Keisuke Onoda*, Yoshifumi Ogasawara, Takahiro Kumono, Yu Hirokawa, Tomihiro Wakamiya, Yuhei Michiwaki, Tatsuya Tanaka, Takashi Agari, Takashi Sugawara, Kazuaki Shimoji, Eiichi Suehiro, Fumitaka Yamane, Hiroshi Itokawa and Akira Matsuno

Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Japan

*Corresponding Author: Keisuke Onoda, Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Japan.

Received: July 08, 2023; Published: August 16, 2023

Abstract

Reports on surgical treatment for postherpetic trigeminal neuralgia have not been encountered. Hence, we described a case of postherpetic trigeminal neuralgia treated with microvascular decompression and obtained positive outcomes. We also included a literature review of the surgical findings. We reported a case involving a 70-year-old man who had herpes zoster infection in the region of the third branch territory of the right trigeminal nerve for 24 years prior with persistent burning pain and numbness in the region without a trigger. His initial medical therapy provided by the family physician was no longer effective. Facial pain and numbness substantially reduced his quality of life. Therefore, he presented to our department for further treatment. His Barrow Neurological Institute pain intensity score was IV. Magnetic resonance imaging revealed trigeminal nerve compression by the superior cerebellar artery. Written informed consent was obtained, and microvascular decompression was performed using the right retrosigmoid approach. No substantial trigeminal nerve compression by the superior cerebellar artery was observed. However, the trigeminal nerve was atrophied. Subsequently, the superior cerebellar artery was moved to decompress the trigeminal nerve. Internal neurolysis was performed as an additional procedure because the degree of compression was less severe. Postoperative facial pain and numbness improved. Surgical treatment of postherpetic trigeminal neuralgia may be considered based on careful review, informed consent, and precise surgical techniques.

Keywords: Herpes Zoster; Trigeminal Neuralgia; Microvascular Decompression; Trigeminal Nerve

References

1. Nalamachu Srinivas and Patricia Morley-Forster. "Diagnosing and Managing Postherpetic Neuralgia”. Drugs and Aging 11 (2012): 863-869.
2. Takao Yukiko., et al. "Incidences of Herpes Zoster and Postherpetic Neuralgia in Japanese Adults Aged 50 Years and Older From a Community-based Prospective Cohort Study: The SHEZ Study”. Journal of Epidemiology 10 (2015): 617-625.
3. Li Guo-Wei., et al. "Clinical Characteristics and Treatment of Trigeminal Neuralgia Following Herpes Zoster”. The Journal of Craniofacial Surgery 5 (2015): e448-451.
4. López-Elizalde., et al. "Minimally Invasive Asterional Approach for Microvascular Decompression in Trigeminal Neuralgia”. Gaceta medica de Mexico 1 (2019): S56-S63.
5. Baschnagel Andrew M., et al. "Trigeminal Neuralgia Pain Relief After Gamma Knife Stereotactic Radiosurgery”. Clinical Neurology and Neurosurgery 117 (2014): 107-111.
6. Sabourin Victor., et al. "Internal Neurolysis for the Treatment of Trigeminal Neuralgia: A Systematic Review”. World Neurosurgery 158 (2022): e829-e842.
7. Raja SN., et al. "Opioids Versus Antidepressants in Postherpetic Neuralgia: A Randomized, Placebo-Controlled Trial”. Neurology 7 (2002): 1015-1021.
8. Urgosík D., et al. "Treatment of Postherpetic Trigeminal Neuralgia with the Gamma Knife”. Journal of Neurosurgery 3 (2000): 165-168.
9. Onoda Keisuke., et al. "A Case of Nervus Intermedius Neuralgia”. World Neurosurgery 137 (2020): 89-92.
10. Kondo A. "Follow-up Results of Microvascular Decompression in Trigeminal Neuralgia and Hemifacial Spasm”. Neurosurgery 1 (1997): 46-51.
11. Oaklander Anne Louise. "Mechanisms of Pain and Itch Caused by Herpes Zoster (shingles)”. The Journal of Pain 9-1.1 (2008): S10-18.

Citation

Citation: Keisuke Onoda., et al. “A Surgical Case of Postherpetic Trigeminal Neuralgia". Acta Scientific Neurology 6.8 (2023): 10-13.

Copyright

Copyright: © 2023 Keisuke Onoda., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.