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Surgical Treatment of Cerebellopontine Angle Cholesteatoma Presenting with Trigeminal Neuralgia

Author: LiLiang
Tutor: MaYi
School: Dalian Medical University
Course: Surgery
Keywords: cerebellopontine Angle cholesteatoma trigeminal neuralgia microscopic vascular decompression
CLC: R739.41
Type: Master's thesis
Year: 2012
Downloads: 5
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Abstract


Objective:The symptom with trigeminal neuralgia (TN) caused by cerebellopontine angle(CPA) cholesteatoma may be clinically indistinguishable from TN with a vascular cause.There is a controversy regarding extent of removal. The purpose of this study is todiscuss the clinical characteristics and surgical outcomes of CPA cholesteatomaspresenting with trigeminal neuralgia.Methods:The79patients with CPA cholesteatoma who presented with TN have acceptedthe surgical treatment in The Secondary Neurosurgery of The People’s Hospital ofLiaoning Province,and all patients underwent tumor removal via the suboccipitalretrosigmoid approach.Through sorting the materials of admission,image and surgeryvideos,consulting literature and follow-up,the follow-up period ranged from5to97months(mean31.8months),27cases lost to follow-up, we obtain and analyze thematerials of52patients.Results:The average age of52patients with CPA cholesteatoma presenting with trigeminalneuralgia was43.77±11.85years old. The mean age at the onset of symptoms was37.26±10.89years old, and the mean preoperative duration of symptoms was6.57±5.30years old. All patients did not remove the tumor completely. Subtotal removal (with onlyremnants of the capsule remaining) in47, and partial removal (partial tumor remaining) in5. Microvascular decompression of the trigeminal nerve were performed simultaneouslyin5cases (9.6%) coexisting arterial compression at the REZ..The symptom was relieved completely in44cases (84.6%), partial relief in7cases(13.5%) and no relief in1case(1.9%). No deaths were occurred in52patients of ourseries. Postoperative complications included5cases (9.6%) with facial hypoesthesia,3 case(s5.8%)with diplopia,4case(s7.7%)with facioplegia,6case(s11.5%)with hearingdisturbance,1case(1.9%)with tinnitus,5cases(9.6%)with aseptic meningitis,3cases(5.8%)with cerebrospinal fluid leakage—1case(1.9%)with otorrhea and2cases(3.8%)with incision leakage,1case(1.9%)with incision infected,1case(1.9%)withinjury of brachial plexus,8cases(15.4%)with herpes labialis.The mean follow-up period was31.8months. The symptom was relievedcompletely in43cases (82.7%), partial relief in4cases (7.7%), and5cases developedrecurrent symptoms: two cases whose symptoms of TN were disappeared in3monthsof postoperation experienced recurrent symptoms after1and2years respectively. Thereare4cases(7.7%)with facial hypoesthesia,1case(1.9%)with diplopia,2case(s3.8%)with facioplegia,6cases(11.5%)with hearing loss and1case(1.9%)with tinnitus.Conclusion:1. TN due to CPA cholesteatoma may be clinically indistinguishable from TNwith a vascular cause. But the occurrence of TN at a younger age is characteristic of TNpatients with cholesteatoma, in contrast with TN due to vascular causes. For young ormiddle-aged people with trigeminal neuralgia,More attention should be paid to excludethe occurrence of the former.2. The suboccipital retrosigmoid approach,to CPA cholesteatoma,is the preferredapproach.3. The principle of operation is that we should remove the tumor as much aspossible on the basis of reducing postoperative complications and surgical risks. For theCPA cholesteatoma presenting with trigeminal neuralgia, specially, the operation wasneeded to dissect the capsule around the trigeminal nerve. MVD should be performed inaddition to tumor removal to attain the decompression of whole course, if coexistingarterial compression at the REZ was recognized. When the capsule is firmly adherent tocritical neurovacular structures and brainstem and the tumour extend largely beyond theoperative field, we should leave adherent portions of the capsule and some contentsbeyond the operative field.4. More attention should be paid to prevention and treatment of aseptic meningitis.It is significant to protect the facial nerve and acoustic nerve, through the gentlyhangding of the nerve to avoid postoperative cranial nerve dysfunction.

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