Transient magnetic resonance imaging signal alterations in the brainstem after microvascular decompression for trigeminal neuralgia: case report.
OBJECTIVE
We present a case of transient signal alterations along the brainstem path of the trigeminal nerve after microvascular decompression in a patient with trigeminal neuralgia. Such signal changes have been previously reported to represent infarction, but in our patient, they seemed to represent reactive neural and nuclear changes attributable to operative manipulation.


METHODS
A 43-year-old woman presented with gradually increasing, medically refractory recurrent trigeminal neuralgia 16 months after initial successful microvascular decompression for trigeminal neuralgia. Repeat microvascular decompression resulted initially in complete pain relief; however, her pain suddenly returned on the 3rd postoperative day. Magnetic resonance imaging (MRI) of this recurrent pain revealed new signal alterations along the brainstem path of the trigeminal nerve. Other than marked reduction in her trigeminal neuralgia, the patient had no postoperative alterations of trigeminal sensory or motor function.


METHODS
The patient's residual postoperative trigeminal neuralgia was successfully treated with carbamazepine. Because of the absence of worrisome signs and symptoms corresponding to the MRI signal alterations, no additional therapy was elected. Follow-up MRI in 1 month revealed near-complete resolution of the postoperative signal alterations along the brainstem path of the trigeminal nerve.


CONCLUSIONS
MRI signal alterations along the brainstem path of the trigeminal nerve after microvascular decompression may be only reactive and do not always represent infarction. Depending on the clinical picture, observation may be all that is necessary in such cases.
Ali
M Jafer
MJ
Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
Gebarski
Stephen
S
Thompson
B Gregory
BG
D000328:Adult; D001933:Brain Stem / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D002196:Capillaries / Q000601:surgery*; D002220:Carbamazepine / Q000627:therapeutic use; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D014277:Trigeminal Neuralgia / Q000188:drug therapy / Q000601:surgery*
D002220:Carbamazepine