Annals of medicine and surgery (2012) · 2024
Chiari malformation and its influence on trigeminal neuralgia: a systematic review.
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Badary Amr, Almealawy Yasser F, Florez-Perdomo William A, Sanker Vivek, Andrew Awuah Wireko, Abdul-Rahman Toufik, Salam Alabide Arwa, Alrubaye Sura N, Saleh Aalaa, Ergen Anil, Chaurasia Bipin, Azab Mohammed A, Atallah Oday
Аннотация
OBJECTIVE: In order to properly understand the correlation between TN and Chiari malformation type I (CMI), it is imperative to delve into the underlying processes and develop efficacious treatment strategies.
METHODS: A comprehensive search was performed regarding trigeminal neuralgia (TN) in individuals diagnosed with CMI. A total of 19 cases were identified in the existing literature.
RESULTS: The review of 19 studies showed that the most commonly affected division was V2 (31.6%), followed by V3 (10.5%) and V1 (5.3%). Radiological findings were variable. The medulla oblongata was compressed in 6 patients (31.6%), the cervical spinal cord showed abnormalities in 3 patients (15.8%) abnormalities; one cervical myelocele (5.26%), two cervical syringomyelia (10.53%) while 5 patients (26.3%) showed normal findings. The skull bones in 4 patients (21,1%) showed deformity in the form of small posterior fossa or platybasia. The surgical treatment was conducted in 14 patients (73.7%). The study suggested that posterior fossa decompression (PFD) plus microvascular decompression (MVD) dual surgical modality yielded the best results for V2 distribution (P=0.017).
CONCLUSION: Chiari malformation type I can directly influence the occurrence and severity of trigeminal neuralgia. Therefore, an effective management of this malformation, like neurovascular decompression, PFD or ventriculoperitoneal shunt, can act as a potential treatment for trigeminal neuralgia. While the PFD alone was effective in the V3 and V1 distribution of trigeminal neuralgia, PFD plus microvascularplus plus microvascular decompression (MVD) as a dual surgical modality yielded the best results for V2 distribution.
METHODS: A comprehensive search was performed regarding trigeminal neuralgia (TN) in individuals diagnosed with CMI. A total of 19 cases were identified in the existing literature.
RESULTS: The review of 19 studies showed that the most commonly affected division was V2 (31.6%), followed by V3 (10.5%) and V1 (5.3%). Radiological findings were variable. The medulla oblongata was compressed in 6 patients (31.6%), the cervical spinal cord showed abnormalities in 3 patients (15.8%) abnormalities; one cervical myelocele (5.26%), two cervical syringomyelia (10.53%) while 5 patients (26.3%) showed normal findings. The skull bones in 4 patients (21,1%) showed deformity in the form of small posterior fossa or platybasia. The surgical treatment was conducted in 14 patients (73.7%). The study suggested that posterior fossa decompression (PFD) plus microvascular decompression (MVD) dual surgical modality yielded the best results for V2 distribution (P=0.017).
CONCLUSION: Chiari malformation type I can directly influence the occurrence and severity of trigeminal neuralgia. Therefore, an effective management of this malformation, like neurovascular decompression, PFD or ventriculoperitoneal shunt, can act as a potential treatment for trigeminal neuralgia. While the PFD alone was effective in the V3 and V1 distribution of trigeminal neuralgia, PFD plus microvascularplus plus microvascular decompression (MVD) as a dual surgical modality yielded the best results for V2 distribution.