Small vestibular schwannoma presented with trigeminal neuralgia: illustrative case.
ABR = auditory brainstem response
MR = magnetic resonance
MRA = magnetic resonance angiogram
MRC = magnetic resonance cisternogram
MRI = magnetic resonance imaging
NIM = nerve integrity monitor
TN = trigeminal neuralgia
VS = vestibular schwannomas
surgery
trigeminal nerve
trigeminal neuralgia
vestibular schwannoma
Journal
Journal of neurosurgery. Case lessons
ISSN: 2694-1902
Titre abrégé: J Neurosurg Case Lessons
Pays: United States
ID NLM: 9918227275606676
Informations de publication
Date de publication:
29 Aug 2022
29 Aug 2022
Historique:
received:
21
06
2022
accepted:
27
07
2022
entrez:
2
9
2022
pubmed:
3
9
2022
medline:
3
9
2022
Statut:
epublish
Résumé
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. 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. 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.
Sections du résumé
BACKGROUND
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
METHODS
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
CONCLUSIONS
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.
Identifiants
pubmed: 36051778
doi: 10.3171/CASE22274
pii: CASE22274
pmc: PMC9426354
doi:
pii:
Types de publication
Case Reports
Langues
eng
Pagination
CASE22274Informations de copyright
© 2022 The authors.
Déclaration de conflit d'intérêts
Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Références
J Fam Pract. 2019 Jul/Aug;68(6):355-357
pubmed: 31381624
Cephalalgia. 2017 Jun;37(7):648-657
pubmed: 28076964
J Orofac Pain. 2000 Spring;14(2):147-51
pubmed: 11203749
J Neurol Surg A Cent Eur Neurosurg. 2021 Mar;82(2):118-124
pubmed: 33291153
J Neurosurg. 1996 May;84(5):818-25
pubmed: 8622156
J Neurosurg. 1998 Mar;88(3):506-12
pubmed: 9488305
World Neurosurg. 2018 Jun;114:e1192-e1198
pubmed: 29614352
Head Neck Pathol. 2020 Dec;14(4):1058-1066
pubmed: 32232723
World Neurosurg. 2020 May;137:89-92
pubmed: 31953093
J Neurooncol. 2021 Jan;151(2):145-156
pubmed: 33415658
Neurosurgery. 2007 Jan;60(1):104-13; discussion 113-4
pubmed: 17228258
Acta Neurochir (Wien). 1995;134(3-4):148-54
pubmed: 8748774