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Otology
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Jameel Muzaffar, Chloe Swords, Adnan Darr, Karan Jolly, Manohar Bance, Sanjiv Bhimrao
Examination: Large lesions or those close to CN (e.g. Meckel cave, cavernous sinus, IAC) may cause CN palsies Commonly CN V/VI as susceptible to compression: Only thin layer of dura between CN and petrous apex
Facial anatomy
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
The mandibular (V3) division of the trigeminal nerve is unique compared to the other branches in that it has both motor and sensory functions. It is the most inferior division and arises from the lower portion of the trigeminal root ganglion. Once it has branched from the ganglion, it travels anteriorly along the floor of Meckel’s cave and through the foramen ovale of the sphenoid bone (posterolateral to the foramen rotundum). The nerve is then sandwiched between the medial tensor muscle of the velum palatinium and lateral pterygoid muscle as it continues to head anteriorly before dividing into a thin anterior and thick posterior trunk.
Clinical Neuroanatomy
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
This is the largest branch of the Vth nerve and includes the motor branch. It exits from the skull base through the foramen ovale, the main sensory trunk being joined by the much smaller motor root, in Meckel’s cave, just outside the skull (Figure 111.8). A meningeal branch re-enters the skull with the middle meningeal artery through the foramen spinosum and conveys sensation from the lateral, middle and anterior cranial fossae. A small branch, the nerve to the medial pterygoid, supplies medial pterygoid, tensor tympani and tensor veli palatini. The main nerve then divides into anterior and posterior trunks.
Primary neurolymphomatosis of the trigeminal nerve
Published in British Journal of Neurosurgery, 2023
Hirotaka Sato, Satoru Hiroshima, Ryogo Anei, Kyousuke Kamada
Our case is the first case of primary NL of the trigeminal nerve that presented with facial pain alone. Iplikcioglu et al.5 also diagnosed a case of primary NL of the trigeminal nerve in a patient admitted with unilateral facial pain and abducens nerve palsy, with the facial palsy rapidly progressing over a short period during the hospital stay. Kinoshita et al.4 also reported a primary NL of the trigeminal nerve in a patient with left side pain, left side lower cranial nerve palsy, and bilateral oculomotor palsy that progressed shortly after hospitalization. Abdel Aziz and van Loveren3 reported a case of facial pain in the V1, V2, and V3 divisions of the trigeminal nerve and abducens nerve palsy on left side. In this case, the main lesion was in Meckel’s cave, and abnormal findings were not observed in the cisternal segment of the trigeminal nerve.
Prepontine cisternal routine for intrathecal targeted drug delivery in craniofacial cancer pain treatment: technical note
Published in Drug Delivery, 2022
Haocheng Zhou, Dong Huang, Dingquan Zou, Junjiao Hu, Xinning Li, Yaping Wang
The prepontine cistern is one subarachnoid space located dorsally to the clivus and ventrally to the pons. The prepontine cistern contains two cranial nerves, that is the fifth cranial nerve (trigeminal nerve) and the sixth cranial nerve (abducens nerve). The abducens nerve has been considered to transverse the anterior pontine membrane rather than through the prepontine cistern (Matsuno et al., 1988). The trigeminal nerve leaves the mid-pons anteriorly and then courses across the space of prepontine cistern. Subsequently, the fifth cranial nerve courses through the porus trigeminus and enters the Meckel cave, which forms the trigeminal or Gasserian ganglion. The trigeminal ganglion then separates into ophthalmic, maxillary and mandibular branches, which mainly governs the sensory perception in the region of face and head.
Management of veins during microvascular decompression for idiopathic trigeminal neuralgia
Published in British Journal of Neurosurgery, 2018
Xu Zhao, Shuai Hao, Minqing Wang, Chao Han, Deguang Xing, Chengwei Wang
A suboccipital superior-lateral cerebellar approach was used for MVD. The superior petrosal veins (SPVs) were released by sharp dissection to avoid vein tearing caused by cerebellar retraction. In occasional cases in which the SPVs severely blocked access to the trigeminal nerve, one tributary that interfered with the manipulation was coagulated and cut. The entire trigeminal nerve from Meckel’s cave to the pons was carefully explored to search for suspicious neurovascular conflicts. The root entry zone (REZ) was defined as the first 5-mm segment of the trigeminal nerve from the entry into the pons.13 After the conflicts were located, the offending vessels were displaced away from the trigeminal nerve by a piece of Teflon pledget placed between the nerve and the offending vessel. Our treatment principle for the offending veins was to save the veins as often as possible. The offending veins were gently dissected and interposed as were the offending arteries. If the offending vein was small (<2 mm in diameter), not a main draining vein, and difficult to dissect, it was coagulated and cut. However, the vein would be saved if it was large (>2 mm in diameter), a main draining vein, a single stem of the SPV, or if it drained from the ventral brainstem.