Trigeminal neuralgia caused by intracranial epidermoid tumor: report of a case and review of the different therapeutic modalities

Abstract

Trigeminal neuralgia (TGN) is characterized by recurrent paroxysms of unilateral facial pain that typically is severe, lancinating, and activated with cutaneous stimulation. Paroxysms typically last for 1 to 2 seconds. Etiology includes compression of the trigeminal nerve by vascular structures, tumors and multiple sclerosis plaques in the medulla spinalis. TGN is rather rare as a presenting symptom with intracranial tumors. Epidermoid tumors comprise 1% of all intracranial tumors. The majority of epidermoid tumors are located at the pontocerebellar angle, the third ventricle, and the suprasellar region. Symptomatology is not different from other tumors located at the same sites. Trigeminal neuralgia may be caused by tumor compressing the nerve itself, an inflammatory response to the epidermoid tumor or vascular compression of the nerve. We describe the case of a 30-year old female presenting with right-sided facial pain. Her past history revealed multiple teeth extractions done to relieve facial pain. Radiological evaluation, including magnetic resonance imaging (MRI), showed a pontocerebellar angle (PCA) epidermoid tumor. TGN resolved completely after total tumor resection. A temporary facial paralysis consequent to surgical removal of the tumor improved 6 months postoperatively, and she remained painfree, without medications.