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Preoperative 3D FIESTA MR images showing an extra-axial tumor (arrow) at the entrance of Meckel's cave that medially compressed and distorted the trigeminal nerve root. The SCA (arrowhead) runs medially proximal to the trigeminal nerve.
Source publication
Cerebellopontine angle tumors might occasionally provoke trigeminal neuralgia but are usually large enough to be diagnosed radiographically. We present a case of trigeminal neuralgia caused by a very small meningioma covering the suprameatal tubercle that displayed hyperostosis at the entrance of Meckel's cave and was not obvious on routine magneti...
Citations
... In fact, even minimum size lesions can result extremely symptomatic if they are located in the vicinity of the trigeminal root entry zone or adjacent to Meckel's cave entrance. [10] However, contralateral tumors cause symptoms through a different mechanism. ey produce a brainstem shift causing contralateral compression of the fifth nerve against the dura or displacing contralateral vessels, which result in microvascular impingement. ...
Background
Trigeminal neuralgia secondary to posterior and middle fossae tumors, whether ipsilateral or contralateral, has been well described. However, this disabling disease has never been reported in the context of anterior fossa neoplasms.
Case Description
A 75-year-old female with right hemifacial pain was diagnosed with an anterior clinoid meningioma. Despite neuroimaging did not show any apparent anatomical or neurovascular conflict, a detailed MRI analysis revealed a V3 hyperintensity. Not only symptoms completely resolved after surgical resection but also this radiological sign disappeared. Nowadays, the patient remains asymptomatic and V3 hyperintensity has not reappeared during her follow-up.
Conclusion
A surgical definitive treatment can be offered to patients suffering from trigeminal neuralgia secondary to lesions adjacent to Gasserian ganglion or trigeminal branches. In this respect, posterior and middle fossae tumors are well-reported etiologies. Nevertheless, in the absence of evident compression, other neoplasms located in the vicinity of these critical structures and considered as radiological findings may be involved in trigeminal pain. Microvascular and pressure gradient changes could be an underlying cause of these symptoms in anterior skull base lesions. Here, we report the case of a patient with uncontrollable hemifacial pain resolved after anterior clinoid meningioma removal.
... The bony prominence above the internal auditory meatus called the suprameatal tubercle (SMT) is frequently observed during posterior fossa surgery [5,10,13]. A large SMT obscures the distal portion of trigeminal nerve root at the juxtaporous trigeminus. ...
Background
The suprameatal tubercle (SMT) may obscure the neurovascular compression (NVC) in microvascular decompression (MVD) for trigeminal neuralgia (TGN). The aim of this study is to address the necessity of resecting SMT in MVD for TGN.
Methods
We retrospectively analyzed radiological findings of 461 MVDs in patients with TGN, focusing on the relation between SMT and the NVC site. Three-dimensional (3D) images were used for preoperative evaluation. The NVC sites were obscured by SMT in 48 patients (10.4%) via the retrosigmoid approach. This study was conducted to review the management of SMT among these patients. Resection of SMT was performed in 8 patients (resected group) for direct visualization of the NVC site. On the other hand, nerve decompression was achieved without resecting SMT for the rest of the 40 patients (non-resected group). Biographical data, radiological findings, intraoperative findings, and surgical outcomes were retrospectively evaluated.
Results
The mean height of SMT obscuring NVC was 5.0 mm (2.8–13.9 mm) above the petrous surface. The NVC was located at a mean of 1.9 mm (0–5.9 mm) from the porous trigeminus. The most common offending vessel was the superior cerebellar artery (SCA, 56.3%), followed by the transverse pontine vein (TPV, 29.2%). In the resected group, the transposing culprit vessels were feasibly performed after direct visualization of the NVC site, whereas in the non-resected group, the SCA was successfully transposed using curved instruments after thorough dissection around the nerve. TPV having contact with the nerve was coagulated and divided. Immediate pain relief was obtained in all patients except one who experienced delayed pain relief 1 month after surgery. Facial numbness at discharge was noted in 9 patients (18.8%); thereafter, numbness diminished over time. Numbness at the final visit was observed in 5 patients (10.4%) at mean of 49 months after MVD. Recurrent pain occurred in 4 patients (8.3%) in total. Statistical analysis showed no significant differences in surgical outcomes between both groups.
Conclusions
Direct visualization of the NVC site by resecting the SMT does not affect surgical outcomes in the immediate and long term. Resecting the SMT is not always necessary to accomplish nerve decompression in most cases by use of suitable instruments and techniques.
... The suprameatal tubercle (SMT) is a variable prominence that lies above the internal acoustic meatus [1]. An enlarged SMT may represent an obstacle during posterior fossa surgeries, including microvascular decompression, where indeed, it can be the cause of trigeminal neuralgia [2,3]. ...
Background: The suprameatal tubercle (SMT) is a variable prominence of the petrosal surface of the temporal bone that lies above the internal acoustic meatus. An enlarged SMT may present an obstacle during surgeries of the posterior fossa, including microvascular decompression or by itself cause trigeminal neuralgia. Methods: Based on our prior study of 200 temporal bones, its data collection and establishing a classiEcation of the SMT this extension study exempliEes its clinical application. Results: According to the classiEcation of the SMT four selected cases are clinically and anatomically correlated to exemplify the utility of this classiEcation. Conclusion: The SMT is a structure that may have variability in its size as well as its location therefore causing a modiEcation of the anatomy. The knowledge of this anatomical variations is important since it can modify intraoperative Endings requiring microsurgical techniques to achieve better outcomes for patients. Visual Abstract
... Trigeminal neuralgia is known to be triggered by vascular compression of the trigeminal nerve root, most frequently bythe dilated superior cerebellar artery. There are other less frequent causes which include posterior fossa tumors, cerebral aneurysms, arteriovenous malformations, multiple sclerosis plaques, etc. Theincidence of posterior fossa tumor-induced TN ranges from 2.1-11.6% in the literature which mainly comprises of meningiomas (14-54%), epidermoid tumors (8-64%) and vestibular schwannomas (7-31%) [4,5]. ...
... Todo lo anterior teniendo en cuenta que son factores mecánicos que se deben a irritación del nervio, lo cual también podría tener asociación con otros tipos de tumores como los dermoides o epidermoides. 9 El linfoma primario del sistema nervioso central es infrecuente, representa cerca del 2% de todos los tumores intracraneales primarios, sin embargo se han reportado casos en los que suele enmascararse dentro de síntomas correspondientes a neuralgia del trigémino sin respuesta a tratamiento, para lo cual se realizan exámenes de extensión en donde se evidencian masas que comprometen el nervio trigémino, como resultado de compresión neurovascular. 10 De los casos de neuralgia de trigémino los sintomáticos corresponden alrededor de 15%, en muchos casos es difícil de identificar signos de alarma o de bandera roja y más cuando se asocia con otras patologías subyacentes, por lo cual es indispensable realizar los estudios pertinentes en el caso Ninguno de los autores recibió alguna remuneración o ayuda financiera para desarrollar el trabajo. ...
La neuralgia del trigémino es característica en personas mayores de 50 años, comprometiendo principalmente el territorio V2 y V3 de dicho nervio de manera unilateral y la carbamezepina es el fármaco con mayor efectividad, pero no siempre responden. La presentación atípica y los signos de alarma ponen en consideración el estudio con resonancia magnética cerebral, pues obliga a descartar una causa secundaria, siendo necesario el análisis de neuroimágenes. Debido a esto, presentamos un caso de quiste epidermoide con neuralgia secundaria, que se presenta con signos de alarma y se deben considerar los estudios complementarios.
... The lesion on the right side of the V. nerve (possibly vascular structure) is visible. This structure during surgery has been found to be compatible with the superior cerebellar artery and pontine abscess [3,5,7,8,10,13,22,26,27,29,31]. ...
... Hasegawa et al. classified CPA tumor-associated mechanisms into four types: type A, the nerve is totally encased by the tumor; type B, the nerve axis is distorted by the tumor; type C, the nerve is shifted by the tumor and contralaterally compressed by the artery, and type D, the nerve is compressed by the tumor-displaced artery [12]. Furthermore, a large and distant tumor can rarely cause contralateral TN remotely as a result of a distorted brainstem [13,23]. In addition to these mechanical factors, chemical irritation of the nerve has also been proposed as a possible pathogenesis of TN associated with dermoid or epidermoid tumors [14]. ...
Trigeminal neuralgia may be idiopathic or may involve other causes. It can be secondary to posterior fossa tumors many times. In the present case, posterior fossa meningioma was detected with trigeminal neuralgia together. However, relevant meningioma is not seen as a cause of trigeminal neuralgia clinic with posterior fossa settlement. Tumor localization and the story of the patient suggest that the two diseases are completely separate processes. Meningioma was completely incidentally visualized during magnetic resonance imaging. In our article, we present this coexistency. We also performed a brief review of the literature investigating the relationship between trigeminal neuralgia and intracranial lesions during this case report.
... Although the classical type of trigeminal neuralgia (TN) is the most common symptom of neurovascular conflict, some patients have the secondary type of TN, in which space-occupying lesions are responsible for the symptoms. [1][2][3] It is believed that $ between 1 and 9.9% of the cases of patients presenting with TN painful manifestation are caused by cerebellopontine angle (CPA) tumors. 4 Meningiomas, schwannomas, and hemangioblastomas are extremely common posterior fossa tumors that may cause TN by directly compressing the trigeminal nerve or by being close to vascular structures around the nerve entry zone. ...
Introduction Cerebellopontine angle (CPA) tumors represent an important cause of persistent and refractory trigeminal neuralgia (TN). It is believed that ∼ between 1 and 9.9% of the cases of patients presenting with TN painful manifestation are caused by space-occupying lesions.
Objective The objective of the present study is to describe the clinical and surgical experience of the operative management of patients presenting with secondary type TN associated with CPA tumors.
Method An observational investigation was conducted with data collection from patients with secondary type TN associated with CPA tumors who were treated with surgical resection of the space-occupying lesion and decompression of the trigeminal nerve from January 2013 to November 2016 in 2 different centers in the western region of the state of São Paulo, Brazil.
Results We operated on 11 consecutive cases in which TN was associated with CPA during the period of analysis. Seven (63.6%) patients were female, and 4 (36.4%) were male. Seven (63.6%) patients presented with right-side symptoms, and 4 (36.4%) presented with left-side symptoms. After 2 years of follow-up, we observed that 8 (72.7%) patients showed a complete improvement of the symptoms, with an excellent outcome, and that 3 (27.3%) patients showed an incomplete improvement, with a good outcome. No patient reported partial improvement or poor outcome after the follow-up. There was no operative mortality.
Conclusion Cerebellopontine angle tumors represent an important cause of TN and must be included in the differential diagnosis of patients presenting with refractory and persistent symptoms. Surgical treatment with total resection of the expansive lesion and effective decompression of the trigeminal nerve are essential steps to control the symptoms.
... Compression by nearby vascular structures, whether arterial or venous, can be alleviated with MVD [9]. Symptomatic compression by a mass lesion may also occur at any point along the nerve, including the region of Meckel's cave [12]. In cases where they may be dual pathology contributing to irritation of the trigeminal nerve, MVD may be insufficient unless both pathologies are addressed. ...
Trigeminal neuralgia (TN) is a debilitating chronic pain disorder characterized by hemifacial lancinating pain originating from the trigeminal nerve. TN is the most common disorder in the broad category of neurovascular compression syndromes (NVCS). A developmental venous anomaly (DVA) causing symptomatic compression of the trigeminal nerve is a rarely reported entity with most cases being effectively treated with microvascular decompression (MVD). Similarly, both benign and malignant neoplasms resulting in symptomatic compression of the trigeminal nerve are known entities that are frequently treated with a combination of conservative management, radiosurgery, rhizotomy, or surgery. We describe here a case of trigeminal neuralgia caused by both DVA and a small enhancing neoplasm. According to our knowledge and literature review, this is the first case of TN caused by such a dual compressive pathology.
... Nearly three-fourth (76.5%) of the dentists correctly reported brain tumor as one of the etiologic factors of trigeminal neuralgia. Some studies have reported trigeminal neuralgia as one of the manifestations of intracranial tumors such as central nervous system lymphoma [33], meningioma [34], cerebellopontine angle tumors such as cholesteatoma [35], and epidermoid tumor [36]. Therefore, dentists should consider brain tumors as differential diagnoses when facing patients with trigeminal neuralgia. ...
Background and Objective
Diagnosis and treatment of chronic orofacial pain are one of the most challenging issues in dentistry. The purpose of this study was to assess the knowledge of general dentists regarding orofacial pain in Kermanshah, Iran.
Methods
This cross-sectional study was conducted in 2016 including general dentists of Kermanshah city. A researcher-designed questionnaire was administered to collect demographic data as well as measuring knowledge of the dentists in four sections including etiology, clinical presentations, physical examination, and treatment of chronic orofacial pain. The questionnaire had acceptable validity (content validity > 0.9) and reliability (intraclass correlation coefficient= 0.857 for test re-test; Cronbach’s alpha= 0.72 for internal consistency). The data were analyzed by the SPSS software (ver. 18.0) using Spearman’s correlation coefficient (P < 0.05).
Results
There were 121 male (72.9%) and 45 female (27.1%) dentists with mean (SD) age of 40.55 (8.03) years and mean (SD) practice history of 13.28 (8.43) years. Mean (SD) knowledge score was 10.54 (2.36) (maximum possible score= 15). 48.2% of dentists had good knowledge in overall. 48.2% about etiology, 45.2% about clinical presentations, 36.1% about physical examination, and 7.8% about treatment had good knowledge. Knowledge had direct and significant relationship with age (r = 0.179; P = 0.022) and practice history (r = 0.18; P = 0.021).
Conclusion
The results showed that the studied dentists did not have enough knowledge about chronic orofacial pain especially in the treatment field. Therefore, it is recommended to implement educational programs to improve their knowledge.
Background:
Trigeminal neuralgia (TN) is a frequent neurosurgical problem negatively influencing the quality of life of patients. The standard surgical treatment is microvascular decompression for primary cases and decompression of the mass effect, mainly tumors, for secondary cases. Neurocysticercosis (NCC) in the cerebellopontine angle is a rare etiology of TN. The authors report a case in which NCC cysts around the trigeminal nerve coexisted with a vascular loop, which compressed the exit of the trigeminal nerve from the pons.
Observations:
A 78-year-old woman presented with a 3-year history of persistent severe pain in the left side of her face, refractory to medical treatment. On gadolinium-enhanced magnetic resonance imaging, cystic lesions were observed around the left trigeminal nerve and a vascular loop was also present and in contact with the nerve. A retrosigmoid approach for cyst excision plus microvascular decompression of the trigeminal nerve was successfully performed. There were no complications. The patient was discharged without facial pain.
Lessons:
Albeit rare, TN secondary to NCC cysts should be considered in the differential diagnosis in NCC-endemic regions. In this case, the cause of the neuralgia was probably both problems, because when both were treated, the patient improved.
