Abstract：
Trigeminal neuralgia (TN) is characterized by paroxysmal episodes of severe shocklike orofacial pain typically resulting from arterial compression on the trigeminal root entry zone. However, neurovascular conflict in more proximal parts of the trigeminal pathway within the pons is extremely rare.
The authors present a case of microvascular decompression for TN caused by dual arterial compression on the dorsolateral pons, along with a brief literature review.
Our patient was a 74-year-old man with episodic left-sided facial stabbing pain. Brain magnetic resonance imaging revealed a dual arterial compression on dorsolateral pons, the known site of the trigeminal sensory nucleus and descending trigeminal tract. Microvascular decompression was performed via a retrosigmoid approach. Complete pain relief and partial improvement of the facial hypesthesia were achieved immediately after surgery and the Barrow Neurological Institute (BNI) pain intensity score improved from V to I, and the BNI hypesthesia score decreased from III to II within a month following surgery. The literature review identified 1 case of TN secondary to an arteriovenous malformation in root entry zone with lateral pontine extension. One month following partial coagulation of the draining vein, the patient was reportedly able to reduce medication dosage by half to achieve an improvement of BNI pain intensity score from V to IIIa.
Neurovascular compression in the trigeminal tract and nucleus is a rare but potential cause of TN. A thorough investigation of the trigeminal pathway should be considered during preoperative evaluation and intraoperative inspection, particularly if no clear offending vessel is identified.
The authors present a case of microvascular decompression for TN caused by dual arterial compression on the dorsolateral pons, along with a brief literature review.
Our patient was a 74-year-old man with episodic left-sided facial stabbing pain. Brain magnetic resonance imaging revealed a dual arterial compression on dorsolateral pons, the known site of the trigeminal sensory nucleus and descending trigeminal tract. Microvascular decompression was performed via a retrosigmoid approach. Complete pain relief and partial improvement of the facial hypesthesia were achieved immediately after surgery and the Barrow Neurological Institute (BNI) pain intensity score improved from V to I, and the BNI hypesthesia score decreased from III to II within a month following surgery. The literature review identified 1 case of TN secondary to an arteriovenous malformation in root entry zone with lateral pontine extension. One month following partial coagulation of the draining vein, the patient was reportedly able to reduce medication dosage by half to achieve an improvement of BNI pain intensity score from V to IIIa.
Neurovascular compression in the trigeminal tract and nucleus is a rare but potential cause of TN. A thorough investigation of the trigeminal pathway should be considered during preoperative evaluation and intraoperative inspection, particularly if no clear offending vessel is identified.
摘要：
背景：三叉神经痛（TN）的特征是阵发性严重的休克样口面部疼痛，通常是由三叉神经根进入区（REZ）的动脉压迫引起的。然而,脑桥内三叉神经通路较近端的神经血管冲突极为罕见。
方法：作者介绍了一例由背外侧脑桥双动脉压迫引起的TN微血管减压术（MVD），以及简短的文献综述。
结果：我们的患者是一名74岁的男性，患有间歇性左侧面部刺痛。脑部MRI显示背外侧脑桥有双动脉压迫,三叉神经感觉核(TSN)和三叉神经降道(DTT)的已知部位。通过乙状窦后入路进行MVD。术后立即实现完全缓解疼痛和部分改善面部感觉过度，BNI疼痛强度评分从V提高到I，术后1个月内BNI感觉减退评分从III降至II。文献综述确定了1例脑桥外侧延伸的REZ动静脉畸形继发的TN。引流静脉部分凝固后一个月，据报道,患者能够将药物剂量减少一半,以实现BNI疼痛强度评分从V改善至IIIa.
结论：三叉神经束和细胞核的神经血管压迫是一种罕见的，而是TN的潜在原因。在术前评估和术中检查期间，应考虑对三叉神经通路进行彻底调查-特别是如果没有明确的违规血管。
方法：作者介绍了一例由背外侧脑桥双动脉压迫引起的TN微血管减压术（MVD），以及简短的文献综述。
结果：我们的患者是一名74岁的男性，患有间歇性左侧面部刺痛。脑部MRI显示背外侧脑桥有双动脉压迫,三叉神经感觉核(TSN)和三叉神经降道(DTT)的已知部位。通过乙状窦后入路进行MVD。术后立即实现完全缓解疼痛和部分改善面部感觉过度，BNI疼痛强度评分从V提高到I，术后1个月内BNI感觉减退评分从III降至II。文献综述确定了1例脑桥外侧延伸的REZ动静脉畸形继发的TN。引流静脉部分凝固后一个月，据报道,患者能够将药物剂量减少一半,以实现BNI疼痛强度评分从V改善至IIIa.
结论：三叉神经束和细胞核的神经血管压迫是一种罕见的，而是TN的潜在原因。在术前评估和术中检查期间，应考虑对三叉神经通路进行彻底调查-特别是如果没有明确的违规血管。
