Evaluation of Fifth Nerve Dysfunction in 136 Patients with Middle and Posterior Cranial Fossae Tumors

Abstract

One-hundred thirty-six patients operated on for extra-axial tumors of the posterior and middle cranial fossae were retrospectively evaluated to define the relevance of trigeminal nerve dysfunction and to correlate clinical and surgical observations. The following data are reported: tumor types, presence of specific trigeminal symptoms and signs, mean duration of symptomatology, anatomical relation between tumor and fifth nerve. Trigeminal symptoms were present in 45 subjects (33.08%) with a mean duration of 23.56 months. Frequency of symptoms was different in various oncotypes. Fifth nerve disturbances were the symptom of onset in 18 subjects (13.23%). A tumoral involvement of the nerve was reported at surgery in 73 patients (53.67%) and was defined as contact, compression or infiltration. Postoperatively, 12 patients showed an improvement of fifth nerve disturbances. A statistically significant difference (p < 0.05) was found in: (1) the incidence of symptoms in patients with and in those without anatomical trigeminal involvement: (2) the incidence of signs in the same groups; (3) the incidence of postoperative relief in patients with fifth nerve compression compared to patients with different surgical findings; (4) the incidence of postoperative relief in patients with typical trigeminal neuralgia compared to those with other symptoms.

Stereotactic Radiosurgery for Patients with Trigeminal Neuralgia Associated with Petroclival Meningiomas

“…Barker et al [1] reported that the most common tumors that cause trigeminal pain are meningiomas, acoustic neuromas and epidermoid tumors. In other reports, trigeminal schwannomas, metastatic carcinomas to the cranial base, brain stem gliomas, arachnoid cysts and lymphomas have been associated with trigeminal pain [2,3,6] . Cheng et al [3] reported an average interval of 6.3 years between the development of facial pain and tumor detection for patients with tumor-related trigeminal neuralgia.…”

“…Between 1 and 6% of patients with facial pain are discovered to have tumors affecting the trigeminal nerve [1][2][3][4]6] . Barker et al [1] reported that the most common tumors that cause trigeminal pain are meningiomas, acoustic neuromas and epidermoid tumors.…”

“…Trigeminal pain may also result from adjacent tumors such as meningiomas, trigeminal schwannomas, vestibular schwannomas, epidermoid cysts and metastases involving the intracranial and cavernous sinus components of the trigeminal nerve [1][2][3][4][5][6] . Up to 6% of patients with facial pain syndromes are discovered to have tumors affecting the trigeminal nerve [1][2][3][4][5][6] .…”

Central Connections of the Lacrimal Functional Unit

“…Corneal anaesthesia is regularly induced by refractive surgery such as PRK or LASIK, [8][9][10][11] or may be caused by compression of the trigeminal nerve or ganglion. 12 A decrease in sensory nerve function can also be caused by systemic disorders such as diabetes or multiple sclerosis. 13 Bilateral topical anaesthesia has been shown to reduce but not abolish lacrimal secretion in both eyes, measured by the Schirmer I test [14][15][16] or by fluorophotometry 15 and similarly, unilateral trigeminal anaesthesia, as caused by herpes simplex keratitis, is accompanied by an ipsilateral reduction in reflex tear secretion, of a degree dependent on the level of sensory loss on the affected side.…”

Neurotrophic keratitis

“…1 Intracranial space-occupying lesions such as neuroma, meningioma, and aneurysms may also determine a compression of the trigeminal nerve or ganglion and produce an impairment of corneal sensitivity. 2 Systemic diseases such as diabetes, multiple sclerosis, and leprosy may decrease sensory nerve function or damage sensory fibres leading to corneal anaesthesia. 3,4 The corneal epithelium is the first target of the disease showing dystrophic changes and defects with poor tendency to spontaneous healing.…”