Endoscopic Resection of Right Petrous Meningioma Causing Trigeminal Neuralgia: "The Double Crush" Phenomenon.

IF 0.6 Q4 CLINICAL NEUROLOGY
Journal of Neurological Surgery Reports Pub Date : 2025-05-21 eCollection Date: 2025-04-01 DOI:10.1055/a-2599-4419
Mazen Zaher, Pedro Aguilar-Salinas, Amna Hussein, Peter Nakaji
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Abstract

Trigeminal neuralgia (TN) is typically caused by neurovascular compression (NVC) at the root entry zone, often involving the superior cerebellar artery. Occasionally, TN may be secondary to cerebellopontine angle (CPA) tumors, such as meningiomas, vestibular schwannomas, or epidermoid cysts. When both a tumor and a vascular loop contribute to nerve compression, the resulting, as we refer to the "double crush" phenomenon, complicates surgical management and necessitates a more comprehensive therapeutic strategy. Literature indicates that a simultaneous approach targeting both the tumor and the NVC is crucial to achieving optimal outcomes. Microvascular decompression (MVD) alone may be insufficient for patients with tumor-associated TN, as the residual mass effect can persist. The literature suggests that combining MVD with tumor resection provides superior pain relief and reduces recurrence rates. An endoscopic retrosigmoid craniotomy offers enhanced visualization and maneuverability, allowing complete tumor resection and effective nerve decompression with excellent clinical results. We present the case of a 55-year-old female with right-sided TN due to a petrous meningioma and an adjacent superior cerebellar artery loop compressing the trigeminal nerve. The patient underwent endoscopic tumor resection and MVD, resulting in significant pain relief and improved facial sensation. This case emphasizes the need to address both compressive etiologies in TN cases associated with CPA tumors to achieve the best clinical outcomes.

内镜下三叉神经痛的右侧岩状脑膜瘤切除术:“双重挤压”现象。
三叉神经痛(TN)通常是由神经血管压迫(NVC)在神经根进入区引起的,通常累及小脑上动脉。偶尔,TN可能继发于桥小脑角(CPA)肿瘤,如脑膜瘤、前庭神经鞘瘤或表皮样囊肿。当肿瘤和血管袢同时压迫神经时,我们称之为“双重压迫”现象,使手术治疗复杂化,需要更全面的治疗策略。文献表明,同时针对肿瘤和NVC的方法对于获得最佳结果至关重要。单独的微血管减压(MVD)可能不足以治疗肿瘤相关TN患者,因为残余肿块效应可能持续存在。文献表明,MVD联合肿瘤切除可以更好地缓解疼痛并降低复发率。内窥镜乙状结肠后开颅术提供了更好的可视性和可操作性,允许完全切除肿瘤和有效的神经减压,具有良好的临床效果。我们提出的情况下,55岁的女性右侧TN由于岩性脑膜瘤和邻近的小脑上动脉环压迫三叉神经。患者接受了内镜下肿瘤切除术和MVD,疼痛明显缓解,面部感觉改善。本病例强调需要解决与CPA肿瘤相关的TN病例的压缩病因,以获得最佳的临床结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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