Tags

Type your tag names separated by a space and hit enter

Microvascular Decompression for Treatment of Trigeminal Neuralgia in Patient with Facial Nerve Schwannoma.
World Neurosurg. 2018 May; 113:142-145.WN

Abstract

BACKGROUND

Secondary trigeminal neuralgia (TN) is uncommon. When a space-occupying lesion with mass effect is identified, the associated TN is often exclusively attributed to the tumor. This report illustrates the importance of considering coexistent actionable pathology when surgically treating secondary TN.

CASE DESCRIPTION

A 51-year-old woman presented with abrupt-onset TN of the V2 and V3 nerve divisions with hypesthesia. She denied changes in hearing, balance, or facial nerve dysfunction. Magnetic resonance imaging revealed a 1.6-cm contrast-enhancing cerebellopontine angle tumor that effaced the trigeminal nerve, consistent with a vestibular schwannoma. In addition, a branch of the superior cerebellar artery abutted the cisternal segment of the trigeminal nerve on T2-weighted thin-slice magnetic resonance imaging. Intraoperative electrical stimulation of the tumor elicited a response from the facial nerve at low threshold over the entire accessible tumor surface, indicating that the tumor was a facial nerve schwannoma. Considering the patient's lack of facial nerve deficit and that the tumor exhibited no safe entry point for intracapsular debulking, tumor resection was not performed. Working between the tumor and tentorium, a branch of the superior cerebellar artery was identified and decompressed with a Teflon pad. At last follow-up, the patient exhibited resolution of her TN. Her hearing and facial nerve function remained intact.

CONCLUSIONS

Despite obstruction from a medium-sized tumor, it is still possible to achieve microvascular decompression of the fifth cranial nerve. This emphasizes the importance of considering other actionable pathology during surgical management of presumed tumor-induced TN. Further, TN is relatively uncommon with medium-sized vestibular schwannomas and coexistent causes should be considered.

Authors+Show Affiliations

Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota, USA.Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: Carlson.matthew@mayo.edu.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29477001

Citation

Marinelli, John P., et al. "Microvascular Decompression for Treatment of Trigeminal Neuralgia in Patient With Facial Nerve Schwannoma." World Neurosurgery, vol. 113, 2018, pp. 142-145.
Marinelli JP, Van Gompel JJ, Link MJ, et al. Microvascular Decompression for Treatment of Trigeminal Neuralgia in Patient with Facial Nerve Schwannoma. World Neurosurg. 2018;113:142-145.
Marinelli, J. P., Van Gompel, J. J., Link, M. J., & Carlson, M. L. (2018). Microvascular Decompression for Treatment of Trigeminal Neuralgia in Patient with Facial Nerve Schwannoma. World Neurosurgery, 113, 142-145. https://doi.org/10.1016/j.wneu.2018.02.079
Marinelli JP, et al. Microvascular Decompression for Treatment of Trigeminal Neuralgia in Patient With Facial Nerve Schwannoma. World Neurosurg. 2018;113:142-145. PubMed PMID: 29477001.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microvascular Decompression for Treatment of Trigeminal Neuralgia in Patient with Facial Nerve Schwannoma. AU - Marinelli,John P, AU - Van Gompel,Jamie J, AU - Link,Michael J, AU - Carlson,Matthew L, Y1 - 2018/02/21/ PY - 2017/12/18/received PY - 2018/02/10/revised PY - 2018/02/12/accepted PY - 2018/2/25/pubmed PY - 2018/5/15/medline PY - 2018/2/25/entrez KW - Classic trigeminal neuralgia KW - Facial nerve schwannoma KW - Microvascular decompression KW - Secondary trigeminal neuralgia KW - Vestibular schwannoma SP - 142 EP - 145 JF - World neurosurgery JO - World Neurosurg VL - 113 N2 - BACKGROUND: Secondary trigeminal neuralgia (TN) is uncommon. When a space-occupying lesion with mass effect is identified, the associated TN is often exclusively attributed to the tumor. This report illustrates the importance of considering coexistent actionable pathology when surgically treating secondary TN. CASE DESCRIPTION: A 51-year-old woman presented with abrupt-onset TN of the V2 and V3 nerve divisions with hypesthesia. She denied changes in hearing, balance, or facial nerve dysfunction. Magnetic resonance imaging revealed a 1.6-cm contrast-enhancing cerebellopontine angle tumor that effaced the trigeminal nerve, consistent with a vestibular schwannoma. In addition, a branch of the superior cerebellar artery abutted the cisternal segment of the trigeminal nerve on T2-weighted thin-slice magnetic resonance imaging. Intraoperative electrical stimulation of the tumor elicited a response from the facial nerve at low threshold over the entire accessible tumor surface, indicating that the tumor was a facial nerve schwannoma. Considering the patient's lack of facial nerve deficit and that the tumor exhibited no safe entry point for intracapsular debulking, tumor resection was not performed. Working between the tumor and tentorium, a branch of the superior cerebellar artery was identified and decompressed with a Teflon pad. At last follow-up, the patient exhibited resolution of her TN. Her hearing and facial nerve function remained intact. CONCLUSIONS: Despite obstruction from a medium-sized tumor, it is still possible to achieve microvascular decompression of the fifth cranial nerve. This emphasizes the importance of considering other actionable pathology during surgical management of presumed tumor-induced TN. Further, TN is relatively uncommon with medium-sized vestibular schwannomas and coexistent causes should be considered. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/29477001/Microvascular_Decompression_for_Treatment_of_Trigeminal_Neuralgia_in_Patient_with_Facial_Nerve_Schwannoma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)30350-4 DB - PRIME DP - Unbound Medicine ER -