三叉神経末梢枝への反復ブロックが聴神経腫瘍切除後の遷延性神経麻痺を改善した1例

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  • Repeated peripheral trigeminal nerve block improved prolonged postoperative nerve palsies
  • ミツマタ シンケイ マッショウシ エノ ハンプク ブロック ガ チョウシンケイ シュヨウ セツジョゴ ノ センエンセイ シンケイ マヒ オ カイゼンシタ 1レイ

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We report a case of a 60-years-old woman with postoperative cranial nerve palsies in the right side following neurosurgical operation who was successfully treated with repeated peripheral nerve block for persistent facial pain in the same side. Forteen months before visiting our outpatient pain clinic, she had an operation for giant vestibular schwannoma in the right side. Following the operation, cranial nerve dysfunction (IV, V, VI, VII, VIII, and IX) occurred probably caused by synechotomy of the tumor. She has had severe facial pain in the right side for 8 months before the visit. Repeated supraorbital, infraorbital, and maxillary nerve blocks with local anesthetic agent markedly alleviated the dysfunction of cranial nerves as well as facial pain during the first 2 months, and to date have been effective for >1 year. Since she experienced frequent shooting pain associated with the persistent dull pain, we speculate that her facial pain was neuropathic and her cranial nerve palsies were a result of cross-talk between sympathetic and injured trigeminal nerve. We also suspect that complex regional pain syndrome (CRPS) in her right facial area prolonged cranial nerve palsy and repeated nerve block on the peripheral trigeminal region alleviated the regional ischemia that would probably be induced by cross-talk. The present case suggests that such CRPS induced by this proposed mechanism should be differentially diganosed for the prolonged palsy of cranial nerves after surgical intervention for vestibular schwannoma.

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