Abstract
Objectives
Cerebellopontine angle tumors are reported causes of trigeminal neuralgia, but trigeminal
neuralgia emerging long after cerebellopontine angle tumor removal, despite the absence
of tumor regrowth, is extremely rare. Surgical resolution is required for intractable
cases, but it is challenging due to the altered anatomy and severe adhesions from
prior surgery, and unclear etiologies.
Design
Retrospective case series.
Participants
About 2,580 patients underwent cerebellopontine angle tumor resection (including vestibular
schwannomas, meningiomas, trigeminal schwannomas, epidermoid cysts, and others) during
a 19-year period.
Main Outcome Measures
Postoperative pain resolution and neurological complications after surgical intervention
for trigeminal neuralgia without tumor regrowth.
Results
Three patients required surgical intervention for delayed-onset trigeminal neuralgia,
occurring 2 to 11 years after the vestibular schwannoma surgery. In all patients,
the offending artery was transposed, and thick arachnoid adhesions were dissected.
Additional procedures included the separation of the compressing vein, the separation
of the adhering facial nerve, and the removal of residual tumor to isolate the trigeminal
nerve. All patients experienced complete pain relief postoperatively without developing
new permanent neurological deficits, except for one patient who developed mild facial
hypoesthesia.
Conclusion
Although rare and technically challenging, surgical intervention can be an effective
and safe treatment for surgery-associated trigeminal neuralgia. Comprehensive management
of all possible etiologies, including separation of the surrounding structures (arteries,
veins, cranial nerves, arachnoid, and residual tumor) from the trigeminal nerve, should
be considered for complete and secure pain relief under detailed neuromonitoring.
keywords
acoustic neuroma - functional neurosurgery - microvascular decompression - neurovascular
compression syndromes - retrosigmoid lateral suboccipital approach
