Trigeminal Ophthalmic Branch Schwannoma: Case Report and Literature Review

Schwannomas are the fourth most common primary neoplasms affecting the brain and cranial nerves. Central lesions commonly arise from sensory nerve roots, and a common intracranial site is the vestibular branch of the 8th nerve (>85%). We present the case report of a patient who has a schwannoma extending from the pterygopalatine fossa to the orbit, complaining about facial pain in the trajectory of the trigeminal ophthalmic branch. Schwannomas represent 1 to 2% of all neoplasms of the orbit, and trigeminal schwannomas are extremely rare, accounting for less than 0.5% of all intracranial tumors.

Síndrome trófico trigeminal / Trigeminal trophic syndrome

El síndrome trófico trigeminal es una enfermedad infrecuente caracterizada por úlceras faciales autoprovocadas en regiones de anestesia o hipoestesia, secundarias al daño del nervio trigémino. Presentamos tres casos de este síndrome en seguimiento en nuestro centro.

Trigeminal trophic syndrome is an uncommon disease characterized by self-inflicted facial ulcers in anesthetic or hypoesthetic areas, secondary to trigeminal nerve damage. We present three cases in follow up at our hospital.

Horner's syndrome and paresthesia in the trigeminal nerve territory secondary to epidural analgesia for labor / Síndrome de Horner e parestesia do território do nervo trigêmeo secundário a analgesia peridural para trabalho de parto

Abstract Currently, epidural analgesia is a common procedure for labor analgesia. Although it is considered a safe technique, it is not without complications. Horner's syndrome and paresthesia within the trigeminal nerve distribution are rare complications of epidural analgesia. We report a case of a pregnant woman who developed Horner's syndrome and paresthesia within the distribution of the trigeminal nerve following epidural analgesia for the relief of labor pain.

Resumo A analgesia peridural é hoje em dia um procedimento comum para analgesia do trabalho de parto. Embora seja considerada uma técnica segura, não está isenta de complicações. A síndrome de Horner e a parestesia do território do nervo trigêmeo são complicações raras da analgesia peridural. Relatamos um caso de uma grávida que desenvolveu a síndrome de Horner e parestesia do território do nervo trigêmeo após analgesia peridural para o alívio da dor do trabalho de parto.

Utilização de lente de contato escleral na abordagem terapêutica da úlcera neurotrófica corneana / Use of scleral contact lens in the therapeutic approach of corneal neurotrophic ulcer

Resumo Neste artigo descrevemos como conduzimos com sucesso um caso de úlcera neurotrófica não responsivo à terapia convencional com o uso de lente de contato escleral e as vantagens desta terapêutica.

Abstract In this paper we describe how we successfully conducted a case of neurotrophic ulcer not responsive to conventional therapy using scleral contact lens and the advantages of this therapy.

Fractionated Gamma Knife Radiosurgery as Initial Treatment for Large Skull Base Meningioma

We present our experience on the hypofractionated Gamma Knife radiosurgery (FGKS) for large skull base meningioma as an initial treatment. We retrospectively reviewed 23 patients with large skull base meningioma ≥10 cm³ who underwent FGKS as the initial treatment option. The mean volume of tumors prior to radiosurgery was 21.2±15.63 cm³ (range, 10.09~71.42). The median total margin dose and marginal dose per fraction were 18 Gy (range, 15~20) and 6 Gy (range, 5~6), respectively. Patients underwent three or four fractionations in consecutive days with the same Leksell® frame. The mean follow-up duration was 38 months (range, 17~78). There was no mortality. At the last follow-up, the tumor volume was stationary in 15 patients (65.2%) and had decreased in 8 patients (34.8%). Six patients who had cranial neuropathy at the time of FGKS showed improvement at the last clinical follow-up. Following FGKS, 4 patients (17%) had new cranial neuropathy. The trigeminal neuropathy was the most common and all were transient. The mean Karnofsky Performance Status score at pre-FGKS and the last clinical follow-up was 97.0±10.4 points (median, 100) and 98.6±6.9 (median, 100) points, respectively. FGKS has showed satisfactory tumor control with functional preservation for large skull base meningiomas. Further prospective studies of large cohorts with long term follow-up are required to clarify the efficacy in the tumor control and functional outcome as well as radiation toxicity.

A Case of Secondary Trigeminal Neuralgia Caused by Infected Postoperative Maxillary Cyst

Postoperative maxillary cyst (POMC) is relatively common complication among patients who underwent Caldwell-Luc surgery. Patients with POMC usually have no symptoms, although cyst extension can result in bone destruction or cystic infection with pain. The trigeminal nerve consists of the ophthalmic nerve, maxillary nerve, and mandibular nerve. Among these branches, the maxillary nerve runs to the lateral and frontal sides of the maxillary sinus wall. POMC can rarely lead to trigeminal neuropathy caused by cyst enlargement that compresses some branches of the trigeminal nerve. Recently, we experienced a case with trigeminal neuralgia due to POMC. The patient was successfully treated with inferior meatal antrostomy. We report this rare case with a literature review.

Trigeminal trophic syndrome simulating rodent ulcer basal cell carcinoma: a new clinico-dermoscopic approach

Abstract Trigeminal trophic syndrome is an uncommon cause of facial ulcers, that affects the sensitive area of the trigeminal nerve. We present the case of an 84-year-old patient with ulcerated facial trigeminal trophic syndrome, and report the development of a clinico-dermoscopic approach for his clinical examination. The value of this model for the diagnosis of facial ulcers suspected to be a rodent ulcer basal cell carcinoma is suggested.

Zóster com comprometimento do nervo trigêmeo: relato de caso / Zoster with Trigeminal Nerve Damage: Case Report

Zóster é uma doença viral pelo qual o mecanismo de reativação, ainda é pouco compreendido. Entretanto, parece estar relacionado com algum tipo de deficiência na imunidade, além do estresse também ser apontado como fator desencadeante. O diagnóstico, na maioria das vezes, é eminentemente clínico, usualmente determinado por lesões vesículobolhosas que envolvem a pele ao longo do trajeto do nervo branquial. O objetivo desse trabalho é relatar um caso clínico de uma paciente, 21 anos de idade, diagnosticada com zóster e comprometimento do nervo trigêmeo, nos ramos oftálmico, maxilar e mandibular. Verificouse aumento de volume em região de terços médio e inferior da face esquerda, edema palpebral, linfadenopatia em região submandibular, lesões cutâneas vesículo-bolhosas em região periorbital, massetérica, geniana e submandibular. As lesões não ultrapassavam a linha média da face. Após o tratamento a paciente não apresentou sequelas. Salientase a necessidade do conhecimento dessas lesões por parte do cirurgião dentista, a fim de estabelecer diagnóstico e tratamento imediato, para minimizar sintomatologia e acompanhamento da neuralgia pós-zóster... (AU)

Zoster is a viral disease in which the reactivation mechanism is poorly understood. However, it seems to be related to an immunity disability, in addition to stress, which is also be appointed as a triggering factor. The diagnosis, in most cases, is eminently clinical, usually determined by vesicle-bullous lesions involving the skin over the brachial nerve pathway. The aim of this study is to report a case of a 21-year-old patient, diagnosed with zoster, with commitment of the trigeminal nerve comprehending the ophthalmic, maxillary and mandibular branches. There was tissue growth in medium-third region and the lower left cheek, eyelid edema, lymphadenopathy in the submandibular region, vesicle-bullous skin lesions in the periorbital, masseteric, genian and submandibular regions. The injury did not exceed the midline of the face. After treatment the patient had no sequelae. It is emphasized the need of understanding these lesions by the dental surgeon, in order to establish diagnosis and the due immediate treatment in order to reduce the symptoms and the follow up of post-zoster neuralgia... (AU)

Compressive Trigeminal Neuropathy after Caldwell-Luc Operation

Most postoperative maxillary cysts develop more than 10 years after a Caldwell-Luc operation. They can manifest with cheek pain, swelling and dental and visual symptoms. Brain imaging should be performed to distinguish trigeminal nerve compression from various other possible causes. It should be treated by surgical intervention to relieve the above-mentioned symptoms. We report a patient who presented with compressive trigeminal neuropathy caused by a postoperative maxillary cyst.

Compressive Trigeminal Neuropathy after Caldwell-Luc Operation

Most postoperative maxillary cysts develop more than 10 years after a Caldwell-Luc operation. They can manifest with cheek pain, swelling and dental and visual symptoms. Brain imaging should be performed to distinguish trigeminal nerve compression from various other possible causes. It should be treated by surgical intervention to relieve the above-mentioned symptoms. We report a patient who presented with compressive trigeminal neuropathy caused by a postoperative maxillary cyst.

Trans-extradural approach to resect trigeminal schwannomas involving the cavernous sinus region / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the techniques and effect of extradural approach for the resection of trigeminal schwannomas involving the cavernous sinus.</p><p><b>METHODS</b>Twenty-three patients (range 26-63 years, mean age 46.2 years) with trigeminal schwannomas involving the cavernous sinus treated by middle fossa extradural approach were retrospectively analyzed. Frontotemporal orbitozygomatic extradural approach was performed in 2 patients. Frontotemporal zygomatic extradural approach was carried out in 21 patients. The first follow-up visit was on the 3rd month after surgery, and if residual was observed on enhanced MRI, then the patient was followed up every 6 months; otherwise, the patient was followed up every 8-12 months.</p><p><b>RESULTS</b>The length of hospital stay after surgery was 7-13 days (mean 8.5 days). Two tumors originated from the ophthalmic branch, 2 from the maxillary branch, 5 from the mandibular branch and 14 from the gasserian ganglion. Total resection was achieved in 21 of the 23 patients (91.3%) and subtotal resection in the other 2 patients. All the patients were followed up from 3 months to 4 years. Median follow-up time was 19 months. The most common symptom was facial hypoesthesia, occurring in 18 patients. This symptom improved in 10 patients and worsened in 8 patients after surgery. New postoperative facial hypoesthesia was observed in 2 patients. Facial pain was observed in 3 patients and subsided after surgery. Two patients had loss of hearing, this symptom improved in 1 patient and worsened in 1 patient after surgery. Diplopia was observed in 6 patients. In 1 of these 6 patients, diplopia resulted from palsy of the oculomotor nerve. In the other 5 patients, diplopia resulted from palsy of the abducens nerve. This symptom improved postoperatively in all these 6 patients. New postoperative atrophy of the temporalis muscle was observed in 3 patients. There was no operation-related mortality. Tumor recurrence was only found in 1 patient after 24 months and was treated by Gamma knife.</p><p><b>CONCLUSIONS</b>The middle fossa extradural approach may be an ideal option for the resection of trigeminal schwannomas involving the cavernous sinus. This approach produces no further impairment, less complication, and is less likely to injured the trigeminal nerve, abducens nerve, trochlear nerve and internal carotid artery.</p>

Analgesic effect of CQM on prosopalgia model rats and its impact on exciting amino acid neurotransmitters / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the analgesic effect of CQM on photochemically-induced prosopalgia model rats, and discuss its impact on the exciting amino acid neurotransmitter-glutamate (Glu).</p><p><b>METHOD</b>Male SD rats were randomly divided into the sham operation group and the prosopalgia group. And the latter was subdivided into the model group, the gabapentin group (100 mg kg(-1)), and the CQM low-dose (35 mg x kg(-1)) and CQM high-dose (70 mg x kg(-1)) groups. The mechanical allodynia test was adopted to evaluate the pain behavior of rats, and reflect the efficacy with the mechanical withdrawal thresholds. The rat striatum extra-cellular fluid was collected by brain micro-dialysis. The Glu level of samples was measured by high performance liquid chromatography-fluorescene detector (HPLC-FLD).</p><p><b>RESULT</b>Compared to the control group, the threshold of the mechanical allodynia of the IoN injury group was decreased significantly (P < 0.05), and the concentration of Glu was increased dramatically (P < 0.05). Compared to the model group, the mechanical allodynia of photochemically-induced prosopalgia model rats increased significantly (P < 0.01), with a notable increase in brain Glu concentration (P < 0.05). Compared with the model group, all of mechanical withdrawal thresholds increased. Among them, the CQM high-dose group showed a remarkably growth at three time points (P < 0.05), with the maximum up to (23 +/- 7.3) g. And the gabapentin group showed a remarkably growth at two time points (P < 0.05), with the maximum up to (20.5 +/- 9.2) g. All of the drug groups showed significantly lower Glu concentrations in rat brains than the model group (P < 0.05).</p><p><b>CONCLUSION</b>CQM can ease the mechanical allodynia of photochemically-induced prosopalgia model rats. Its analgesic effect may be related to the decrease of Glu concentrations in striatum extra-cellular fluid.</p>

Idiopathic Trigeminal Neuropathy with Brain MRI Abnormalities

No abstract available.

Cluster Headache Presenting With Raeder's Syndrome

No abstract available.

Dolor neuropático en el trigémino / Trigeminal neuralgia

Las neuralgias constituyen dolores neuropáticos cuyo criterio diagnóstico fundamental es la localización, el criterio espacial es el más importante y de algún modo determinante para clasificar un dolor como una neuralgia especí-fica de algún nervio, es el conjunto de todas las características clínicas lo que nos permitirá hacer el diagnóstico y diferenciarlo de otros dolores craneofaciales. La Neuralgia del Trigémino es la más frecuente en presentación y en todas las patologías de dolor neuropático, es la que está asociada a mayor sintomatología depresiva y con más índice de suicidio e ideas de muerte por la severidad de la intensidad del dolor y de la alteración en la calidad de vida del paciente. Es importante sospecharla, diagnosticarla y darle un tratamiento adecuado ya que el paciente puede padecer un dolor crónico que se convierte posteriormente en una enfermedad. Conocer la existencia de estos síndromes dolorosos y sus características clínicas ayudará al neurólogo en el diagnóstico diferencial de las cefaleas y en la orientación diagnóstica y terapéutica correcta.

Analgesic effect of Corydalis yanhusuo in a rat model of trigeminal neuropathic pain / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the analgesic effect of Corydalis yanhusuo on trigeminal neuropathic pain.in a rat model.</p><p><b>METHOD</b>Rat model of trigeminal neuralgia pain were established by inducing chronic constriction injury (CCI) of the infraorbital branch of the trigeminal nerve (ION). The effect of Corydalis yanhusuo, a traditional Chinese medicine, in ameliorating the pain was tested. Western blotting was performed to investigate the change of cannabinoid CB1 receptors in the Vc the injury of the infraorbital branch of the trigeminal nerve (ION-CCI). CB1 receptor antagonist AM 251 was applied to observe its effect on the analgesic effect of Yanhusuo.</p><p><b>RESULT</b>Administration of dl-THP (2 mg/kg) intraperitoneally increased the response threshold and the cut-off threshold to the mechanical stimulation in ION-CCI rat models. ION-CCI induced an upregulation of cannabinoid CB1 receptors within the ipsilateral of Vc. The effect of Yanhusuo was antagonized by the application of AM 251.</p><p><b>CONCLUSION</b>The analgesic effect of Yanhusuo involves the participation of CB1 receptors, suggesting that Yanhusuo may offer a useful therapeutic approach for trigeminal neuropathic pain.</p>

Isolated Trigeminal Neuropathy Caused by Pontine Infarction

No abstract available.

The relationship between the stomatognathic system and body posture: [review]

In recent years, many researchers have investigated the various factors that can influence body posture: mood states, anxiety, head and neck positions, oral functions (respiration, swallowing), oculomotor and visual systems, and the inner ear. Recent studies indicate a role for trigeminal afferents on body posture, but this has not yet been demonstrated conclusively. The present study aims to review the papers that have shown a relationship between the stomatognathic system and body posture. These studies suggest that tension in the stomatognathic system can contribute to impaired neural control of posture. Numerous anatomical connections between the stomatognathic system's proprioceptive inputs and nervous structures are implicated in posture (cerebellum, vestibular and oculomotor nuclei, superior colliculus). If the proprioceptive information of the stomatognathic system is inaccurate, then head control and body position may be affected. In addition, the present review discusses the role the myofascial system plays in posture. If confirmed by further research, these considerations can improve our understanding and treatment of muscular-skeletal disorders that are associated with temporomandibular joint disorders, occlusal changes, and tooth loss.