Trigeminal neuralgia and vascular compression in patients with trigeminal schwannomas: case report.
OBJECTIVE
Trigeminal neuralgia (TN) is often associated with neurovascular compression. However, intracranial tumors are occasionally observed, particularly when symptoms are atypical. We describe three patients with Type-1 TN and trigeminal schwannoma diagnosed by magnetic resonance imaging, with concomitant arterial compression of the trigeminal nerve.


METHODS
All three patients had Type-1 TN with spontaneous onset, paroxysm-triggered pain, and response to antiepileptic medication. Contrast-enhanced T1-weighted magnetic resonance imaging scans demonstrated an ipsilateral enhancing perineural mass consistent with a schwannoma. Two of the three patients had previously undergone gamma knife radiosurgery without improvement. Subsequent high-resolution magnetic resonance imaging in all three patients revealed obvious compression of the trigeminal nerve by an arterial structure.


METHODS
Two patients underwent retrosigmoid craniectomy followed by microvascular decompression and remain pain-free. One patient elected not to pursue surgical intervention.


CONCLUSIONS
Although intracranial tumors are occasionally observed in patients with TN, neurovascular compression must still be considered as an etiology, especially if typical TN symptoms are reported.
Miller
Jonathan P
JP
Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.
Acar
Feridun
F
Burchiel
Kim J
KJ
D000368:Aged; D003390:Cranial Nerve Neoplasms / Q000175:diagnosis / Q000601:surgery*; D003399:Craniotomy; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008866:Microsurgery; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000601:surgery*; D009442:Neurilemmoma; D019635:Neurosurgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000601:surgery*; D014277:Trigeminal Neuralgia / Q000175:diagnosis / Q000601:surgery*