Neurovascular Compression Syndromes

Question 1

Which of the following vessels is the main offender in disabling positional vertigo?
● A. SCA
● B. AICA
● C. PICA
● D. VA
● E. BA

Answer 1

B. AICA

Question 2

What is the treatment of status trigeminus?
● A. IV diazepam
● B. IV epival
● C. IV carbamazepine
● D. IV phenobarbital
● E. IV levetiracetam

Answer 2

C. IV carbamazepine

Question 3

In which of the following, trigeminal neuralgia (TGN) is more common?
● A. Right side
● B. Left side
● C. Bilaterally
● D. In v1 distribution
● E. In all three divisions

Answer 3

A. Right side

Question 4

Which of the following is best for v3 neuralgia?
● A. Radiofrequency
● B. Balloon compression
● C. Glycerol injection
● D. Motor cortex stimulation
● E. SRS

Answer 4

A. Radiofrequency

Question 5

What is the dose of SRS used for TGN at the center of lesion?
● A. 30 to 40 Gy
● B. 40 to 50 Gy
● C. 50 to 60 Gy
● D. 60 to 70 Gy
● E. 70 to 80 Gy

Answer 5

E. 70 to 80 Gy

Question 6

How is percutaneous trigeminal radiofrequency rhizotomy (RFR) lesioning done?
● A. 60 to 70 C × 30 sec
● B. 60 to 70 C × 30 sec
● C. 60 to 70 C × 90 sec
● D. 70 to 90 C × 90 sec
● E. 70 to 90 C × 60 sec

Answer 6

C. 60 to 70 C × 90 sec

Question 7

What is the success rate of microvascular decompression (MVD) for TGN?
● A. 30 to 50%
● B. 50 to 75%
● C. 75 to 80%
● D. 80 to 90%
● E. 90 to 95%

Answer 7

C. 75 to 80%

Question 8

Which of the following is an effective medical management for hemifacial spasm?
● A. Carbamazepine
● B. Phenytoin
● C. Botulinum toxin
● D. Baclofen
● E. Dantrolene

Answer 8

C. Botulinum toxin

Question 9

Tic convulsif is a combination of which of the following?
● A. GeN + hemifacial spasm
● B. GeN + focal UE fits
● C. Hemifacial spasm + focal UE fits
● D. GeN + status trigeminus
● E. Hemifacial spasm + glossopharyngeal neuralgia

Answer 9

A. GeN + hemifacial spasm

Question 10

Post vagal section for glossopharyngeal neuralgia, 24 hours monitoring is required for which of the following?
● A. BP
● B. Syncope
● C. Cardiovascular complications
● D. Respiratory failure
● E. Neck hematoma

Answer 10

C. Cardiovascular complications

Question 11

Which of the following are neurovascular compression syndromes?
● A. Trigeminal neuralgia due to 5th cranial nerve involvement
● B. Hemifacial spasm due to 7th cranial nerve involvement
● C. Geniculate neuralgia or disabling positional vertigo due to 7th cranial nerve (nevus intermedius) or 8th cranial nerve involvement respectively
● D. Glossopharyngeal neuralgia due to 9th cranial nerve involvement
● E. All of the above

Answer 11

E. All of the above

Question 12

TGN is caused by compression on 5th nerve by which artery?
● A. Anterior inferior cerebellar artery
● B. Posterior inferior cerebellar artery
● C. Superior cerebellar artery
● D. Vertebral artery
● E. Posterior inferior cerebellar artery

Answer 12

C. Superior cerebellar artery

Question 13

What percentage of trigeminal neuralgia patients will ultimately fail medical therapy and require surgery?
● A. 25%
● B. 50%
● C. 75%
● D. 85%
● E. 95%

Answer 13

C. 75%

Question 14

Which of the following is included in the medical therapy of TGN?
● A. Carbamazepine (Tegretol) 100 mg PO BID, increased by 200 mg/d up to maximum of 1,200 mg/d divided TID
● B. Oxcarbazepine (Trileptal) 300 mg PO BID, increased by 600 mg/d every week up to maximum of 2,400 mg/d
● C. Baclofen 5 mg PO TID, increase every day by 5 mg/dose up to maximum of 80 mg/d in QID
● D. Gabapentin started with 100 mg PO BID, titrate to 5 to 7 mg/kg/d (3,600 mg/d maximum)
● E. All of the above

Answer 14

E. All of the above

Question 15

Complications of percutaneous radiofrequency include all of the following except?
● A. Partial masseter weakness
● B. Oculomotor paresis (usually temporary)
● C. Bitemporal hemianopsia
● D. Reduced hearing (secondary to paresis of tensor tympani)
● E. Neuroparalytic keratitis (keratitis due to fifth nerve deficit which impairs sensation)

Answer 15

C. Bitemporal hemianopsia

Question 16

Radiofrequency rhizotomy, glycerol injection into Meckel’s cave, mechanotrauma by inflation of no. 4 Fogarty catheter balloon, or injection of sterile boiling water is used to selectively destroy A delta and C fibers while preserving A alpha and beta fibers. All of these procedures come under which
heading?
● A. Blocking the trigger
● B. Percutaneous trigeminal rhizotomy
● C. Intradural retrogasserian trigeminal nerve section
● D. Stereotactic radiosurgery
● E. Peripheral trigeminal nerve branch procedures to block or ablate the division involved with pain

Answer 16

B. Percutaneous trigeminal rhizotomy

Question 17

For stereotactic radiosurgery, 4 to 5 mm isocenter in the trigeminal nerve root entry zone is used which is identified on MRI. What is the dose of radiation that is used for this procedure?
● A. 50 to 60 Gy
● B. 60 to 70 Gy
● C. 70 to 80 Gy
● D. 80 to 90 Gy
● E. 40 to 50 Gy

Answer 17

C. 70 to 80 Gy

Question 18

What is the postoperative care after percutaneous trigeminal rhizotomy?
● A. Ice pack to face on the side of procedure for 4 hours
● B. Soft diet
● C. Routine activity when alert
● D. Avoid narcotics
● E. If corneal reflex is impaired, then natural tear drops 2 to 3 drops every 2 hours is used on the affected side
● F. All of the above

Answer 18

F. All of the above

Question 19

How is dura opened during microvascular decompression for trigeminal neuralgia?
● A. Curvilinear with each end at the sinus and convexity away from the junction
● B. Inverted T shaped
● C. In x shape
● D. In y-shaped pattern
● E. Both A and B

Answer 19

E. Both A and B

Question 20

Hemifacial spasm is typically caused by compression of facial nerve by which of the following?
● A. PICA
● B. SCA
● C. VA
● D. AICA
● E. MCA

Answer 20

D. AICA