Tentorial meningioma and painful tic convulsif

Abstract

A case is presented of painful tic convulsif caused by a posterior fossa meningioma, with right trigeminal neuralgia and ipsilateral hemifacial spasm. Magnetic resonance images showed an ectatic right vertebral artery as a signal-void area in the right cerebellopontine angle. At operation the tentorial meningioma, which did not compress either the fifth or the seventh cranial nerves directly, was totally removed via a suboccipital craniectomy. The patient had complete postoperative relief from the trigeminal neuralgia and her hemifacial spasm improved markedly with decreased frequency. From a pathophysiological standpoint, the painful tic convulsif in this case was probably produced by the tumor compressing and displacing the brainstem directly, with secondary neurovascular compression of the fifth and seventh nerves (the so-called "remote effect").

Arachnoid cyst associated with painful tic convulsif

“…1-3 PTC caused by space occupying masses such as epidermoid cyst, schwannoma, and meningioma of the cerebellopontine angle (CPA) have been reported. [4][5][6][7] Reduction in the posterior cranial fossa volume due to structural malformation has also been implicated rarely as a cause of trigeminal neuralgia. 8 However, a cystic lesion of the posterior fossa with no close proximity to the nerve causing PTC has not been reported to our knowledge.…”

“…[1][2][3] Tumors have also been reported to result in PTC. [4][5][6][7] We report a patient with an arachnoid cyst of the posterior fossa causing PTC.…”

Hemifacial Spasm Caused by a Huge Tentorial Meningioma

“…Tumors remote to the CPA causing HFS are rarely reported and the pathogenic mechanism is not clear. In adults, reported lesions include tentorial meningiomas 3,14) , tumors in the fourth ventricle 16,20) , occipital falcine meningioma 1) , and contralateral CPA meningioma 17) and acoustic neuroma 13) . Fourth ventricle tumors may induce HFS as a result of direct compression of the facial colliculus and intramedullary facial nerve fibers 4,20) .…”

“…Cancelli et al 3) reported HFS due to a tentorial paramedian meningioma and suggested four mechanisms : 1) distortion and/or compression of the seventh nerve root; 2) accentuation of the pre-existing subclinical neurovascular conflict; 3) compression of the facial nucleus; and 4) venous outflow obstruction due to the dislocation of anatomical structures by the tumor mass or transverse sinus invasion. Ogasawara et al 14) experienced a case of tentorial meningioma resulting in trigeminal neuralgia and HFS. They thought that the painful tic convulsif was probably produced by the tumor's compressing and displacing the brainstem directly, with secondary neurovascular compression of the fifth and seventh cranial nerves.…”

“…HFS can also develop as a result of other pathological conditions around the cerebellopontine angle (CPA), such as tumors, aneurysms, or arteriovenous malformations involving the REZ of the affected facial nerve 6,7,9,11,15,18,19) . Lesions distant to the CPA are very rare causes of HFS 1,3,5,14,17) . We report the unique case of a huge tentorial meningioma, which did not occupy the CPA.…”