Chiari type 1.5 malformation as a cause of secondary trigeminal neuralgia: case report and literature discussion

IF 0.7 Q4 CLINICAL NEUROLOGY Egyptian journal of neurosurgery Pub Date : 2024-05-02 DOI:10.1186/s41984-024-00264-x
Ahmet Cemil Ergün, Bilal Ertuğrul, Gökhan Yildirim, Metin Kaplan
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Abstract

Chiari syndrome is a very rare cause of secondary trigeminal neuralgia (TN). There are a few cases of TN associated with Chiari syndrome in the literature, and all of these cases were reported as Chiari type 1. In this report, we present a case of secondary trigeminal neuralgia caused by Chiari type 1.5 for the first time unlike the literature. A 38-year-old male patient, who had frequent and severe attacks of pain under the orbit, at the chin and rim of the mouth, was evaluated with craniocervical Magnetic Resonance Imaging (MRI) and revealed Chiari type 1.5 malformation and syringomyelia. The mechanism of TN associated with Chiari malformation is unclear. However, the main concepts emphasized in cases presented in the literature are compression and stretching. The rapid relief of pain after decompression surgery in these cases also supports this situation. It can be predicted that compression and tension forces will become more pronounced in Chiari type 1.5 malformation, in which the brainstem elongation and ventral pressure are more prominent. Decompression of the foramen magnum provides rapid and effective pain control in the treatment of TN accompanying Chiari 1.5 syndrome that does not respond to medical treatment.
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作为继发性三叉神经痛病因的 Chiari 1.5 型畸形:病例报告和文献讨论
恰里综合征是继发性三叉神经痛(TN)的一个非常罕见的病因。文献中有几例与Chiari综合征相关的TN病例,这些病例都被报告为Chiari 1型。在本报告中,我们首次在文献中发现了一例由 Chiari 1.5 型引起的继发性三叉神经痛。一名 38 岁的男性患者经常发作眼眶下方、下巴和口腔边缘的剧烈疼痛,经颅颈部磁共振成像(MRI)评估,发现其患有 Chiari 1.5 型畸形和鞘膜积液。与Chiari畸形相关的TN的发病机制尚不清楚。不过,文献中的病例强调的主要概念是压迫和拉伸。在这些病例中,减压手术后疼痛的迅速缓解也证明了这一点。可以预测,在脑干伸长和腹腔压力更为突出的 1.5 型 Chiari 畸形中,压迫力和拉伸力会变得更为明显。在治疗伴有Chiari 1.5综合征且药物治疗无效的TN时,对枕骨大孔进行减压可快速有效地控制疼痛。
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