Table 4.
Summary of cases in groups A and B with preoperative and postoperative signal changes in the brainstem region of the trigeminal nerve
| Case | Age | Sex | Preoperative treatment history | Preoperative symptoms | Intraoperative manipulation | Postoperative symptoms | Postoperative imaging type | Follow up MRI at 6 months |
|---|---|---|---|---|---|---|---|---|
| A-1 | 66 | M | Medication | Stabbing pain inside the mouth | Transposition of the SCA, TCA with teflon | Stabbing pain inside the mouth | a | a |
| A-2 | 58 | F | Medication | Stabbing pain in the forehead and upper eyelid | Coagulation and dissection of the branch of the TPV Transposition of the TPV with fibrin glue | Stabbing pain relieved, but residual pain in the forehead and upper eyelid | a | a |
| A-3 | 79 | F | Medication Percutaneous nerve block | Stabbing pain in the cheek and sublingual zone | Transposition of the SCA, AICA, TCA with teflon | Stabbing pain relieved, but residual pain in the sublingual zone Hypesthesia of the sublingual zone | a | a |
| A-4 | 71 | F | Medication Gamma knife treatment | Stabbing pain in the cheek and sublingual zone | Transposition of the SCA, AICA with teflon | Stabbing pain relieved, but residual pain in the sublingual zone Hypesthesia of the entire face on the surgical side | c | c |
| B-1 | 53 | F | Medication | Stabbing pain inside the mouth | Transposition of the SCA with teflon Coagulation and dissection of the TPV | Dysethesia inside the mouth | a | Not performed |
| B-2 | 61 | M | Medication | Stabbing pain in the cheek | Transposition of the SCA with teflon | Hypesthesia in the cheek | a | Not performed |
| B-3 | 73 | F | Medication | Stabbing pain in the cheek | Transposition of the SCA, AICA, TPV with teflon | Stabbing pain relieved, but residual pain in the cheek | a, b | a, b |
| B-4 | 70 | F | Medication Percutaneous nerve block | Stabbing pain in the sublingual zone | Transposition of the AICA with teflon Transposition of the TPV with fibrin glue | Dysethesia of sublingual zone | a, c | Not performed |
| B-5 | 67 | M | Medication | Stabbing pain in the cheek | Transposition of the SCA, TPV with fibrin glue | Disappearance of symptoms | a | a |
| B-6 | 54 | M | Medication | Stabbing pain in the cheek | Transposition of the SCA with teflon | Disappearance of symptoms | a | Diminished the signal |
In all cases, the causative artery was transposed using Teflon or fibrin glue. In group A, coagulation and dissection of the transverse pontine vein (TPV) branch was performed in one case and attached to the petrous bone with fibrin glue. In group B, arachnoidectomy around the causative vein was performed in four cases. One of them underwent coagulation and dissection of the TPV, while Teflon was used in one patient, and fibrin glue was used in two patients for the transposition of the causative vein.
In group B, three of the six patients underwent 3D T2–SPACE MRI after six months. In one of them (case B-6), the T2 high-intensity signals disappeared, with a resolved symptom of numbness. The remaining two patients had residual T2 high-intensity signals: case B-3 had residual stabbing pain, and case B-5 had resolution of symptoms. SCA, superior cerebellar artery; TCA, trigeminocerebellar artery; TPV, transverse pontine vein; AICA, anterior inferior cerebellar artery