三叉神经痛(TN)的特征是在三叉神经的体感分布中出现闪电性疼痛发作,并伴有对非伤害性刺激的超敏反应。表皮样囊肿有时引起TN。为了计划手术,稳态相长干涉(CISS)图像有助于理解肿瘤的位置,范围,以及与颅神经的关系,与脑脊液(CSF)相比,表皮样囊肿显示为低信号。然而,我们在这里描述了一个由表皮样囊肿引起的TN病例,其术中发现与术前和术后CISS图像不同。一名49岁的妇女患有TN。CISS图像显示与右桥小脑角的CSF相比,三叉神经延长和低信号肿瘤。CISS图像显示肿瘤将围绕三叉神经,伸进Meckel腔,并侵犯和压迫三叉神经的根进入区(REZ)。然而,与我们的预期相反,三叉神经没有被肿瘤包围。神经内窥镜显示肿瘤压迫REZ,但肿瘤不存在于Meckel腔内.我们在三叉神经周围进行了部分肿瘤切除,她的症状好转了.然而,术后SS图像与术前相似,所以我们无法评估剩余的肿瘤。病理诊断为表皮样囊肿。术中发现有时与手术前和手术后的SS图像不同,使得难以对表皮样囊肿的剩余部分进行随访。
Trigeminal neuralgia (TN) is characterized by lightning pain paroxysms in the somatosensory distribution of the trigeminal nerve accompanied by hypersensitivity to non-nociceptive stimuli. Epidermoid cysts sometimes cause TN. To plan the surgery, constructive interference in steady state (CISS) image is useful for understanding the tumor\'s location, extent, and relationship against the cranial nerves, and epidermoid cysts are shown as hypointense compared to cerebrospinal fluid (CSF). However, we herein describe a
case with TN due to epidermoid cysts, whose intraoperative findings are different from the preoperative and postoperative CISS image. A 49-year-old woman has suffered from TN. CISS images revealed the prolonged trigeminal nerve and the hypointense tumor compared to the CSF at the right cerebellopontine angle. CISS image suggested that the tumor would surround the trigeminal nerve, reach into the Meckel cavity, and offend and compress the trigeminal nerve\'s root entry zone (REZ). However, contrary to our expectation, the trigeminal nerve was not surrounded by the tumor.
Neuroendoscope revealed that the tumor compressed the REZ, but the tumor was not present in the Meckel cavity. We performed partial tumor removal around the trigeminal nerve, and her symptoms improved. However, the postoperative CISS image was similar to the preoperative one, and so we could not evaluate the remaining tumor. The pathological diagnosis was epidermoid cysts. Intraoperative findings are sometimes different from the pre- and postoperative CISS images, making it difficult to follow up the remaining part of the epidermoid cyst.