Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors

Abstract

During a 20-year period, 26 patients with typical symptoms of trigeminal neuralgia were found to have posterior fossa tumors at operation. These cases included 14 meningiomas, eight acoustic neurinomas, two epidermoid tumors, one angiolipoma, and one ependymoma. The median patient age was 60 years and 69% of the patients were women. Sixty-five percent of the symptoms were left sided. The median preoperative duration of symptoms was 5 years. The distribution of pain among the three divisions of the trigeminal nerve was similar to that found in patients with trigeminal neuralgia who did not have tumors; however, more divisions tended to be involved in the tumor patients. The mean postoperative follow-up period was 9 years. At operation, the root entry zone of the trigeminal nerve was examined for vascular cross-compression in 21 patients. Vessels compressing the nerve at the root entry zone were observed in all patients examined. Postoperative pain relief was frequent and long lasting. Using Kaplan-Meier methods the authors estimated excellent relief in 81% of the patients 10 years postoperatively, with partial relief in an additional 4%.

The Effects of Stereotactic Radiosurgery on Secondary Facial Pain

“…The mechanism of pain production by intracranial tumors was considered to be a direct trigeminal root compression or vascular compression secondary to displacement by the tumor [5,9]. As mentioned above, one patient with a vestibular schwannoma complained of continued facial pain despite the decrease in tumor volume, and follow-up MRI revealed vascular compression which had not been identified at prior imaging.…”

“…Young et al [8] also reported good results of radiosurgical treatment of tumor-related trigeminal neuralgia. They reported favorable results (pain relief more than 50% in 88.9% of cases) corresponding to the results of microsurgical resection of tumors [5]. However, these two radiosurgical reports have the limitation of a short-term follow-up.…”

“…A higher incidence of neurologic deficits such as facial hypesthesia and a younger age of onset have been reported in patients with secondary trigeminal neuralgia when compared with patients with primary trigeminal neuralgia [2±4]. For the relief of facial pain in tumor-related cases, microsurgical tumor resection has offered good or excellent results with long-term follow-up [5]. Several authors have reported their results for primary and secondary facial pain treated by Gamma Knife stereotactic radiosurgery [6±8].…”

Классическая Невралгия Тройничного Нерва

“…В тех случаях, ко-гда клиника классической НТН сопровождается чувствительным дефицитом, используют термин чувствительная тригеминальная нейропатия [331,423]. У больных рассеянным склерозом также наблюдается НТН, которую многие авторы относят ко вторичной НТН [63,74,154,158,169,170,184,340,354,365,366,378].…”

Trigeminal neuralgia caused by a trigeminocerebellar artery

“…2,3 We report a case of trigeminal neuralgia caused by an artery that had almost encircled the nerve, which was successfully decompressed surgically, and discuss the anatomy of the offending artery and trigeminal nerve root vasculature. …”