Trigeminal Sinire Vasküler Temasın Araştırıldığı Bir Kadavra Çalışması

Amaç: Trigeminal sinirin sisternal segmenti içinde kök varyasyonları, roor enter zone’a vasküler basının normal popülasyondaki dağılımını araştırmak.Gereç ve Yöntemler: Basit rastgele örneklem metoduyla seçilmiş 30 taze kadavrada, 60 trigeminal sinir, trigeminal sinir beyinsapı çıkış noktasından, Mekcel’s cave giriş noktasına kadar binoküler lup ile mikrocerrahi set kullanılarak araknoid diseksiyonu yapılmıştır. Sisternal segment içinde trigeminal sinirin ve vasküler yapılarla olan komşuluk ilişkileri ve tipleri araştırıldı. Bulgular: 30 vasküler temasın saptandığı olgularda 22 %73,3 ’sinde arter, 8 %26,6 ’inde venöz yapılar görüldü. Arteriel yapıların 14 %46,6 ’ünde süperior cerebellar arter, 8 %26,6 ’inde anterior inferior cerebellar arter olarak tanımlandı. Süperior petrozal ven, trigeminal sinire venöz temastan sorumlu bulunmuştur.Sonuç: Bu kadavra çalışmasının sonuçlarına göre vasküler temas insidental olarak normal populasyonun %50’sinde görülmektedir

Anahtar Kelimeler:

Trigeminal sinir, Kadavra, Anatomik çalışma, Vasküler yapılar

A Cadaver Study for Investigating Vascular Contact with the Trigeminal Nerve

Objective: The present study investigates root variations within the cisternal segment of the trigeminal nerve and the distribution of vascular compression at the root entry zone in a normal population. Material and Methods: In total, 60 trigeminal nerves taken from 30 fresh cadavers, selected based on a simple random sampling method, were dissected with an arachnoid dissection from the exit point of the trigeminal nerve from the brainstem until the point of entry to Meckel’s cave using a binocular loop and microsurgery set. The vicinity of the vascular structures and the types of trigeminal nerve in the cisternal segment were investigated. Results: In total, 30 cases of vascular contact were detected, involving arterial and venous structures in 22 73.3% and 8 26.6% cases, respectively. Arterial structures were defined as the superior cerebellar artery and the anterior inferior cerebellar artery in 14 46.6% and 8 26.6% cases, respectively. The superior petrosal vein was found to be responsible for venous contact to the trigeminal nerve.Conclusion: The results of this cadaveric study showed that vascular contact could be incidentally found in 50 percent of the normal population

Keywords:

Trigeminal nerve, Cadaver, Anatomical study, Vascular structures,

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1. Joo W, Yoshioka F, Funaki T, Mizokami K, Rhoton AL. Microsurgical anatomy of the trigeminal nerve. Clin Anat 2014; 27(1):61-88.
2. Daniels DL, Pech P, Pojunas KW, Kilgore DP, Williams AL, Haughton VM. Trigeminal nerve: Anatomic correlation with MR imaging. Radiology 1986; 159(3):577-83.
3. Fitzgerald MJT.Clinical neuroanatomy and related neuroscience. W. B. Saunders, New York 2002; 175-80.
4. Klun B, Prestor B. Microvascular relations of the trigeminal nerve: An anatomical study. Neurosurgery 1986; 19(4):535-9.
5. Wilson CB, Yorke C, Prideau G. Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm. West J Med 1980; 132:481-4.
6. Yaşargil M. G. Microneurosurgery vol 1. Stuttgart: Georg Thieme Verlag, 1984; 25-53.
7. Bahat D, Ray D, Raslan A. Trigeminal neuralgia in young adults. J Neurosurg 2011; 114:1306-11.
8. Cruccu G, Gronseth G, Alksne J. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol 2008; 15:1013-28.
9. Gronseth G, Cruccu G, Alksne J. Practice parameter: The diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): Report of the Quality Standards Subcommittee of American Academy of Neurology and the European Federation of Neurological Societies. Neurology 2008; 71:1183-90.
10. Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 1967; 26:159-62.
11. Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia N Engl J Med. 1996;334(17):1077-83.
12. Love S, Coakham H. Trigeminal neuralgia pathology and pathogenesis. Brain 2001; 124:2347-60.
13. Thomas K, Vilensky J. The anatomy of vascular compression in trigeminal neuralgia. Clin Anat 2014; 27(1): 89-93.
14. Dandy WE. Concerning the cause of trigeminal neuralgia. J Surg 1935; 24:447-55.
15. Dandy WE. An operation for the cure of tic douloureux. Partial section of the sensory root at the pons. Arch Surg 1929; 18:687-734.
16. Jannetta PJ. Treatment of trigerninal neuralgia by suboccipital and transtentorial cranial operations. Clin Neurosurg 1977; 24:538-49.
17. Janetta PJ, Marc RM, Brent LC, Brian RS, Comey CH, Resnick DK. Microvascular decompression of cranial nerves: Lessons learned after 4400 operations. J Neurosurg 1999; 90: l-8.
18. Haines SJ, Jannetta PJ, Zorub DS. Microvascular relations of the trigeminal nerve: An anatomical study with clinical correlation. J Neurosurg 1980; 52:381-6.
19. Hardy DG, Rhoton AL. Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve. J Neurosurg 1978; 49:669-78.
20. Ramesh VG, Premkumar G. An anatomical study of the neurovascular relationships at the trigeminal root entry zone. J Clin Neurosci 2009; 16(7):934-6.
21. Miller J, Acar F, Hamilton B, Burchiel K. Preoperative visualization of neurovascular anatomy in trigeminal neuralgia. J Neurosurg 2008; 108(3):477-82.
22. Yousry I, Moriggl B, Holtmannspoetter M, Schmid UD, Naidich TP, Yousry TA. Detailed anatomy of the motor and sensory roots of the trigeminal nerve and their neurovascular relationships: A magnetic resonance imaging study. J Neurosurg 2004; 101:427-34.
23. Ueda F, Suzuki M, Fujinaga Y, Kadoya M, Takashima T. In vivo anatomical analysis of arterial contact with trigeminal nerve: Detection with three-dimensional spoiled grass imaging. Br J Radiol 1999; 72:838-45.