Secondary Trigeminal Neuralgia in Cerebellopontine Angle Tumors

Abstract

The analysis of the treatment results in patients with cerebellopontine angle (CPA) tumors, manifested as trigeminal neuralgia (TN). During the 10-year period from 1998 to 2008, 14 patients with verified CPA tumors that had the typical manifestations of TN were operated on at our hospital (5.8% from all patients with TN who underwent surgery). In nine cases the epidermoid was identified; three patients had meningioma, one patient had acoustic neurinoma, and one patient had lipoma. The follow-up of all patients lasted at least 12 months. The intraoperative assessment identified the three variants of relationship between the tumors and neurovascular structures: (1) tumor grows around the trigeminal nerve; (2) the tumor causes compression and displacement of the trigeminal nerve; and (3) tumor presses the arterial vessel to the trigeminal nerve by moving the vessel or nerve. For six patients, with removal of tumor a microvascular decompression of the trigeminal nerve was performed. Complete pain relief was achieved in 12 patients (86%). TN is an expectative symptom of CPA tumors. The most frequent cause of secondary TN of CPA tumors is epidermoid. All patients with manifestations of TN should undergo the magnetic resonance imaging for early diagnosis of CPA tumor.

Effectiveness and Safety of Microvascular Decompression Surgery for Treatment of Trigeminal Neuralgia

“…7,8 Whatever, most of them are etiologically caused by cerebellovascular compression of the trigeminal root, no matter if directly or indirectly pushed by neoplasms or adhesions in the cerebellopontine angle. 9,10 Nevertheless, the pathophysiology of the disease have not been well understood today. It was speculated that an ephaptic transmission occurred at the micro-injury site of the trigeminal nerve fibers compressed by a vessel, which may also result in hyperexcitability of the trigeminal nucleus.…”