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Vol. 26. Num. 2.March - April 2015
Pages 53-104
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Vol. 26. Num. 2.March - April 2015
Pages 53-104
Case Report
DOI: 10.1016/j.neucir.2014.09.003
Decision-making in classic trigeminal neuralgia concurrent with a pontine cavernous malformation: Causal or coincidental association?
La toma de decisiones en la clásica neuralgia del trigémino concurrente con una malformación cavernosa pontina: ¿causa o asociación fortuita?
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Maud Parisea,b,
Corresponding author
, Marcus André Aciolyb, Maurice Vincenta,c, Emerson Leandro Gasparettoa
a Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
b Department of Surgical Specialties, Division of Neurosurgery, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
c Department of Neurology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Table 1. Summary of reported cases of brainstem cavernous malformation presenting with trigeminal neuralgia.
Abstract

Trigeminal neuralgia is classically associated with neurovascular compression of the trigeminal nerve, at the root entry zone (REZ). However, patients are occasionally affected by intra-axial involvement of trigeminal sensory fibers caused by demyelinating diseases, strokes and, rarely, pontine cavernous malformations. We discuss the management strategies and decision-making process in a 55-year-old patient, affected by trigeminal neuralgia with 2 potential causative mechanisms: a neurovascular conflict at the trigeminal REZ and an ipsilateral cavernous malformation at the pontine nucleus of the trigeminal nerve.

Keywords:
Trigeminal neuralgia
Neurovascular compression
Brainstem cavernous malformation
Resumen

La neuralgia del trigémino está clásicamente asociada con la compresión neurovascular del nervio trigémino, en la zona de entrada de la raíz (REZ). Sin embargo, los pacientes son ocasionalmente afectados por la implicación intra-axial de las fibras sensitivas del trigémino causadas por enfermedades desmielinizantes, accidentes cerebrovasculares, y raramente por malformaciones cavernosas pontinas. Se discuten las estrategias y la toma de decisiones en un paciente de 55 años de edad, afectado por la neuralgia del trigémino, con dos posibles mecanismos causales: un conflicto neurovascular en la zona de entrada de la raíz del trigémino y una malformación cavernosa en el núcleo pontino del trigémino ipsilateral.

Palabras clave:
Neuralgia del trigémino
Compresión neurovascular
Malformación cavernosa del tronco cerebral

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