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December 11, 2017
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Teaching Video NeuroImages: Trigeminal neuralgia due to compression by the superior cerebellar artery

December 12, 2017 issue
89 (24) e290
A man in his 50s had longstanding left-sided trigeminal neuralgia triggered by eating and brushing his teeth, which was refractory to maximal medical management. MRI fast imaging employing steady-state acquisition demonstrated left trigeminal nerve compression by the left superior cerebellar artery (figure). Therefore, the patient underwent a craniotomy for microvascular decompression (MVD). In select patients, MVD can be an effective treatment for trigeminal neuralgia.1,2 Prognostic indicators of long-term relief include male sex, immediate postoperative relief, and duration of symptoms for less than 8 years.1 The patient's adhered nerve was freed from the artery (video at Neurology.org). Facial pain improved substantially in the immediate postoperative period.
Figure Trigeminal neuralgia imaging and microvascular decompression
(A) MRI fast imaging employing steady-state acquisition demonstrates left trigeminal nerve compression (region marked by red asterisk) by the left superior cerebellar artery (SCA) (yellow arrow). (B) Left retrosigmoid craniotomy (yellow asterisk marks the retractor on the cerebellum) with microsurgical dissection revealed the trigeminal nerve adherent (likely site of compression) to the left SCA (yellow arrow). (C) The nerve was freed from the pulsating artery (yellow arrow; yellow asterisk marks the retractor on the cerebellum).

Teaching Slides

Neurology® data supplements are not copyedited before publication. Published editorials and translations have been copyedited. © 2017 American Academy of Neurology. Files in this Data Supplement:
Teaching Slides - PowerPoint Presentation

Footnote

Download teaching slides: Neurology.org

Supplementary Material

File (827295_video_final.mp4)
File (teachingslides-trigeminal_neuralgia.pptx)
File (video_legend.docx)

REFERENCES

1.
Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996;334:1077–1084.
2.
Sindou M. Microvascular decompression for trigeminal neuralgia. In: Practical Handbook of Neurosurgery. Berlin: Springer; 2009:1448–1462.

Information & Authors

Information

Published In

Neurology®
Volume 89Number 24December 12, 2017
Pages: e290
PubMed: 29229694

Publication History

Published online: December 11, 2017
Published in print: December 12, 2017

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

Joshua Bakhsheshian, MD, MS
From the Department of Neurological Surgery (J.B., B.A.S., M.H.P.), Keck School of Medicine, University of Southern California, Los Angeles; and UC Irvine School of Medicine (K.G.), CA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Khodayar Goshtasbi, BS
From the Department of Neurological Surgery (J.B., B.A.S., M.H.P.), Keck School of Medicine, University of Southern California, Los Angeles; and UC Irvine School of Medicine (K.G.), CA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Ben A. Strickland, MD
From the Department of Neurological Surgery (J.B., B.A.S., M.H.P.), Keck School of Medicine, University of Southern California, Los Angeles; and UC Irvine School of Medicine (K.G.), CA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Martin H. Pham, MD
From the Department of Neurological Surgery (J.B., B.A.S., M.H.P.), Keck School of Medicine, University of Southern California, Los Angeles; and UC Irvine School of Medicine (K.G.), CA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to Dr. Bakhsheshian: [email protected]

Author Contributions

Joshua Bakhsheshian: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and final approval. Khodayar Goshtasbi, Ben Strickland, Martin Pham: acquisition of data, analysis or interpretation of data, accept responsibility for conduct of research and final approval.

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Cited By
  1. A compression and transmission method for surveillance video data using SPICE protocol and DWT in cloud desktop environment, Journal of Ambient Intelligence and Humanized Computing, (2019).https://doi.org/10.1007/s12652-019-01567-w
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