J Neurol Surg A Cent Eur Neurosurg 2021; 82(02): 118-124
DOI: 10.1055/s-0040-1718708
Original Article

Trigeminal Neuralgia Secondary to Intracranial Neoplastic Lesions: a Case Series and Comprehensive Review

Luigi Valentino Berra
1   Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy
1   Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy
Lara Mastino
1   Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy
Andrea Di Rita
2   Department of Neurosurgery, San Carlo Borromeo Hospital, Milan, Italy
Valerio Di Norcia
1   Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy
Antonio Santoro
1   Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy
Manolo Piccirilli
1   Department of Neurology and Psychiatry, Neurosurgery, Sapienza University of Rome, Rome, Italy
› Author Affiliations


It is known that intracranial tumors may trigger trigeminal neuralgia (TN) in some patients although the exact prevalence and occurrence is not completely defined yet. In the present study, we present a case series of patients with brain tumor and a clinical diagnosis of TN as the first and main manifestation of the disease. A retrospective analysis was performed involving patients diagnosed with brain tumor whose exclusive clinical feature our department focused on was TN. In addition, a review of all published cases was performed. From January 2017 to November 2018, 718 patients with brain tumor were admitted to our department, 17 of which suffered of TN, of which 8 patients presented with at least another neurologic symptom and 9 patients presented with TN alone, with typical symptoms of stubbing electric pain in 6 cases. In our series, we found that 2.3% of patients admitted for brain tumors had TN. In 0.8% of cases, TN was the main clinical symptom. The prevalence of tumor lesion in patients with facial neuropathic pain is not defined, but it is a well-known recognized initial symptom; however, early cerebral magnetic resonance imaging (MRI) is not yet strongly recommended in patients with newly diagnosed trigeminal neuralgia. The purpose of this article is, especially in unusual cases, to show that the application of such MR techniques and preoperative evaluation may contribute to diagnosis, indication, and surgery planning.

Ethical approval

All the procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Publication History

Received: 15 April 2020

Accepted: 08 June 2020

Article published online:
08 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Agrawal M, Agrawal V, Agrawal R, Pramod DS. Trigeminal neuralgia secondary to posterior fossa tumor. Natl J Maxillofac Surg 2010; 1 (01) 71-73
  • 2 Eller JL, Raslan AM, Burchiel KJ. Trigeminal neuralgia: definition and classification. Neurosurg Focus 2005; 18 (05) E3
  • 3 Zakrzewska JM. Diagnosis and differential diagnosis of trigeminal neuralgia. Clin J Pain 2002; 18 (01) 14-21
  • 4 Devine M, Rahman N, Connor SEJ, Patel J, Renton T. Evaluation of routine magnetic resonance imaging of patients with chronic orofacial pain. Int J Oral Maxillofac Surg 2019; 48 (01) 48-55
  • 5 Meng L, Yuguang L, Feng L, Wandong S, Shugan Z, Chengyuan W. Cerebellopontine angle epidermoids presenting with trigeminal neuralgia. J Clin Neurosci 2005; 12 (07) 784-786
  • 6 Guo Z, Ouyang H, Cheng Z. Surgical treatment of parapontine epidermoid cysts presenting with trigeminal neuralgia. J Clin Neurosci 2011; 18 (03) 344-346
  • 7 Cirak B, Kiymaz N, Arslanoglu A. Trigeminal neuralgia caused by intracranial epidermoid tumor: report of a case and review of the different therapeutic modalities. Pain Physician 2004; 7 (01) 129-132
  • 8 Gurcan O, Gurcay AG, Kazanci A. et al. Trigeminal neuralgia as an unusual isolated symptom of pituitary adenoma: case report and review of the literature. Turk Neurosurg 2016; 26 (01) 180-183
  • 9 Xia L, Zhong J, Zhu J. et al. Cholesteatoma of cerebellopontine angle presented as trigeminal neuralgia. J Craniofac Surg 2014; 25 (04) 1540-1542
  • 10 Bennett MH, Jannetta PJ. Evoked potentials in trigeminal neuralgia. Neurosurgery 1983; 13 (03) 242-247
  • 11 Bowsher D, Miles JB, Haggett CE, Eldridge PR. Trigeminal neuralgia: a quantitative sensory perception threshold study in patients who had not undergone previous invasive procedures. J Neurosurg 1997; 86 (02) 190-192
  • 12 Mursch K, Schäfer M, Steinhoff BJ, Behnke-Mursch J. Trigeminal evoked potentials and sensory deficits in atypical facial pain: a comparison with results in trigeminal neuralgia. Funct Neurol 2002; 17 (03) 133-136
  • 13 Nurmikko TJ. Altered cutaneous sensation in trigeminal neuralgia. Arch Neurol 1991; 48 (05) 523-527
  • 14 Sinay VJ, Bonamico LH, Dubrovsky A. Subclinical sensory abnormalities in trigeminal neuralgia. Cephalalgia 2003; 23 (07) 541-544
  • 15 Chou CT, Liang JF. Trigeminal schwannoma presenting as atypical trigeminal neuralgia and masseter atrophy. Acta Neurol Taiwan 2014; 23 (01) 38-39
  • 16 Shulev Y, Trashin A, Gordienko K. Secondary trigeminal neuralgia in cerebellopontine angle tumors. Skull Base 2011; 21 (05) 287-294
  • 17 Hung LC, Wu CS, Lin CC, Fang WK, Hsu YC. Epidermoid cyst presenting as isolated trigeminal neuralgia - two case reports. Acta Neurol Taiwan 2013; 22 (03) 133-137
  • 18 Son DW, Choi CH, Cha SH. Epidermoid tumors in the cerebellopontine angle presenting with trigeminal neuralgia. J Korean Neurosurg Soc 2010; 47 (04) 271-277
  • 19 Peker S, Ussel I, Pamir N. Trigeminal neuralgia due to brainstem vascular malformations: report of two cases and review of the literature. J Neurol Sci 2012; 29 (03) 594-597
  • 20 Perrini P, Rasile F, Leggate J. Trigeminal neuralgia as initial symptom of paramedian tentorial meningioma. Neurol Sci 2009; 30 (01) 81-83
  • 21 Scavo CG, Roperto R, Cacciotti G, Mastronardi L. Cystic progression of a cavernous malformation at the level of the trigeminal root entry zone presenting with sudden onset of trigeminal neuralgia. J Craniofac Surg 2018; 29 (08) e728-e730
  • 22 Noma N, Hayashi M, Kitahara I. et al. Painful trigeminal neuropathy attributed to a space-occupying lesion presenting as a toothache: a report of 4 cases. J Endod 2017; 43 (07) 1201-1206
  • 23 Niwant P, Motwani M, Naik S. Atypical trigeminal neuralgia secondary to meningioma. Case Rep Dent 2015; 2015: 462569
  • 24 Ang JW, Khanna A, Walcott BP, Kahle KT, Eskandar EN. Central nervous system lymphoma presenting as trigeminal neuralgia: a diagnostic challenge. J Clin Neurosci 2015; 22 (07) 1188-1190
  • 25 Khalatbari M, Amirjamshidi A. Trigeminal neuralgia as the initial manifestation of temporal glioma: report of three cases and a review of the literature. Surg Neurol Int 2011; 2: 114
  • 26 Jia DZ, Zhou MD, Jiang YQ, Li G. Trigeminal neuralgia caused by a choroid plexus papilloma of the cerebellopontine angle: case report and review of the literature. J Int Med Res 2010; 38 (01) 289-292
  • 27 Tancioni F, Gaetani P, Villani L, Zappoli F, Rodriguez Y, Baena R. Neurinoma of the trigeminal root and atypical trigeminal neuralgia: case report and review of the literature. Surg Neurol 1995; 44 (01) 36-42
  • 28 Vitek L, Tettenborn B. Cavernous angioma in the brachium pontis presenting with trigeminal neuralgia: a case report. Eur Neurol 2002; 48 (04) 226-228
  • 29 Pereira de Morais NM, Mascarenhas AL, Soares-Fernandes JP, Moreira da Costa JA. Cranial nerve cavernous malformations causing trigeminal neuralgia and chiasmal apoplexy: report of 2 cases and review of the literature. Surg Neurol Int 2012; 3: 105