RESUMO
Trigeminal schwannomas are complex lesions that may be related to many critical neurovascular structures. We present the case of a 59-year-old male presenting a history of left-sided trigeminal neuralgia. Preoperative imaging demonstrated a mass highly suggestive of a trigeminal schwannoma, and microsurgical resection was indicated considering the progressive symptomatology and important mass effect (Video 1). A middle fossa route including an anterior petrosectomy was chosen. The patient was placed supine with the head rotated to the contralateral side, and an arcuate incision was performed. A V-shaped zygomatic osteotomy was done to mobilize the temporalis muscle more inferiorly and better expose the middle fossa floor. Following craniotomy, peeling of the dura propria from the lateral wall of cavernous sinus was carried out starting by coagulation of middle meningeal artery. Some tumor was already identified and removed, and then the anterior petrosectomy was performed until we exposed the posterior fossa dura. The middle fossa dural incision was connected with the other one at the posterior fossa dura, by coagulation of the superior petrosal sinus. The tentorium was completely cut toward the incisura. After lesion debulking, the tumor was progressively removed by peeling the arachnoid from the lesion to maintain arachnoid planes and preserve the nerves and their blood supply. Postoperative imaging demonstrated complete tumor resection. The patient's symptoms improved, and there were no neurologic deficits on follow-up. Extensive laboratory training is fundamental to be familiarized with the normal anatomic nuances and prepared to face the anatomy distorted by lesion. Informed consent was obtained from the patient for the procedure and publication of this operative video.
Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Microcirurgia/métodos , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Osso Petroso/cirurgia , Doenças do Nervo Trigêmeo/cirurgia , Fossa Craniana Média/cirurgia , Neoplasias dos Nervos Cranianos/complicações , Craniotomia , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/complicações , Doenças do Nervo Trigêmeo/complicações , Neuralgia do Trigêmeo/etiologiaRESUMO
Trigeminal trophic syndrome occurs secondary to trigeminal nerve injury, leading to anaesthesia and paraesthesia, with consequent vigorous facial skin manipulation and lesion production, simulating other facial diseases such as ulcerative discoid lupus erythematosus, tumours and other artificially produced lesions. Ulceration and destruction of the ala nasi is a typical feature besides scratching end excoriations in the cutaneous segment affected. In this series, we present the features of five patients with trigeminal trophic syndrome, highlighting possible confusion with cutaneous lupus. Differential diagnoses, including discoid lupus erythematosus, are discussed, as well as possible treatment modalities.
Assuntos
Traumatismos Faciais/etiologia , Úlcera Cutânea/etiologia , Doenças do Nervo Trigêmeo/diagnóstico , Adulto , Idoso , Brasil , Dermatite/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Lúpus Eritematoso Cutâneo , Lúpus Eritematoso Discoide , Masculino , Síndrome , Doenças do Nervo Trigêmeo/complicaçõesRESUMO
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.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Úlcera da Córnea/terapia , Lentes de Contato , Oftalmoscopia , Esclera , Tobramicina/uso terapêutico , Nervo Trigêmeo/fisiopatologia , Vitamina A/uso terapêutico , Cicatrização , Ofloxacino/uso terapêutico , Acuidade Visual , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/etiologia , Doxiciclina/uso terapêutico , Ajuste de Prótese , Córnea/inervação , Doenças do Nervo Trigêmeo/complicações , Lubrificantes Oftálmicos , Microscopia com Lâmpada de Fenda , Gabapentina/uso terapêutico , Solução Salina/uso terapêutico , HipestesiaRESUMO
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.
Assuntos
Dor Facial/etiologia , Postura/fisiologia , Curvaturas da Coluna Vertebral/etiologia , Sistema Estomatognático/fisiologia , Transtornos da Articulação Temporomandibular/complicações , Doenças do Nervo Trigêmeo/fisiopatologia , Dor Facial/fisiopatologia , Humanos , Equilíbrio Postural , Curvaturas da Coluna Vertebral/fisiopatologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Doenças do Nervo Trigêmeo/complicaçõesRESUMO
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.
Assuntos
Humanos , Dor Facial/etiologia , Postura/fisiologia , Curvaturas da Coluna Vertebral/etiologia , Sistema Estomatognático/fisiologia , Transtornos da Articulação Temporomandibular/complicações , Doenças do Nervo Trigêmeo/fisiopatologia , Dor Facial/fisiopatologia , Equilíbrio Postural , Curvaturas da Coluna Vertebral/fisiopatologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Doenças do Nervo Trigêmeo/complicaçõesRESUMO
Los schwannomas son tumores de naturaleza benigna o maligna, originados a partir de las células de Schwann de la vaina de mielina de nervios periféricos, autónomos y pares craneanos. Dentro de estos últimos, el nervio trigémino es el segundo en frecuencia en ser afectado. Se presenta el caso de una paciente de 33 años portadora de una neuralgia trigeminal izquierda típica de 4 meses de evolución, con un estudio imagenológico que muestra un tumor originado del nervio infraorbitario izquierdo. Se practica exéresis de la lesión, cuyo estudio histológico revela un schwannoma benigno del nervio infraorbitario. No existen casos con afectación de este nervio publicados a la fecha en la literatura internacional que se ha revisado.
Schwannomas are benign or malignant tumors that arise from Schwann cells in the myelin sheath of peripheral, autonomic or cranial nerves. Among the latter, involvement of the trigeminal nerve is usually the second in frequency. We report the case of a 33 year old patient presenting with a left trigeminal neuralgia of 4 month of evolution. The imaging study showed a tumor of the left infraorbital nerve. The lesion was excised, and the histological study revealed a benign Schwannoma of the infraorbital nerve. To our knowledge, this is the first report of this nerve being affected.
Assuntos
Feminino , Adulto , Humanos , Doenças do Nervo Trigêmeo/diagnóstico , Doenças do Nervo Trigêmeo/terapia , Neoplasias dos Nervos Cranianos/diagnóstico , Neoplasias dos Nervos Cranianos/terapia , Dor Facial/etiologia , Doenças do Nervo Trigêmeo/complicações , Neurilemoma/diagnóstico , Neurilemoma/terapiaAssuntos
Neoplasias dos Nervos Cranianos/complicações , Dor Facial/etiologia , Herpes Zoster da Orelha Externa/patologia , Neurilemoma/complicações , Doenças do Nervo Trigêmeo/complicações , Neoplasias dos Nervos Cranianos/patologia , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Neurilemoma/patologia , Tomografia Computadorizada por Raios X , Doenças do Nervo Trigêmeo/patologiaRESUMO
A anestesia corneana por ser uma condição rara, freqüentemente é confundida ou não diagnosticada durante o exame de rotina do segmento anterior. Relato de caso de um paciente de 18 anos encaminhado ao ambulatório de córnea e doenças externas com quadro clinico de síndrome de olho seco e com diagnóstico provável de síndrome de Sjõgren. Era amblíope de olho direito devido à opacidade corneana no eixo visual secundária a trauma com unha na infância. Foi pesquisada sensibilidade corneana que era ausente em ambos os olhos; olho seco grave e com BUT (tempo de quebra do filme lacrimal) menor que 4 segundos. Foi feito diagnóstico de anestesia corneana congênita associada a hipoestesia do nervo trigêmio pela avaliação neurológica da sensibilidade facial e movimentos bruscos do queixo que evidenciavam alterações sensoriais do nervo. O oftalmologista geral e principalmente o especialista em segmento anterior devem ter como rotina a pesquisa da sensibilidade corneana no exame do segmento anterior.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Córnea/congênito , Hipestesia/congênito , Ceratoconjuntivite/diagnóstico , Doenças do Nervo Trigêmeo/congênito , Nervo Trigêmeo/anormalidades , Doenças da Córnea/complicações , Opacidade da Córnea/complicações , Face/anormalidades , Hipestesia/complicações , Ceratoconjuntivite/etiologia , Exame Neurológico , Doenças do Nervo Trigêmeo/complicaçõesRESUMO
Corneal anesthesia is a rare condition, therefore its diagnosis is frequently impaired or it is not noticed during the anterior segment examination. Case report of a 18-year-old patient referred to our Corneal and External Disease Department who complained of dry eye symptoms and with a suspicion of Sjögren's syndrome. She had amblyopia of the right eye, consequence of corneal leucoma over the visual axis secondary to a fingernail traumatism inflicted by herself in childhood. On the ophthalmologic examination corneal sensitivity was absent in both eyes. Severe dry eye and breakup time less than four seconds. Diagnosis of congenital corneal anesthesia was established, secondary to trigeminal anesthesia found on neurological evaluation of facial sensitivity. She also showed sudden movements of the chin which evidenced sensorial pathology of the trigeminal nerve. The general ophthalmologist and specially anterior segment specialists must perform tests for corneal sensitivity during the routine eye examination.
Assuntos
Doenças da Córnea/congênito , Hipestesia/congênito , Ceratoconjuntivite/diagnóstico , Doenças do Nervo Trigêmeo/complicações , Adolescente , Doenças da Córnea/complicações , Humanos , Hipestesia/complicações , Ceratoconjuntivite/etiologia , Masculino , Doenças do Nervo Trigêmeo/congênitoRESUMO
We describe a female patient with hemimasticatory spasm, a rare movement disorder due to dysfunction of the motor trigeminal nerve of unknown origin. This patient had an excellent response to botulinum toxin therapy.