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| 概要 |
神経血管減圧術で,充填物(テフロン・フェルト)の肉芽腫性変化が原因で早期再発をきたした症例を経験した.患者は40歳女性.発作性の右三叉神経痛に対し神経血管減圧術を行った.術後2カ月目に発作性の疼痛が再発したが,テグレトールで経過観察した.術後3年目に突然疼痛が増悪した.テフロン・フェルトは初回手術直後より単純CTで淡い高吸収域を示し,再発時には高吸収域の増大と増強効果を認め,肉芽腫に特徴的な所見を...示した.第2回目手術ではテフロン・フェルトと三叉神経は白色の腫瘤で覆われていた.腫瘤とテフロン・フェルトを摘出し再減圧した.術後疼痛は消失した.組織学的所見は肉芽腫であった. 早期再発例では充填物の肉芽腫性変化もその原因と疑い,単純ならびに造影CTで経過観察を行う必要があると考えられた.
A case of recurrent trigeminal neuralgia due to granulomatous change in a prosthesis (Teflon felt) for microvascullar decompression (MVD) is reported. A 40-year-old woman experiencing right trigeminal neuralgia presented at our institution. A Teflon felt prosthesis was inserted between the caudal loops of the duplicated Superior cerbellar arteries (SCAs) and the pons for MVD. The symptoms of neuralgia resolved immediately after surgery. Two months after Surgery, the trigeminal neuralgia recurred and was controlled by carbamazepine (CBZ) administration. Three years thereafter, the pain suddenly became severe and was no longer controllable with CBZ. Radiographic images showed typical findings of granuloma in the right prepontine cistern. The granuloma size subsequently increased, and a second surgery was performed. The root entry zone of the trigeminal nerve and SCAs, where the Teflon felt was inserted at the time of the first surgery, were completely covered by a soft, white, granulomatous mass and the prosthesis adhered to the nerve and SCAs. Most of the prosthesis was removed, and the SCAS were attached to the interior surface of the cerbellar tentorium. The pain resolved soon after the second surgery, although slight hypesthesia of the light cheek remained. The patient's postoperative status has been uneventful during 10 months of follow-up. Histological examination revealed that the mass was a granuloma. In this patient, the CT findings were characterized by all abnormally long duration of marked enhancement and increased size of the lesion, which were compatible with a diagnosis of granuloma. It should be borne in mind that granulomatous changes in prostheses may result in early recurrence of trigeminal neuralgia. Therefore patients with early recurrence should be followed up with CT scanning, since the results of surgical removal of the prosthesis and granuloma are good.続きを見る
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