MALPOSITIONED ENDOLYMPHATIC SUBARACHNOID SHUNT CAUSING TRIGEMINAL NEURALGIA - CASE-REPORT

A case is presented of a 64-year-old female with a fifteen year histor y of right facial pain. The last nine years the facial pain is describ ed as an intense, stabbing pain in the maxillary division of the right trigeminal nerve. The patient had Meniere's Disease for which an endo lymphatic subarachnoid shunt was placed fifteen years prior. The patie nt underwent intensive medical and several surgical therapies for pain . Some of the procedures were initially successful but none provided l asting relief. Because of severe recurrent right facial pain, the pati ent underwent a right open partial rhizotomy of the trigeminal nerve v ia a retrosigmoid approach. Intraoperative findings included the end o f the endolymphatic subarachnoid shunt in association with the trigemi nal nerve roots. The end of the shunt was removed at the time of surge ry. Postoperatively the patient has been pain free for thirty months. It is proposed a malpositioned or migrated endolymphatic subarachnoid shunt may be a cause of trigeminal neuralgia.