Trigeminal Palsy Research Articles

Trigeminal nerve palsy in nasopharyngeal carcinoma: Correlation between clinical findings and magnetic resonance imaging

Our aim was to document the relationship between clinical and MRI evidence of trigeminal nerve involvement. The MRI and medical records of 924 consecutive patients with newly diagnosed nasopharyngeal carcinoma (NPC) were reviewed retrospectively. A total of 92 divisions of palsied trigeminal nerves were found clinically in 46 patients (5.0%). The involved trigeminal nerve was ophthalmic nerve (V1; n = 21), the maxillary division (V2; n = 41), and the mandibular division (V3; n = 30). Of the 316 patients with MRI-demonstrated trigeminal nerve involvements, the symptoms were lacking in 270 patients (85.4%). Of the 92 clinical palsied trigeminal nerve divisions, 91 nerves (98.9%) showed MRI evidence of 1 or more trigeminal nerve involvements. Of the 91 palsied trigeminal nerve with MRI evidence, 85 divisions (93.4%) were found with intracranial or orbital segment involvement, 6 (6.6%) divisions were found only basicranial evidence, and 83 (91.2%) divisions were found with cavernous sinus invasion. The incidence of MRI-evidenced trigeminal nerve involvement is high and often asymptomatic in NPC. Almost all patients with clinical trigeminal nerve palsies had MRI evidence of trigeminal nerve involvement in intracranial or orbital segment, especially in cavernous sinus.

Neoadjuvant therapy in a patient with clival plasmacytoma associated with multiple myeloma: a case report

Background Plasmacytoma is a localized mass of metastatic plasma cells. These lesions rarely involve the petroclival region and carry a high risk of progression to MM and poor prognosis. Case Description We report a 65-year-old woman who presented with a large clival plasmacytoma causing right trigeminal and abducens nerve palsies and was diagnosed with MM after transsphenoidal biopsy. She underwent neoadjuvant chemoradiotherapy followed by radical resection of the residual tumor. Conclusion We presented our treatment strategy including neoadjuvant chemoradiotherapy followed by radical resection of the lesion. The patient has experienced complete remission, and succeeding MRI revealed no evidence of local recurrence.

Lyme disease with lymphocytic meningitis, trigeminal palsy and silent thalamic lesion

We describe a follow-up in a 15-year-old boy with neuroborreliosis diagnosed by clinical symptoms, CSF and serum analysis. MRI revealed a thalamic lesion and an enhancement of the right trigeminal nerve clinically associated with mild hypasthesia in the right maxillary region. Both, clinical symptoms and radiological findings disappeared within 2 months after treatment. Borrelia burgdorferi specific IgM and IgG in CSF and IgG in serum became negative between 6 and 12 months after diagnosis. We show that neuroborreliosis at an early stage may present only with moderate neurological deficits and that at this stage MRI reveals distinct cerebral lesions which might even precede clinical manifestation. Thus, early diagnosis and treatment of neuroborreliosis may prevent persistent neurologic lesions.

Trigeminal nerve palsy and Horner’s syndrome following epidural analgesia for labor: a subdural block?

Horner's syndrome is a rare complication of epidural analgesia for labor. Much more uncommon is trigeminal nerve palsy. Both complications may be attributed to a subdural localization of the catheter, as we demonstrated clinically by a repeat injection and patchy sympathetic block and with the typical image on epidurography.

Infra- and Supratentorial Enterogenous Cyst

Intracranial enterogenous cysts are uncommon and for such cysts to extend in both supra- and infratentorial compartments is even rarer. We report a 20-year-old woman who presented with an 8-month history of gradual onset progressive headache, left hemiparesis, left deafness, unsteadiness, and blurred vision. On examination she had sensorineural deafness on the left, left trigeminal and left hypoglossal cranial nerve palsies, left hemiparesis (4/5 MRC), and bilateral papilledema. MRI scan demonstrated a very large cystic lesion involving the left temporal and peri-insular region and the left CPA region, with gross midline shift and compression of the left lateral ventricle. Histopathological examination of the cyst and its capsule confirmed an enterogenous cyst. There have been only two other cases of this nature and extent reported in the literature.

Horner's Syndrome and Trigeminal Nerve Palsy following Epidural Analgesia for Labor

Epidural analgesia is a widely used method of pain control in the labor and delivery setting but is not without risks. We present a case of Horner's syndrome and trigeminal nerve palsy as a rare complication of epidural analgesia in an obstetric patient. Although reported in few instances in the anesthesia literature, awareness among providers in obstetrics is critical because this could be the first sign of a high sympathetic blockade resulting in potential maternal-fetal morbidity.

脳卒中の外科における合併症の予防と対策 硬膜動静脈ろうの血管内治療における合併症の現状と対策

To evaluate complications and their prevention in endovascular treatment of dural arteriovenous fistulas (AVFs), we analyze the medical records of 105 patients (47 men 58 women, mean age of 64.2 years) treated with endovascular procedures from 1990 to 2003 in our clinic. Dural AVF was located at the cavernous sinus in 43 patients, transverse-sigmoid sinus in 43, and other regions in 19. There were 201 procedures, including 97 transarterial embolizations (TAE), 84 transvenous embolizations (TVE), 17 surgical TVEs, and 3 sinoplasties. Twelve complications were recorded in 10 patients (3 cavernous sinus, 5 transverse-sigmoid sinus, and 2 craniocervical junction lesions). The complications were divided into 4 categories: wrong strategy (1 case), venous thrombosis (2 cases), procedural error (7 cases), and general condition (1 case; pulmonary embolism). One of the superficial middle cerebral veins was obliterated after coiling of the cavernous sinus in 1 patient, resulting in a mild transient hemiparesis (wrong strategy). The syndrome of paradoxical worsening occurred in 1 patient with cavernous sinus dural AVF after TAE (venous thrombosis of the central retinal vein). One patient with sigmoid sinus dural AVF suffered long-lasting dizziness after TVE. Ipsilateral endolymphatic hydrops were observed and speculated to be a causative factor of the patient's dizziness (venous thrombosis of the inner ear). The procedural error included trigeminal nerve palsy due to excess coil packing (1 case in TVE), ischemic cranial neuropathy (3 cases in TAE), and migration of the embolic materials via the feeding arterial collateral network (3 cases in TAE). Morbidity and mortality were 4.8% and 1.0%, respectively. We discuss causes and preventive measures.

Vesicular Eruption in a Child With Trigeminal Nerve Palsy During TopicalTherapy With Substance P and Insulinlike Growth Factor I for NeurotrophicKeratitis

Vesicular Eruption in a Child With Trigeminal Nerve Palsy During TopicalTherapy With Substance P and Insulinlike Growth Factor I for NeurotrophicKeratitis

Surgery of cerebellopontine angle epidermoid cysts: Role of the widened retrolabyrinthine approach combined with endoscopy

Objectives To evaluate the use of the retrolabyrinthine approach (RLA) combined with endoscopy with particular reference to preservation of cranial nerve function and completeness of excision in surgery of epidermoid cysts. Methods A retrospective study was performed on a series of 8 consecutive patients of whom 7 have undergone surgery. Main outcome measures Measures include audiological and neurological status preoperatively and postoperatively, size of the lesion, the surgical approach, completeness of excision, and operative morbidity. Results The tumors were all large, ranging from 2 × 3 cm to 6 × 6 cm. Presenting symptoms were headache (75%), dysequilibrium (62%), trigeminal nerve palsy (38%), abducens nerve palsy (25%), and, rarely, auditory symptoms. Seven patients underwent surgery, 5 by the RLA, 1 by a translabyrinthine approach (TLA), and 1 by a transcochlear approach. Complete excision was achieved in 5 of the 7 patients. A transtentorial approach was combined in 2 cases (1 RLA, 1 TLA). Endoscopy was used in 3 cases. It allowed a complete tumor excision. One case of keratinous meningitis was observed. Trigeminal nerve function returned to normal in all patients. Postoperative facial nerve function was grade I in 5 cases and grade III in 2 cases. Hearing was preserved in 3 cases as class A, 1 case as class B. In the 2 cases presenting with abducens nerve palsy preoperative symptoms were initially aggravated before returning to normal function by 1 year postoperatively. The RLA with endoscopy allowed less invasive surgery and preservation of hearing in 4 of the 5 cases where it was attempted. Tumor control appeared better than with the suboccipital approach. Mortality and postoperative morbidity also appear reduced. Conclusion RLA combined with endoscopy should be considered as the standard approach for excision of epidermoid cysts. Extension of this approach into a TLA or transcochlear approach will depend on preoperative difficulties and preoperative hearing.

Abducens schwannoma inside the cavernous sinus proper: case report

Background Only 2 cases of abducens nerve schwannoma solely inside the cavernous sinus have been reported. In both cases, abducens nerve palsy remained after operation. We report the first case of abducens nerve schwannoma inside the cavernous sinus proper with postoperative recovery from abducens nerve palsy. Case description The patient was a 47-year-old female who developed left abducens and trigeminal nerve palsies. Neuroradiological examination revealed left intra-cavernous sinus tumor. Total removal of the tumor was performed. The location of the tumor was confirmed intraoperatively inside the cavernous sinus itself, with no relation to the trigeminal nerve. Further, the relation of the tumor to one particular nerve fiber within the abducens nerve bundle was confirmed inside the cavernous sinus. After surgery, the patient had transient abducens nerve palsy. It had totally disappeared by 6 months. Conclusion When the tumor origin is just within the spacious cavernous sinus rather than more posterior in the narrow dural tunnel of Dorello's canal, successful preservation of the nerve function is possible postoperatively through a thorough knowledge of the membranous anatomy and careful preoperative study of the radiographic findings.

Hamartoma in the internal auditory canal

An 11 year old girl presented with hearing loss in her left ear and left trigeminal and facial nerve palsy. Radiological examinations revealed an enlargement of the left internal acoustic canal and the existence of a mass protruding from the canal into the cerebellopontine angle. The partial resection of the mass by a suboccipital craniectomy resulted in ceasing the progression of her symptoms. Histological diagnosis was hamartoma with cerebellar heterotopia. The concurrence of heterotopic cerebellar tissue could help to understand the pathogenesis of hamartomas.

Horner’s syndrome and trigeminal nerve palsy after lumbar epidural analgesia for labor and delivery

This report highlights transient Horner’s syndrome and trigeminal nerve palsy following labor epidural analgesia. A 29-year-old primigravida had a lumbar epidural catheter placed for analgesia in labor. The analgesia was maintained by infusion of a dilute local anesthetic/opioid mixture and turned off after achieving complete cervical dilation. Approximately 1 hour after delivery she complained of heaviness in her left eyelid, and was noted to have left-sided ptosis and paresthesia within the distribution of the ophthalmic and maxillary divisions of the trigeminal nerve, which resolved over the next 2 hours. There were no other neurologic changes. Horner’s syndrome and cranial nerve palsies can occur as a consequence of epidural analgesia for labor.

Fractionated stereotactic radiotherapy for vestibular schwannoma (VS): Comparison between cystic-type and solid-type VS

Purpose: To compare the effectiveness and complications of fractionated stereotactic radiotherapy (SRT) for cystic-type vestibular schwannoma (VS) with those of solid-type VS. Methods and Materials: In 65 patients treated with fractionated SRT between 1991 and 1999, 20 were diagnosed with cystic VS, in which at least one-third of the tumor volume was a cystic component on magnetic resonance imaging (MRI), and 45 were diagnosed with solid VS. Thirty-six Gy to 50 Gy in 20–25 fractions was administered to the isocenter and approximately 80% of the periphery of the tumor. All cystic and solid components were included in the gross tumor volume. The mean follow-up period was 37 months, ranging from 6 to 97 months. Results: The actuarial 3-year rate of no episode of enlargement greater than 2.0 mm was 55% for cystic-type and 75% for solid-type VS; the difference was statistically significant ( p = 0.023). The actuarial 3-year tumor-reduction (reduction in tumor size greater than 2.0 mm) rates were 93% and 31%, respectively ( p = 0.0006). The overall actuarial tumor control rate (no tumor growth greater than 2.0 mm after 2 years or no requirement of salvage surgery) was 92% at 5 years in 44 patients with a follow-up period of 2 or more years. There was no difference in the class hearing preservation rate between cystic VS and solid VS. No permanent trigeminal or facial nerve palsy was observed in either group. Conclusion: Transient tumor enlargement occurs in cystic VS more frequently than in solid-type VS, but the subsequent tumor-reduction rate in cystic VS is better.

Corneal ulcer associated with deposits of norfloxacin

To report a case of corneal ulcer associated with deposits of norfloxacin. Case report. A 40-year-old man with right trigeminal and facial nerve palsies and decreased tear secretion developed a corneal ulcer with white deposits in the right eye. The deposits were removed and analyzed by high-performance liquid chromatography. High-performance liquid chromatography results disclosed that the deposits on the corneal surface had the same retention time as norfloxacin. The patient discontinued norfloxacin ophthalmic solution and recovered successfully. Clinicians should be aware that frequent applications of topical norfloxacin in patients with decreased tear secretion may result in deposition of the drug on the cornea.

Treatment of cranial base meningiomas with linear accelerator radiosurgery.

Radiosurgery is increasingly being used to treat cranial base tumors. Since 1989, 55 patients with cranial base meningiomas were treated at Stanford University Medical Center with linear accelerator radiosurgery. An analysis of the clinical and radiographic results of this patient population was the focus of this study. The mean patient age was 55.1 years (range, 28-82 yr). The mean tumor volume was 7.33 cm3 (range, 0.45-27.65 cm3). The radiation dose averaged 18.3 Gy (range, 12-25 Gy), delivered with an average of 2.2 isocenters (range, 1-5). Patients were evaluated retrospectively through clinic notes from follow-up examinations, and residual tumor volume was measured during follow-up imaging studies. The length of follow-up averaged 48.4 months (range, 17-81 mo). Tumor stabilization after radiosurgery was noted in 38 patients (69%), shrinkage in 16 patients (29%), and enlargement in only 1 patient (2%). The results of follow-up magnetic resonance imaging demonstrated decreased central contrast uptake in 11 meningiomas (20%), possibly indicating evidence of central tumor necrosis or tumor vessel obliteration. Neurological status was improved in 15 patients in the series (27%) and unchanged in 34 patients (62%). Three patients (5%) died during the follow-up period, all as a result of causes other than tumor progression. Three patients (5%) developed new permanent symptoms (one patient with seizures, one patient with mild right hemiparesis, and one patient with both vagal and hypoglossal nerve palsy). All other complications were transient, including partial trigeminal nerve palsy in seven patients and diplopia in three patients. The 2-year actuarial tumor control rate was 98%. Although our follow-up period is short, this experience corroborates previous reports that radiosurgery can be used to ablate selected small cranial base meningiomas, with good clinical results and modest morbidity.

Carotid artery hemorrhage resulting from temporal bone fracture

Temporal bone fractures represent 22% of all skull fractures and are being recognized more frequently as a result of high-resolution computed tomography (CT).l These fractures are commonly caused by blunt head trauma associated with motor vehicle accidents or falls. The clinical manifestations of temporal bone fractures include hemotympanum, hearing loss, vertigo, facial paralysis, and cerebrospinal fluid otorrhea. 2 Ghoyareb et al2 documented several unusual complications of temporal bone fractures, including abducens palsy, trigeminal paralysis, and aseptic sigmoid sinus thrombosis. Injuries to the petrous carotid artery in temporal bone fracture have not been widely reported in the English literature. This rare case of internal carotid artery injury from temporal bone fracture serves to characterize the clinical presentation of this complication and is the first such report to include CT confirmation of petrous carotid artery rupture.

V-4-55 - Disrupted and migrated microcatheter in the vertebrobasilar system in endovascular embolization of cerebellar AVM: Failure in endovascular and microneurosurgical retrieval

To evaluate the use of the retrolabyrinthine approach (RLA) combined with endoscopy with particular reference to preservation of cranial nerve function and completeness of excision in surgery of epidermoid cysts.A retrospective study was performed on a series of 8 consecutive patients of whom 7 have undergone surgery.Measures include audiological and neurological status preoperatively and postoperatively, size of the lesion, the surgical approach, completeness of excision, and operative morbidity.The tumors were all large, ranging from 2 × 3 cm to 6 × 6 cm. Presenting symptoms were headache (75%), dysequilibrium (62%), trigeminal nerve palsy (38%), abducens nerve palsy (25%), and, rarely, auditory symptoms. Seven patients underwent surgery, 5 by the RLA, 1 by a translabyrinthine approach (TLA), and 1 by a transcochlear approach. Complete excision was achieved in 5 of the 7 patients. A transtentorial approach was combined in 2 cases (1 RLA, 1 TLA). Endoscopy was used in 3 cases. It allowed a complete tumor excision. One case of keratinous meningitis was observed. Trigeminal nerve function returned to normal in all patients. Postoperative facial nerve function was grade I in 5 cases and grade III in 2 cases. Hearing was preserved in 3 cases as class A, 1 case as class B. In the 2 cases presenting with abducens nerve palsy preoperative symptoms were initially aggravated before returning to normal function by 1 year postoperatively. The RLA with endoscopy allowed less invasive surgery and preservation of hearing in 4 of the 5 cases where it was attempted. Tumor control appeared better than with the suboccipital approach. Mortality and postoperative morbidity also appear reduced.RLA combined with endoscopy should be considered as the standard approach for excision of epidermoid cysts. Extension of this approach into a TLA or transcochlear approach will depend on preoperative difficulties and preoperative hearing.

V-4-54 - Intraoperative bleeding in early surgery of vertebral artery aneurysms

To evaluate the use of the retrolabyrinthine approach (RLA) combined with endoscopy with particular reference to preservation of cranial nerve function and completeness of excision in surgery of epidermoid cysts.A retrospective study was performed on a series of 8 consecutive patients of whom 7 have undergone surgery.Measures include audiological and neurological status preoperatively and postoperatively, size of the lesion, the surgical approach, completeness of excision, and operative morbidity.The tumors were all large, ranging from 2 × 3 cm to 6 × 6 cm. Presenting symptoms were headache (75%), dysequilibrium (62%), trigeminal nerve palsy (38%), abducens nerve palsy (25%), and, rarely, auditory symptoms. Seven patients underwent surgery, 5 by the RLA, 1 by a translabyrinthine approach (TLA), and 1 by a transcochlear approach. Complete excision was achieved in 5 of the 7 patients. A transtentorial approach was combined in 2 cases (1 RLA, 1 TLA). Endoscopy was used in 3 cases. It allowed a complete tumor excision. One case of keratinous meningitis was observed. Trigeminal nerve function returned to normal in all patients. Postoperative facial nerve function was grade I in 5 cases and grade III in 2 cases. Hearing was preserved in 3 cases as class A, 1 case as class B. In the 2 cases presenting with abducens nerve palsy preoperative symptoms were initially aggravated before returning to normal function by 1 year postoperatively. The RLA with endoscopy allowed less invasive surgery and preservation of hearing in 4 of the 5 cases where it was attempted. Tumor control appeared better than with the suboccipital approach. Mortality and postoperative morbidity also appear reduced.RLA combined with endoscopy should be considered as the standard approach for excision of epidermoid cysts. Extension of this approach into a TLA or transcochlear approach will depend on preoperative difficulties and preoperative hearing.

Bilateral trigeminal nerve palsy during an extensive lumbar epidural block

A rare case of trigeminal nerve blockade arising in the course of obstetric lumbar epidural anaesthesia is described. There was extensive bilateral spread of nerve-block up to the C4 level with respiratory distress after top-up for caesarean section, and subsequent epidurography revealed high epidural spread of contrast. The mechanism of the trigeminal nerve palsy was the source of some controversy, particularly as to whether intracranial spread of local anaesthetic had occurred, possibly following accidental subdural or subarachnoid injection.

神経麻ひで判明した翼口蓋か腺様嚢胞癌例

Adenoid cystic carcinoma is a common malignant tumor which usually arises in the salivary glands but occasionally arises in the nasal or paranasal cavity.We report an unusual case of adenoid cystic carcinoma in a 39-year-old woman who presented right trigeminal and hypoglossal nerve palsy. MRI showed a diffuse tumor mass in the right paranasal sinuses infiltrating to the base of the skull. We thought the tumor originated in the posterior wall of the right maxillary antrum and the pterygopalatine fossa, then spread posteriorly to the cavernous sinus along the infraorbital nerve and inferiorly along the internal carotid artery.We concluded that it was too late for a curative resection, and a total of 63.2 Gy radiotherapy was administered. Following therapy, the tumor regressed in size, but did not disappear.