The Tethered Effect of Vestibular Schwannoma Tumor Shrinkage Following Stereotactic Radiosurgery in Secondary Trigeminal Neuralgia

Percutaneous balloon compression for secondary trigeminal neuralgia caused by cerebellopontine angle tumors

OBJECTIVE

The most common cause for trigeminal neuralgia (TN) is vascular compression at the nerve root, and microvascular decompression (MVD) has been proven to be an effective surgical approach for this disease. For some patients, TN is secondary to the intracranial space-occupying lesion, and tumor resection is usually recommended. However, it is not easy to determine proper treatments when craniotomy is infeasible. In this study, we aim to explore the clinical outcomes of percutaneous balloon compression (PBC) for secondary TN caused by cerebellopontine angle (CPA) tumors.

METHODS

From June 2016 to December 2019, 15 patients with TN caused by CPA tumors underwent PBC in Nanjing Drum Tower Hospital. The clinical features, surgical outcomes, and complications of these patients were analyzed retrospectively.

RESULTS

Fourteen out of the 15 patients had immediate pain relief after successful PBC, while one showed occasional pain, without needing any medication. No patients had a relapse of facial pain within a mean follow-up of 32.5 months. As for surgical complications, 14 patients experienced facial numbness, and six had masseter muscle weakness. No patients experienced serious surgical morbidities.

CONCLUSIONS

For the patients with TN caused by CPA tumors, PBC could be considered a useful technique, especially when craniotomy is infeasible.

Levetiracetam in management of bilateral trigeminal neuralgia due to large glomus tumor case report

Background:

Trigeminal neuralgia can be classical or idiopathic. While trigeminal neuralgia (TN) due to space-occupying lesions is atypical, such lesions rarely cause severe TN secondary to trigeminal nerve irritation. Mass effect from these lesions has been shown to correlate with symptom burden, due to direct or indirect compressive effects. A tethering effect, provoked by an abnormal root-stretching force, theoretically plays a role in trigeminal nerve hyperexcitability.

Case:

The likely etiology in this case presentation is a large glomus tumor invading the middle and posterior cranial fossa. Glomus tumors are uncommon benign tumors of the head and neck derived from neural crest cells. Even more strikingly, a large glomus tumor causes bilateral TN due to direct compression on one side and indirect compression on the contralateral side.

Conclusion:

Although the gold standard in TN management is carbamazepine, other anti-epileptic drugs (AEDs) have been used in the treatment of patients unable to take carbamazepine. A few studies suggest levetiracetam alleviates central and neuropathic pain, supporting the hypothesis that it may be effective in management of TN.

Surgical Treatment of Secondary Trigeminal Neuralgia Induced by Cerebellopontine Angle Tumors: A Single-Center Experience

OBJECTIVE

Secondary trigeminal neuralgia (TN) caused by cerebellopontine angle (CPA) tumors are rare, although TN may be a primary manifestation in the neurosurgery department. In this study, we aimed to retrospectively assess patients with CPA tumor-induced TN from a single center.

METHODS

Of 819 consecutive patients with TN treated at our center between 2007 and 2017, 36 with CPA tumor-induced TN were enrolled, and their medical and surgical records were analyzed.

RESULTS

The 36 patients accounted for 4.4% of all patients with TN. A comparison of patients with classic and tumor-induced TN indicated significant intergroup differences in the mean age at surgery (58.94 vs. 49.33 years, P = 0.000), the mean age at onset of TN (52.01 vs. 38.04 years), and affected side (298/485 vs. 22/14 in left/right, P = 0.006); no such difference was noted in the sex ratio (0.598 vs. 0.385, P = 0.214). The rates of excellent, good, and fair clinical outcomes were 80.56%, 13.89%, and 2.78%, respectively. The offending vessels found during surgery included the superior and anterior inferior cerebellar arteries in 3 and 4 cases, respectively. Postoperative complications included aseptic meningitis (1 case), facial numbness (2 cases), hearing disturbance (3 cases), facial palsy (4 cases), hemorrhage (1 case), and diplopia (2 cases).

CONCLUSIONS

Secondary TN caused by CPA tumors is not as frequent as classic TN. Compared with classic TN, tumor-induced TN is characterized by symptom onset and surgery at a younger age. Direct compression rather than chemical irritation is the cause of secondary TN.