3 cases of trigeminal nerve pain with cranial depression

1Summary of medical recordscase 1: female, 46 years old, and admitted to hospital in May 2017 with "one year of recurrence after the recurrence of the right-hand facial intermittent lightning-like pain surgery"The nature of the pain is burning, needle-like, sudden burst, duration of several seconds to several minutesThe pain was dominated by the 1st and 2nd branches of the trigeminal nerve, and the third in severe timeThe right side of the face has a clear trigger point, in the external stimulation is very easy to induce, the cold, hot stimulation is particularly obviousOral kamaxipine effect is still available3 years ago the pain worsened and frequent seizures, the patient in the outside hospital under the nerve tearing and the nerve-free alcohol injectionPostoperative facial pain was significantly relieved, but the nerve domination area under the right side of the face remained numb1 year ago the patient had no trigger pain relapsed again, and the effect of the drug treatment on the disease was poorbody: the neck is slightly shorter, the function of the activity is not accessible, the hair is not significantly decreasedThe head MRI examination excluded intracranial occupatic lesions that oppressed the peripheral blood vessels of the trigeminal nerve, and the sacrogenic image considered the cranial base depressionFurther CT examination was identified as cranial depressionAdmission diagnosis: right trident nerve pain; After admission to the hospital in the whole hemp down the trident nerve envelope loose and combingDuring the operation, the right-hand bisinus was taken into the road, fully exposed to the cranial skull around the mastuoroot and star points, and the electric drill and grinding drill formed a 2.5 cm x 2.5 cm bone window, and exposed the edge of the bline and part of the cross-sinusThe arc cuts through the epidural and hangs it in the direction of the sinus Under the microscope, the brain ridge fluid is released and decompressed by looking down along the edge of the cerebellum Due to the patient's cranial depression, the ear door position is relatively upward, the surface hearing nerve walking and the brain stem is parallel state and tension is high, the surgery exposed trident nerve is not ideal, pay attention to protect the surface hearing nerve Under the microscope, the trigeminal nerve is thinned and shortened by pressure, and no visible vascular damage is seen the surgery to loosen the trigeminal nerve envelope, microscopic peeler combs the trident nerve, and give a gasket spout spout around the trident nerve to disperse the pressure of the trigeminal nerve free segment General off cranial, no drainage is placed After the patient is awake, the self-reported pain disappears, accompanied by slight numbness in the right side of the face (before numbing the nerve domination zone of the lower right side) Postoperative diagnosis: right trigeminal nerve pain; craniofacial depression The patient was discharged from the hospital after surgery with a slight numbness on his right face, which was slightly less severe than after surgery No facial palsy and hearing impairment After 2 or 5 months after surgery are given a telephone call back, self-reporting in addition to the right side of the nerve control area of the numbness of no improvement, the rest of the facial numbness basically disappeared Figure 1 with trigeminal nerve pain microsurgery with cranial depression 1A preoperative CT examination is clearly for cranial depression; 1B met in the hearing nerve walkand and brain stem in parallel state and high tension; 1C mirror see trigeminal nerve pressure thinning, shortening, no visible liability blood vessels; 1D The peripheral of the trigeminal nerve was given a gasket to relieve the pressure on the intracranial free section of the trigeminal nerve
cases 2: male, 40 years old, and was admitted to hospital in October 2016 with "eight years of intermittent electric shock-like pain in the left nasal lip ditch" Severe lysadays, the left side of the head and face have pain, has been intermittent oral kamaxipine treatment, the effect is not ideal serious impact on daily life 2 years ago under the line nerve waterless alcohol closed treatment, the effect is poor The CT examination in the hospital was clearly a dent in the base of the skull MRI examination did not see the left side of the trident nerve around the obvious vascular walking, excluding the occupaposition of lesions Check body: the patient's neck is short, the remaining examination did not see obvious abnormalities Admission diagnosis: left trident nerve pain; cranial depression admission programme with case 1 The difficulty of exposure, nerve walking and trigeminal nerve stress were all seen in case 1 In this patient surgery in the trigeminal nerve out of the lower edge of the brain stem can be seen a small blood vessel closely related to the nerve, during the operation to give gasket isolation, parallel trigeminal nerve combing and cobweb loose treatment, to strengthen the effect of postoperative treatment The pain in the left nasal lip ditch disappeared after the operation and the upper and lower lip of the left side was slightly numb After 9d discharged from the hospital, when discharged from the hospital, self-described lip numbness significantly relieved The second and sixth months after the operation called back all normal cases 3: female, 52 years old, and admitted to hospital in December 2015 for "12 years of intermittent electric shock-like pain in the right armof and upper right lip" In severe cases, pain can be radiated to the right side of the stoic and nasal roots, emotional agitation, exertion and hot and cold stimulation can be induced Having practiced Chinese medicine, acupuncture and cream in the hospital, the pain was relieved Recent intermittent exacerbation of symptoms lasts for about 3 months, and the effect of treatment on the disease is poor hospital mrI examination did not show blood vessels around the right trident nerve The CT examination is clearly a dent in the base of the skull Admission to the body neck short, low on the pillow, blood pressure 140/86mmHg, other examination did not see abnormal Admission diagnosis: right trident nerve pain; craniofacial depression The same case seen in the hospital treatment programme and the operation 1 The patient was discharged from the hospital 12d after surgery, and when he was discharged, he described his facial numbness slightly and the pain did not re-attack After 3 or 8 months of telephone call return visit, self-reported pain did not re-attack, the right side of the nasal lip ditch still has a slight numbness, the remaining no obvious abnormalities 2 Discussion cranial depression is a common clinical abnormal disease of nervous system development, the disease is based on the large hole of the pillow bone as the center of the skull bone tissue, vertebrae and pivotal vertebral developmental malformation, vertebral to cranial cavity into, the spinal ventricles higher than normal level into the large hole of the pillow bone, so that the large hole in the pillow bone stenosis, the back of the skull becomes small, thus compressing the myelin, the small brain and pulling nerve root Common clinical manifestations include headache, dizziness, short neck length, low post-hair, limited neck movement, hoarseness, numbness of one side or both upper limbs, pain, muscle atrophy, and fine hand movement disorders with fingers But clinically rare is the secondary trigeminal nerve pain due to cranial depression analysis of the group of 3 cases of trigeminal nerve pain as the main clinical manifestations of cranial depression, its common characteristics are as follows: long onset time, disease in the adult age, neck short, neck function is basically normal, surgery are not well exposed, face-to-hearing nerve walking variation, trigeminal nerve squeeze thinning, nerve scarcity no obvious responsibility blood vessels, operation difficult According to the above analysis: the patient of craniofacial depression due to the change of cranial background structure, the pressure of the later cranial nest increased, resulting in the above situation The trigeminal nerve is located above the cranial endoden, considered to be subject to pressure from the brain stem, cerebellum and the base of the skull, which damages the intracranial free section of the trigeminal nerve under long-term stress, followed by pain symptoms in the trigeminal nerve-dominated area in the past trigeminal nerve microvascular decompression treatment, the trident nerve peripheral patients without obvious responsibility blood vessels, the treatment is trident nerve envelope loose and trigeminal nerve dry combing treatment, do not place gaskets Based on past experience, all three patients were treated according to the above method, but given the clear pressure thinning of the Trident nerve, gaskets were placed around the trigeminal nerve during the operation to relieve the pressure on the trigeminal nerve free segment In the clinical diagnosis and treatment process, patients with long medical history, young age, with short neck should pay more attention to preoperative screening work and preoperative evaluation, reduce the risk of surgery and the incidence of complications