The Tethered Effect of Vestibular Schwannoma Tumor Shrinkage Following Stereotactic Radiosurgery in Secondary Trigeminal Neuralgia
The Tethered Effect of Vestibular Schwannoma Tumor Shrinkage Following Stereotactic Radiosurgery in Secondary Trigeminal Neuralgia
复制标题
立体定向放射外科治疗继发性三叉神经痛后前庭神经鞘瘤肿瘤缩小的系留效应
DOI：
10.1016/j.wneu.2018.12.002
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发表时间：
2019
影响因子：
2
通讯作者：
Yamakami Iwao
中科院分区：
文献类型：
--
作者：
Izumi Masaki;Higuchi Yoshinori;Yakufujiang Maidinamu;Motoshima Takayuki;Horiguchi Kentaro;Aoyagi Kyoko;Nagano Osamu;Serizawa Toru;Iwadate Yasuo;Yamakami Iwao
背景血管和肿瘤压迫三叉神经引起三叉神经痛。然而，先前已报道，引起异常根拉伸力的拴系效应在三叉神经过度兴奋中起作用。我们报告2例前庭神经鞘瘤患者，经立体定向放射外科治疗后，肿瘤缩小后出现典型的三叉神经痛表现。此外，我们还讨论了三叉神经痛的机制。病例描述两名患者没有三叉神经功能障碍的历史，包括三叉神经痛，进行SRS前庭神经鞘瘤。两名患者在SRS后短暂肿瘤扩张后均显示肿瘤缩小。两名患者在肿瘤体积达到峰值时均未出现面部疼痛或感觉迟钝。然而，三叉神经痛发生在肿瘤缩小后。1例患者接受了手术，因为神经痛是药物治疗难治性的;虽然三叉神经粘附并栓系到肿瘤上，但肿瘤和神经之间没有发现神经血管冲突。我们切除了肿瘤的一部分，在神经和肿瘤之间切开，减轻了栓系效应。结论本病例显示SRS后肿瘤缩小的栓系效应，被认为在三叉神经痛中起作用。神经根周围的手术切除对于药物抵抗性神经痛是有效的，即使肿瘤缩小。在这种情况下，部分肿瘤切除是足够的，因为肿瘤已经被放射外科手术控制。
BackgroundCompression of the trigeminal nerve by vessels and tumors causes trigeminal neuralgia. However, a tethering effect, provoking an abnormal root-stretching force, has been previously reported to play a role in trigeminal nerve hyperexcitability. We report 2 patients with vestibular schwannomas treated by stereotactic radiosurgery (SRS) who presented with typical manifestations of trigeminal neuralgia after tumor shrinkage. Furthermore, we discuss the mechanisms of trigeminal neuralgia.Case DescriptionTwo patients without a history of trigeminal dysfunction, including trigeminal neuralgia, underwent SRS for vestibular schwannomas. Both patients demonstrated tumor shrinkage after transient tumor expansion following SRS. Neither patient presented with facial pain or dysesthesia at the time of peak tumor volume. However, trigeminal neuralgia occurred after tumor shrinkage. One patient underwent surgery, as the neuralgia was refractory to medical treatment; although the trigeminal nerve was adhered and tethered to the tumor, no neurovascular conflict was identified between the tumor and the nerve. We removed the tumor partially, dissecting between the nerve and the tumor, and relieved the tethered effect. Trigeminal neuralgia was relieved without medication after surgery.ConclusionsThe present cases demonstrate a tethered effect of tumor shrinkage after SRS, which was considered to play a role in trigeminal neuralgia. Surgical dissection surrounding the nerve root is effective for medically resistant neuralgia, even if the tumor shrinks. Partial tumor removal is adequate in such cases, as the tumor has been controlled by radiosurgery.