Small vestibular schwannoma presented with trigeminal neuralgia: illustrative case

Abstract

BACKGROUND A vestibular schwannoma (VS) presenting with paroxysmal facial electric shock pain, that is, trigeminal neuralgia (TN), is relatively rare. Furthermore, TN is extremely rare in small VSs. OBSERVATIONS Herein, the authors report the case of a 52-year-old woman with a complaint of right TN. Magnetic resonance (MR) imaging revealed a right VS of 12-mm diameter that compressed the trigeminal nerve. Although she did not report any hearing impairment, audiometry revealed decreased high-frequency range on the right side. The tumor was excised using the right retrosigmoid approach, and TN was confirmed to be caused by direct compression of the trigeminal nerve by the VS. Sufficient decompression of trigeminal nerve was done. The proximity of the trigeminal nerve root to the vestibular nerve root was the cause of TN. TN disappeared immediately after surgery, and there was no worsening of hearing impairment and facial paralysis. LESSONS It is important to remember that TN may occur with direct tumor compression, even in small VSs. A preoperative 3-dimensional MR cisternogram/angiogram fusion image clearly showed direct tumor compression of the trigeminal nerve and the absence of responsible vessels, which was useful for surgical planning.

An Atypical Presentation of Acoustic Neuroma With Facial Paresthesia: A Case Report

“…To date, there are very few case reports [1,7] in the literature of acoustic neuroma mimicking facial paresthesia, whereas most of the published work [8][9][10][11] is on trigeminal neuralgia or oromandibular pain secondary to acoustic neuroma. When the tumor reaches a size of 2 cm, it extends out of the acoustic meatus and starts to compress the trigeminal nerve [12].…”