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. 2015 Feb;28(1):36-41.
doi: 10.15274/NRJ-2014-10117.

Intracranial trigeminal schwannoma

Ajay Agarwal  1
Affiliations

Intracranial trigeminal schwannoma

Ajay Agarwal. Neuroradiol J. 2015 Feb.

Abstract

Intracranial trigeminal schwannomas are rare tumors. Patients usually present with symptoms of trigeminal nerve dysfunction, the most common symptom being facial pain. MRI is the imaging modality of choice and is usually diagnostic in the appropriate clinical setting. The thin T2-weighted CISS 3D axial sequence is important for proper assessment of the cisternal segment of the nerve. They are usually hypointense on T1, hyperintense on T2 with avid enhancement post gadolinium. CT scan is supplementary to MRI, particularly for tumors located in the skull base. Imaging plays a role in diagnosis and surgical planning. In this pictorial essay, we retrospectively reviewed imaging findings in nine patients with pathologically proven trigeminal schwannoma. Familiarity with the imaging findings of intracranial trigeminal schwannoma may help to diagnose this entity.

Keywords: MR; schwannoma; trigeminal nerve.

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Figures

Figure 1.
Figure 1.
A 45-year-old female presented with recurrent right sided facial pain. Axial T2 (A), T1 pre (B) and T1 post contrast (C) MR images demonstrate an enhancing lesion arising from the cisternal segment of the right trigeminal nerve.
Figure 2.
Figure 2.
A 49-year-old female presented with left-sided facial numbness. Axial T1 pre (A) and T1 post contrast (B) MR images demonstrate a small avidly enhancing lesion in relation to the cisternal segment of the left trigeminal nerve just proximal to Meckel’s cave.
Figure 3.
Figure 3.
A 55-year-old male presented with difficulty in chewing and right-sided facial paresthesia. Axial T2 (A), T1 pre (B) and T1 post contrast (C) MR images demonstrate a large homogenously enhancing dumbbell-shaped extra-axial mass extending from the posterior fossa to Meckel’s cave on the right along the expected course of the trigeminal nerve.
Figure 4.
Figure 4.
A 52-year-old female presented with right-sided facial irritation. Axial T2 (A), axial T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a globular enhancing mass in the right Meckel’s cave arising from the trigeminal ganglion.
Figure 5.
Figure 5.
A 17-year-old female presented with difficulty in hearing and right facial pain. Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebellopontine angle cisterns and right Meckel’s cave. This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma.
Figure 6.
Figure 6.
A 50-year-old male presented with right facial pain and double vision. Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckel’s cave.
Figure 7.
Figure 7.
A 60-year-old female presented with headache and dizziness. Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckel’s cave with significant local mass effect.
Figure 8.
Figure 8.
A 48-year-old male presented with numbness on the left side of face in the distribution of V2. Axial T2 (A), coronal T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a mildly enhancing well-defined rounded mass in the region of the left foramen rotundum. There was bony remodeling on CT (not shown).
Figure 9.
Figure 9.
A 51-year-old female presented with left facial paresthesia in the distribution of V3. Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extracranial extension. There was bony remodeling on CT (not shown).
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