Secondary Trigeminal Neuralgia Caused by Meningiomas Involving the Meckel’s Cave and Microsurgical Decompression

Introduction: Trigeminal neuralgia (TN), characterized by a sudden onset of severe, piercing facial pain, significantly diminishes the quality of life. Petroclival (PC) meningiomas frequently invade Meckel’s cave through the porus trigeminus, leading to secondary TN. Microsurgery and stereotactic radiosurgery (SRS) are treatment options. This study evaluated microsurgery for PC meningioma-induced TN and investigated symptom control, outcomes, and treatment strategies.

Materials and Methods: We conducted a retrospective analysis of PC meningiomas patients who underwent tumor resection between January 2021 and December 2022. Among a total of 58 patients, 20 presented with severe TN. Radiographic assessments, clinical evaluations, and surgical techniques were analyzed. The primary outcome was pain relief, as assessed by the Barrow Neurological Institute (BNI) score.

Results: Among 20 patients (male/female: 3/17, median age: 52.8 years), 17 (85%) underwent anterior petrosal or combined petrosal approaches, and 3 (15%) underwent retrosigmoid approaches. 80% showed improvement in TN after microsurgery and were off all medications at the final follow-up (BNI I or II). Patients with no improvement in symptoms included those who relapsed after surgery or SRS, or who underwent the RMSOC approach.

Conclusions: Microsurgery is effective in improving BNI scores in TN patients. It is crucial to open the porus trigeminus and perform direct nerve decompression if a tumor has invaded Meckel's cave. Surgical intervention is recommended when SRS is ineffective.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024