gastrointestinal tract. Furthermore, a plain brain CT indicated no abnormalities in the brain. However, examination of a Gd-DTPA enhanced MRI and the liquor revealed that she had leptomeningeal leukemia with oculomotor and trigeminal nerve infiltration. Systemic administration of methotrexate (MTX) and cytarabine, and intrathecal injection of MTX were partially effective. Repeated Gd-DTPA enhanced MRI showed the shrinkage and reduced enhancement of oculomotor and trigeminal nerve, parallel to the improvement in the liquor. This case demonstrates the importance of MRI not only in the evaluation of therapy, but also in the early diagnosis of central nervous system leukemia.

Adolescent↗

Neurinomas of the trigeminal nerve.

Trigeminal neurinomas account for about 0.2 per cent of all intracranial tumors and for about 2 to 3 per cent of all intracranial neurinomas. Trigeminal neurinomas occur most frequently in persons in the middle decades of life, with the highest incidence between the ages of 38 and 40 years. They show no sex predilection. Although very rare, trigeminal neurinomas are of considerable interest to the neurotologist because of their relation to the temporal bone, skull base, sphenoid and maxillary sinuses, nasopharynx, infratemporal fossa, and, in rare instances, the oral cavity. In addition to producing disturbances of fifth nerve sensory and motor function, these tumors are often associated with other symptoms, such as occlusion of the eustachian tube (sensation of fullness and conductive hearing loss), otalgia, exophthalmos, paralysis of the third, fourth, and sixth cranial nerves, and signs of posterior fossa involvement (sensorineural hearing loss, tinnitus, cerebellar ataxia, and involvement of cranial nerves VII and IX through XI), any of which may be the initial clinical manifestation of the neurinoma. Symptoms depend on the site of origin and course of development. Bilateral trigeminal neurinomas are a manifestation of the central form of neurofibromatosis.

Adult↗

Cavernous malformation of the trigeminal nerve manifesting with trigeminal neuralgia: case report.

OBJECTIVE AND IMPORTANCE: We describe a patient with a cavernous malformation within the trigeminal nerve at the nerve root entry zone who presented with trigeminal neuralgia. CLINICAL PRESENTATION: A 52-year-old woman sought treatment after experiencing dizziness and lancinating left facial pain for almost a year. Neurological examination revealed diminished sensation in the distribution of the trigeminal nerve on the left. Magnetic resonance imaging demonstrated a minimally enhancing lesion affecting the trigeminal nerve. INTERVENTION: The patient underwent a retrosigmoid craniotomy. At the nerve root entry zone, the trigeminal nerve was edematous with hemosiderin staining. The lesion, which was resected with microsurgical technique, had the appearance of a cavernous malformation on gross and histological examination. The patient's pain improved significantly after resection. CONCLUSION: Cavernous malformations can afflict the trigeminal nerve and cause trigeminal neuralgia. Microsurgical excision can be performed safely and is associated with improvement in symptoms.

Cranial Nerve Neoplasms↗

Radiographic position of the trigeminal nerve in the skull for angiographic determination of arterial-nerve relationship in trigeminal neuralgia: results of a radiologic-anatomic study.

The positions of 20 trigeminal nerves in the skulls of 12 cadavers were evaluated radiographically. Small metal clips were attached to the nerves and radiographs were obtained in straight AP, Towne and lateral projections. It was found that the trigeminal nerve had a fairly constant position in the skull with respect to the internal auditory meatus in the AP and Towne projections and the petrous ridges in the lateral view. This information can be used during vertebral angiography to predict whether an arterial loop is sufficiently close to the trigeminal nerve root for arterial compression of the nerve, causing trigeminal neuralgia, to be a realistic possibility.

Adult↗

Isolated hypertrophic interstitial neuropathy of the trigeminal nerve associated with trigeminal neuralgia. Case report of an entity not previously described.

Hypertrophic interstitial neuropathy (HIN) of the trigeminal nerve was observed in a patient with trigeminal neuralgia who had no other neurological abnormalities. Pathological documentation confirmed focal HIN. No similar histologically documented case of isolated trigeminal nerve involvement by HIN has been reported previously.

Adult↗

Solitary metastatic breast carcinoma in a trigeminal nerve mimicking a trigeminal neurinoma. Case report.

An unusual case of a metastatic adenocarcinoma located entirely within the trigeminal nerve is reported. The patient, with a history of breast cancer, presented with a pure trigeminal mononeuropathy. The neurological and neuroradiological findings in this patient were quite similar to those of a patient with trigeminal neurinoma. Surgery revealed that the tumor was located within the trigeminal nerve and its appearance was similar to that of a neurinoma. However, histopathological studies proved the tumor to be an adenocarcinoma that was related to the breast cancer treated earlier. A solitary metastatic tumor arising solely in a trigeminal nerve is quite rare; this is the first report of such a case metastasized from breast cancer.

Aged↗

Somatosensory evoked potentials following trigeminal nerve stimulation in trigeminal neuralgia.

The examination of somatosensory evoked potentials following trigeminal nerve stimulation in 20 subjects with idiopathic trigeminal neuralgia revealed a pathological increase in latency of the first positive component on the involved side in 7 (41%) of the 17 patients without antecedent surgical treatment. The mean difference in latency between the two sides was 1.3 msec (2p greater than or equal to 0.005). These results are indicative of microtraumatization of the trigeminal nerve in the posterior fossa by blood vessels, for example, leading to local demyelinization. The method seems to be of diagnostic value in selecting patients for more decompression by posterior fossa operations.

Adult↗

[The diagnosis of the nature of the lesion of the trigeminal nerve root in trigeminal neuralgia].

The authors examined 64 patients with unilateral trigeminal neuralgia by computed tomography and registration of trigeminal somatosensory evoked potentials. The values of the evoked potentials on the involved side differed essentially from those on the healthy side. This allows vascular compression of the trigeminal nerve root in the posterior cranial fossa to be identified authentically and the indications for surgical treatment of trigeminal neuralgia by microvascular decompression thus determined. The diagnosis of vascular compression of the root of the trigeminal nerve was established in 33 patients, who were then operated on. The diagnosis was confirmed during the operation: pain was relieved completely in all patients after surgical treatment.

Chronic Disease↗

[Avulsion of the peripheral nerve of the trigeminal nerve].

There are variety of surgical methods in treating trigeminal neuralgia. They can all be devided in two large groups: less invasive procedures and decopmressive procedures in the region of pontocerebelar angle. Peripheral neurectomy, exeresis or avulsion of peripheral branches of trigeminal nerv are methods for elderly patients with serious cardiopulmonal disturbances. We performed avulsion of peripheral branches at 58 patients, all older than 60 years. In 32 patients we did avulsion of only one of three branches of trigeminal nerv, while in 26 patients the combined avulsion of two branches was performed. There were no postoperative complications.

Aged↗

Gamma knife radiosurgery as a primary treatment for prolactinomas.

OBJECT: The purpose of this study was to estimate the efficacy of gamma knife radiosurgery (GKS) in controlling tumor growth and endocrinopathy associated with prolactinomas. METHODS: Between 1993 and 1997, 164 of 469 patients with pituitary adenomas treated by GKS harbored prolactinomas. The dose to the tumor margin ranged from 9 to 35 Gy (mean 31.2 Gy), and the visual pathways were exposed to a dose of less than 10 Gy. The mean tumor diameter was 13.4 mm. The mean follow-up time for 128 cases was 33.2 months (range 6-72 months). Tumor control was observed in all but two patients who underwent surgery 18 and 36 months, respectively, after GKS. Clinical cure was achieved in 67 cases. Clinical improvement was noted with a decrease in the hyperprolactinemia after GKS. Nonetheless, in 31 (29%) of 108 patients who were followed for more than 2 years no improvement in serum prolactin levels was demonstrated, although this could be normalized by bromocriptine administration after treatment. Nine infertile women became pregnant 2 to 13 months after GKS and all gave birth to normal children. There was no visual deterioration related to GKS. Five women experienced premature menopause. In these patients there was subtotal disappearance of the tumor and an empty sella developed. CONCLUSIONS: Gamma knife radiosurgery as a primary treatment for prolactinomas can be safe and effective both for controlling tumor growth and for normalization of prolactin hypersecretion. A higher margin dose (> or = 30 Gy) seemed to be associated with a better clinical outcome. Gamma knife radiosurgery may make prolactinomas more sensitive to the bromocriptine.

Humans↗

[The microvascular decompression of the trigeminal nerve root in trigeminal neuralgia].

Microvascular decompression of the root of the trigeminal nerve was carried out in 35 patients with trigeminal neuralgia. The principles of the surgical interventions and the intraoperative findings are described. The peculiarities of neurovascular conflict are analysed in comparison with the neurovascular conflict are analysed in comparison with the of the trigeminal root caused by the main trunk and branches of the superior cerebellar artery, the anterior inferior cerebellar artery, and the superior petrosal vein, relieved pain completely in all cases. The advantages of microvascular decompression over other methods of surgical treatment are emphasized and the authors' own method for the prevention of recurrent compression and pain syndrome is suggested.

Adult↗

The trigeminal nerve.

The trigeminal nerve is described in terms of segmental anatomy and regional pathology. The common brain stem lesions are neoplasms, vascular disease, and demyelinating processes. Common lesions affecting the cisternal segment and Meckel's cave are schwannoma, meningioma, epidermoid, vascular ectasia, and aneurysm. Common lesions affecting the cavernous segment include meningioma, trigeminal schwannoma, lymphoma, metastasis, and vascular lesions. Skull base abnormalities include chordoma, chondrosarcoma, metastasis, bone dysplasias, and Paget's disease. The peripheral divisions of the trigeminal nerve are commonly involved by adjacent inflammatory disease in the sinuses, perineural spread of malignancy, and schwannoma. Unfortunately, the anatomic site of a lesion cannot be accurately predicted on the basis of clinical symptomatology. Successful imaging evaluation must include the entire course of the trigeminal nerve from the brain stem and upper cervical cord through the peripheral branches.

Aged↗

Primary nerve-sheath tumours of the trigeminal nerve: clinical and MRI findings.

We reviewed the clinical and MRI findings in primary nerve-sheath tumours of the trigeminal nerve. We retrospectively reviewed the medical records, imaging and histological specimens of 10 patients with 11 primary tumours of the trigeminal nerve. We assessed whether tumour site, size, morphology or signal characteristics were related to symptoms and signs or histological findings. Histological proof was available for 8 of 11 tumours: six schwannomas and two plexiform neurofibromas. The other three tumours were thought to be schwannomas, because they were present in patients with neurofibromatosis type 2 and followed the course of the trigeminal nerve. Uncommon MRI appearances were observed in three schwannomas and included a large intratumoral haemorrhage, a mainly low-signal appearance on T2-weighted images and a rim-enhancing, multicystic appearance. Only four of nine schwannomas caused trigeminal nerve symptoms, including two with large cystic components, one haemorrhagic and one solid tumor. Of the five schwannomas which did not cause any trigeminal nerve symptoms, two were large. Only one of the plexiform neurofibromas caused trigeminal nerve symptoms. Additional neurological symptoms and signs, not related to the trigeminal nerve, could be attributed to the location of the tumour in three patients.

Adolescent↗

Electrical study of jaw and orbicularis oculi reflexes after trigeminal nerve surgery.

Trigeminal nerve ophthalmic and motor division function was assessed clinically and electrically in 32 patients who had undergone various surgical procedures for trigeminal neuralgia. Using known electrophysiological techniques, the orbicularis oculi and jaw reflexes were tested in all subjects. Abnormalities of the orbicularis oculi reflex were anticipated on the basis of ophthalmic division anaesthesia. However, jaw reflex abnormalities appeared in operated cases with no clinical or electromyographic evidence of masseter denervation. These results were unexpected, and imply that the proprioceptive fibres of the jaw reflex are mediated by a sensory and not a motor root as previously believed.

Adult↗