{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:44:29Z","timestamp":1770115469486,"version":"3.49.0"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"8","license":[{"start":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T00:00:00Z","timestamp":1740355200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,2,24]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Petrous apex cephaloceles (PACs) are rare cystic lesions that can present with increased intracranial pressure and bony remodeling of the skull. PACs may be associated with trigeminal neuralgia (TN); however, direct causality is not clear. To the author\u2019s knowledge, this is the first case reporting bony decompression of the foramina ovale and rotundum via an extended endoscopic endonasal approach (EEA) for the management of TN in the presence of concurrent PACs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>Herein, the authors present the case of a 19-year-old male with bilateral PACs and severely refractory TN surgically managed with decompression of the foramina ovale and rotundum and surrounding bony regions near the maxillary nerve (cranial nerve [CN] V2) and mandibular nerve (CNV3). Prior to EEA, he trialed ten medications and underwent cerebrospinal fluid diversion trials, two microvascular decompressions, and stereotactic radiosurgery with variable symptom relief. Complete resolution of TN occurred 4 months after EEA, and he was weaned off of medication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>An extended EEA to decompress CNV divisions at the foramina rotundum and ovale may be effective in refractory cases. PACs and associated bony dehiscence may complicate the understanding of TN etiology and impair radiographic visualization of CNV and surrounding structures. There is no clear evidence to support surgical management of PACs and symptom resolution.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24283\">https:\/\/thejns.org\/doi\/10.3171\/CASE24283<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24283","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T02:57:00Z","timestamp":1740365820000},"source":"Crossref","is-referenced-by-count":1,"title":["Resolution of refractory trigeminal neuralgia after endoscopic decompression of the foramina rotundum and ovale in a patient with bilateral petrous apex cephaloceles: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5112-2401","authenticated-orcid":true,"given":"Hope M.","family":"Reecher","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5173-2602","authenticated-orcid":true,"given":"Stephanie A.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie K.","family":"Cheok","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7843-7072","authenticated-orcid":true,"given":"Samon G.","family":"Tavakoli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Feller","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan T.","family":"Zwagerman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"18","key":"bib1","series-title":"Birth Defects Res","first-page":"1420","article-title":"National population-based estimates for major birth defects, 2010-2014","volume":"111","author":"Mai","year":"2019","unstructured":"Mai CTIsenburg JLCanfield MANational population-based estimates for major birth defects, 2010-2014. Birth Defects Res. 2019;111(18):1420-1435."},{"issue":"10","key":"bib2","series-title":"AJNR Am J Neuroradiol","first-page":"1867","article-title":"Petrous apex cephaloceles","volume":"22","author":"Moore","year":"2001","unstructured":"Moore KRFischbein NJHarnsberger HRPetrous apex cephaloceles. AJNR Am J Neuroradiol. 2001;22(10):1867-1871."},{"key":"bib3","series-title":"World Neurosurg","first-page":"360","article-title":"Trigeminal neuralgia caused by vascular compression from the petrous carotid artery with bony erosion and Meckel cave encephalocele: clinical imaging with surgical video","volume":"145","author":"Erginoglu","year":"2021","unstructured":"Erginoglu USayyahmelli SBaskaya MK.Trigeminal neuralgia caused by vascular compression from the petrous carotid artery with bony erosion and Meckel cave encephalocele: clinical imaging with surgical video. World Neurosurg. 2021;145:360-362."},{"issue":"3","key":"bib4","series-title":"Neurol India","first-page":"857","article-title":"Trigeminal neuralgia secondary to Meckel\u2019s cave meningoencephaloceles: a systematic review and illustrative case","volume":"70","author":"Mart\u00ednez","year":"2022","unstructured":"Mart\u00ednez JLDomingo RARowland NCVandergrift WA III.Trigeminal neuralgia secondary to Meckel\u2019s cave meningoencephaloceles: a systematic review and illustrative case. Neurol India. 2022;70(3):857-863."},{"issue":"8","key":"bib5","series-title":"Otol Neurotol","first-page":"1131","article-title":"Invasive cerebrospinal fluid cysts and cephaloceles of the petrous apex","volume":"27","author":"Isaacson","year":"2006","unstructured":"Isaacson BCoker NJVrabec JTYoshor DOghalai JS.Invasive cerebrospinal fluid cysts and cephaloceles of the petrous apex. Otol Neurotol. 2006;27(8):1131-1141."},{"issue":"22","key":"bib6","series-title":"J Neurosurg Case Lessons","article-title":"Cavum trigeminale cephalocele associated with intracranial hypertension in an 18-month-old child: illustrative case","volume":"1","author":"Miccoli","year":"2021","unstructured":"Miccoli GCicala DSpennato PImperato ARuggiero CCinalli G.Cavum trigeminale cephalocele associated with intracranial hypertension in an 18-month-old child: illustrative case. J Neurosurg Case Lessons. 2021;1(22):CASE21136."},{"issue":"4","key":"bib7","series-title":"Skull Base Surg","first-page":"289","article-title":"Unusual presentations of middle fossa encephaloceles: report of two cases","volume":"9","author":"Shafa","year":"1999","unstructured":"Shafa BArle JKotapka M.Unusual presentations of middle fossa encephaloceles: report of two cases. Skull Base Surg. 1999;9(4):289-294."},{"issue":"7","key":"bib8","series-title":"Acta Neurochir (Wien)","first-page":"1183","article-title":"Rare cause of trigeminal neuralgia: Meckel\u2019s cave meningocele","volume":"157","author":"Alobaid","year":"2015","unstructured":"Alobaid ASchaeffer TVirojanapa JDehdashti AR.Rare cause of trigeminal neuralgia: Meckel\u2019s cave meningocele. Acta Neurochir (Wien). 2015;157(7):1183-1186."},{"issue":"1","key":"bib9","series-title":"Rofo","first-page":"93","article-title":"Cephalocele of the petrous apex: a rare etiology of trigeminal neuralgia","volume":"188","author":"Sporns","year":"2016","unstructured":"Sporns PBHeermann PBurg MCSuero Molina EJCnyrim CD.Cephalocele of the petrous apex: a rare etiology of trigeminal neuralgia. Article in German. 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Cephalagia. 2018;38(1):1-211."},{"key":"bib12","series-title":"Front Neurol","article-title":"Narrow ovale foramina may be involved in the development of primary trigeminal neuralgia","volume":"13","author":"Li","year":"2022","unstructured":"Li SLiao CQian MYang XZhang W.Narrow ovale foramina may be involved in the development of primary trigeminal neuralgia. Front Neurol. 2022;13:1013216."},{"issue":"2","key":"bib13","series-title":"Neurosurgery","first-page":"182","article-title":"Pain outcomes following microvascular decompression for drug-resistant trigeminal neuralgia: a systematic review and meta-analysis","volume":"86","author":"Holste","year":"2020","unstructured":"Holste KChan AYRolston JDEnglot DJ.Pain outcomes following microvascular decompression for drug-resistant trigeminal neuralgia: a systematic review and meta-analysis. 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Pract Neurol. 2021;21(5):392-402."},{"key":"bib17","series-title":"World Neurosurg","first-page":"226","article-title":"A systematic review of repeat microvascular decompression for recurrent or persistent trigeminal neuralgia","volume":"158","author":"Jiao","year":"2022","unstructured":"Jiao LYe HLv JA systematic review of repeat microvascular decompression for recurrent or persistent trigeminal neuralgia. World Neurosurg. 2022;158:226-233."},{"issue":"6","key":"bib18","series-title":"Med Hypotheses","first-page":"1179","article-title":"Trigeminal neuralgia is caused by maxillary and mandibular nerve entrapment: greater incidence of right-sided facial symptoms is due to the foramen rotundum and foramen ovale being narrower on the right side of the cranium","volume":"65","author":"Neto","year":"2005","unstructured":"Neto HSCamilli JAMarques MJ.Trigeminal neuralgia is caused by maxillary and mandibular nerve entrapment: greater incidence of right-sided facial symptoms is due to the foramen rotundum and foramen ovale being narrower on the right side of the cranium. 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Brain. 2001;124(12):2347-2360."},{"issue":"4","key":"bib21","series-title":"Insights Imaging","first-page":"499","article-title":"Neuroimaging of Meckel\u2019s cave in normal and disease conditions","volume":"9","author":"Malhotra","year":"2018","unstructured":"Malhotra ATu LKalra VBNeuroimaging of Meckel\u2019s cave in normal and disease conditions. Insights Imaging. 2018;9(4):499-510."},{"issue":"10","key":"bib22","series-title":"Surg Radiol Anat","first-page":"1179","article-title":"The association between petrous apex cephalocele and empty sella","volume":"37","author":"Jamjoom","year":"2015","unstructured":"Jamjoom DZAlorainy IA.The association between petrous apex cephalocele and empty sella. Surg Radiol Anat. 2015;37(10):1179-1182."},{"key":"bib23","series-title":"World Neurosurg","first-page":"e1174","article-title":"Bony dehiscence of the horizontal petrous internal carotid artery canal: an anatomic study with surgical implications","volume":"114","author":"Spiessberger","year":"2018","unstructured":"Spiessberger ABaumann FKothbauer KFBony dehiscence of the horizontal petrous internal carotid artery canal: an anatomic study with surgical implications. World Neurosurg. 2018;114:e1174-e1179."},{"issue":"7","key":"bib24","series-title":"Otol Neurotol","first-page":"1001","article-title":"Petrous carotid canal dehiscence: an anatomic and radiographic study","volume":"29","author":"Hearst","year":"2008","unstructured":"Hearst MJKadar AKeller JTChoo DIPensak MLSamy RN.Petrous carotid canal dehiscence: an anatomic and radiographic study. Otol Neurotol. 2008;29(7):1001-1004."},{"issue":"6","key":"bib25","series-title":"J Neurosurg","first-page":"1067","article-title":"Trigeminal neuralgia and hemifacial spasm as false localizing signs in patients with a contralateral mass of the posterior cranial fossa. Report of three cases","volume":"84","author":"Matsuura","year":"1996","unstructured":"Matsuura NKondo A.Trigeminal neuralgia and hemifacial spasm as false localizing signs in patients with a contralateral mass of the posterior cranial fossa. Report of three cases. J Neurosurg. 1996;84(6):1067-1071."},{"issue":"4","key":"bib26","series-title":"BMJ Case Rep","first-page":"e242328","article-title":"Rare case of bilateral petrous apex cephalocele","volume":"14","author":"Pruthi","year":"2021","unstructured":"Pruthi ARai GMehra K.Rare case of bilateral petrous apex cephalocele. BMJ Case Rep. 2021;14(4):e242328."},{"issue":"18","key":"bib1","series-title":"Birth Defects Res","first-page":"1420","article-title":"National population-based estimates for major birth defects, 2010-2014","volume":"111","author":"Mai","year":"2019","unstructured":"Mai CTIsenburg JLCanfield MANational population-based estimates for major birth defects, 2010-2014. Birth Defects Res. 2019;111(18):1420-1435."},{"issue":"10","key":"bib2","series-title":"AJNR Am J Neuroradiol","first-page":"1867","article-title":"Petrous apex cephaloceles","volume":"22","author":"Moore","year":"2001","unstructured":"Moore KRFischbein NJHarnsberger HRPetrous apex cephaloceles. AJNR Am J Neuroradiol. 2001;22(10):1867-1871."},{"key":"bib3","series-title":"World Neurosurg","first-page":"360","article-title":"Trigeminal neuralgia caused by vascular compression from the petrous carotid artery with bony erosion and Meckel cave encephalocele: clinical imaging with surgical video","volume":"145","author":"Erginoglu","year":"2021","unstructured":"Erginoglu USayyahmelli SBaskaya MK.Trigeminal neuralgia caused by vascular compression from the petrous carotid artery with bony erosion and Meckel cave encephalocele: clinical imaging with surgical video. World Neurosurg. 2021;145:360-362."},{"issue":"3","key":"bib4","series-title":"Neurol India","first-page":"857","article-title":"Trigeminal neuralgia secondary to Meckel\u2019s cave meningoencephaloceles: a systematic review and illustrative case","volume":"70","author":"Mart\u00ednez","year":"2022","unstructured":"Mart\u00ednez JLDomingo RARowland NCVandergrift WA III.Trigeminal neuralgia secondary to Meckel\u2019s cave meningoencephaloceles: a systematic review and illustrative case. Neurol India. 2022;70(3):857-863."},{"issue":"8","key":"bib5","series-title":"Otol Neurotol","first-page":"1131","article-title":"Invasive cerebrospinal fluid cysts and cephaloceles of the petrous apex","volume":"27","author":"Isaacson","year":"2006","unstructured":"Isaacson BCoker NJVrabec JTYoshor DOghalai JS.Invasive cerebrospinal fluid cysts and cephaloceles of the petrous apex. Otol Neurotol. 2006;27(8):1131-1141."},{"issue":"22","key":"bib6","series-title":"J Neurosurg Case Lessons","article-title":"Cavum trigeminale cephalocele associated with intracranial hypertension in an 18-month-old child: illustrative case","volume":"1","author":"Miccoli","year":"2021","unstructured":"Miccoli GCicala DSpennato PImperato ARuggiero CCinalli G.Cavum trigeminale cephalocele associated with intracranial hypertension in an 18-month-old child: illustrative case. J Neurosurg Case Lessons. 2021;1(22):CASE21136."},{"issue":"4","key":"bib7","series-title":"Skull Base Surg","first-page":"289","article-title":"Unusual presentations of middle fossa encephaloceles: report of two cases","volume":"9","author":"Shafa","year":"1999","unstructured":"Shafa BArle JKotapka M.Unusual presentations of middle fossa encephaloceles: report of two cases. 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Rofo. 2016;188(1):93-94."},{"issue":"8","key":"bib10","series-title":"J Craniofac Surg","first-page":"2168","article-title":"Narrow foramen ovale and rotundum: a role in the etiology of trigeminal neuralgia","volume":"27","author":"Liu","year":"2016","unstructured":"Liu PZhong WLiao CLiu MZhang W.Narrow foramen ovale and rotundum: a role in the etiology of trigeminal neuralgia. J Craniofac Surg. 2016;27(8):2168-2170."},{"issue":"1","key":"bib11","series-title":"Cephalagia","first-page":"1","article-title":"Headache Classification Committee of the International Headache Society (HIS). The International Classification of Headache Disorders","volume":"38","year":"2018","unstructured":"Headache Classification Committee of the International Headache Society (HIS). The International Classification of Headache Disorders, 3rd edition. Cephalagia. 2018;38(1):1-211."},{"key":"bib12","series-title":"Front Neurol","article-title":"Narrow ovale foramina may be involved in the development of primary trigeminal neuralgia","volume":"13","author":"Li","year":"2022","unstructured":"Li SLiao CQian MYang XZhang W.Narrow ovale foramina may be involved in the development of primary trigeminal neuralgia. Front Neurol. 2022;13:1013216."},{"issue":"2","key":"bib13","series-title":"Neurosurgery","first-page":"182","article-title":"Pain outcomes following microvascular decompression for drug-resistant trigeminal neuralgia: a systematic review and meta-analysis","volume":"86","author":"Holste","year":"2020","unstructured":"Holste KChan AYRolston JDEnglot DJ.Pain outcomes following microvascular decompression for drug-resistant trigeminal neuralgia: a systematic review and meta-analysis. Neurosurgery. 2020;86(2):182-190."},{"key":"bib14","series-title":"Front Neurol","article-title":"Recurrence rates after microvascular decompression in patients with primary trigeminal neuralgia and its influencing factors: a systematic review and meta-analysis based on 8,172 surgery patients","volume":"12","author":"Chen","year":"2021","unstructured":"Chen FNiu YMeng FRecurrence rates after microvascular decompression in patients with primary trigeminal neuralgia and its influencing factors: a systematic review and meta-analysis based on 8,172 surgery patients. Front Neurol. 2021;12:738032."},{"issue":"18","key":"bib15","series-title":"Med (Baltim)","first-page":"e15167","article-title":"Repeat microvascular decompression for patients with persistent or recurrent trigeminal neuralgia: prognostic factors and long-term outcomes","volume":"98","author":"Cheng","year":"2019","unstructured":"Cheng JMeng JLei DHui X.Repeat microvascular decompression for patients with persistent or recurrent trigeminal neuralgia: prognostic factors and long-term outcomes. Med (Baltim). 2019;98(18):e15167."},{"issue":"5","key":"bib16","series-title":"Pract Neurol","first-page":"392","article-title":"Trigeminal neuralgia: a practical guide","volume":"21","author":"Lambru","year":"2021","unstructured":"Lambru GZakrzewska JMatharu M.Trigeminal neuralgia: a practical guide. 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World Neurosurg. 2022;158:226-233."},{"issue":"6","key":"bib18","series-title":"Med Hypotheses","first-page":"1179","article-title":"Trigeminal neuralgia is caused by maxillary and mandibular nerve entrapment: greater incidence of right-sided facial symptoms is due to the foramen rotundum and foramen ovale being narrower on the right side of the cranium","volume":"65","author":"Neto","year":"2005","unstructured":"Neto HSCamilli JAMarques MJ.Trigeminal neuralgia is caused by maxillary and mandibular nerve entrapment: greater incidence of right-sided facial symptoms is due to the foramen rotundum and foramen ovale being narrower on the right side of the cranium. 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Surg Radiol Anat. 2015;37(10):1179-1182."},{"key":"bib23","series-title":"World Neurosurg","first-page":"e1174","article-title":"Bony dehiscence of the horizontal petrous internal carotid artery canal: an anatomic study with surgical implications","volume":"114","author":"Spiessberger","year":"2018","unstructured":"Spiessberger ABaumann FKothbauer KFBony dehiscence of the horizontal petrous internal carotid artery canal: an anatomic study with surgical implications. World Neurosurg. 2018;114:e1174-e1179."},{"issue":"7","key":"bib24","series-title":"Otol Neurotol","first-page":"1001","article-title":"Petrous carotid canal dehiscence: an anatomic and radiographic study","volume":"29","author":"Hearst","year":"2008","unstructured":"Hearst MJKadar AKeller JTChoo DIPensak MLSamy RN.Petrous carotid canal dehiscence: an anatomic and radiographic study. 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