Trochlear Schwannoma Presenting with Isolated Trigeminal Neuralgia.

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Trochlear Schwannoma Presenting with Isolated Trigeminal Neuralgia.

World Neurosurg. 2017 Apr 18;:

Authors: Nesvick CL, Perry A, Graffeo CS, Raghunathan A, Hammack JE, Van Gompel JJ

Abstract
BACKGROUND: Schwannomas arising from the cranial nerves controlling extraocular eye movements are very rare and usually present with some degree of diplopia.
CASE DESCRIPTION: We report a 50-year-old woman who presented with isolated left-sided trigeminal neuralgia of six months' duration. Imaging demonstrated a homogeneously enhancing mass in the left ambient cistern, and the patient was taken to the operating room for resection. A retrosigmoid approach was used, and the mass was directly visualized arising from the trochlear nerve and compressing on the dorsal root entry zone of the trigeminal nerve. A gross total resection of the mass was achieved, and a microvascular decompression of the trigeminal nerve was performed. The tumor was pathologically confirmed as a schwannoma. At three-month follow-up, the patient's facial pain was resolved, and her extraocular eye movements were intact.
CONCLUSIONS: There are 32 previously reported pathology-confirmed cases of trochlear schwannoma in the English-language literature. The majority of these tumors arose from the cisternal segment of the nerve, and most patients presented with frank trochlear nerve palsy on exam. We report the first patient with trochlear schwannoma to present with isolated trigeminal neuralgia.

PMID: 28434965 [PubMed - as supplied by publisher]

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