1/15. cerebellopontine angle lipoma: case report and review of the literature.Intracranial lipomas located in the cerebellopontine angle are extremely rare. These tumours are mal-developmental lesions which can cause slowly progressive neurological symptoms. The clinical management of these tumours differs significantly from other lesions in this region. A 27 year old woman presented with a 2-month history of vertigo and a slowly progressive deterioration of hearing in the left ear. Computed tomography (CT) revealed a large low-density mass in the left cerebellopontine angle without any contrast-enhancement. In T1-weighted magnetic resonance imaging (MRI) the lesion was hyper-intense and did not enhance after application of gadolinium. Areas of lower signal intensity inside of the lesion were suggested as incorporated cranial nerves. A left retro-sigmoidal approach in a semi-sitting position was chosen to expose the tumour. After reducing the tumour mass, the tumour was dissected from the cranial nerves which were incorporated into the tumour. The residual tumour was adherent to the brain stem and the encased lower cranial nerves, allowing only a near subtotal resection of the highly vascularized tumour in order to avoid neurological deficits. The histological examination revealed a lipoma. Attempts at complete removal of cerebellopontine angle lipomas usually result in severe neurological deficits. Conservative treatment should therefore be preferred. Limited surgery is indicated if the patients suffer from disabling neurological symptoms and signs e.g., vertigo, nausea, trigeminal neuralgia, facial weakness or facial spasm.- - - - - - - - - - ranking = 1keywords = neuralgia (Clic here for more details about this article) |
2/15. meningioma manifested as temporomandibular joint disorder: a case report.Pain in the temporomandibular joint (TMJ) and the surrounding region constitutes a symptom of TMJ disorders. Various dental causes usually stimulate the trigeminal nerve, developing facial pain which triggers trigeminal neuralgia. However, trigeminal neuralgia may also arise from irritation of the endocranial root of the nerve, due to occult damage which has not yet manifested other symptoms, for example a meningioma. In this manner, the actual cause of pain in the ipsilateral half of the face may be interpreted incorrectly and may possibly be attributed to a TMJ dysfunction syndrome. This results in long-term frustration and burdening of the patient. The case of a 47-year-old woman is presented who complained of symptoms of a painful TMJ disorder. She was initially treated with the appropriate dental procedures and, upon continuation of the pain, was examined with CT scanning, which proved to be negative despite the existence of a cerebral lesion. Further investigation with MRI, however, revealed a meningioma of 5 mm size, in the region of the cerebellopontine angle.- - - - - - - - - - ranking = 2keywords = neuralgia (Clic here for more details about this article) |
3/15. trigeminal neuralgia due to an acoustic neuroma in the cerebellopontine angle.This case report first reviews the intracranial tumors associated with symptoms of trigeminal neuralgia (TN). Among patients with TN-like symptoms, 6 to 16% are variously reported to have intracranial tumors. The most common cerebellopontine angle (CPA) tumor to cause TN-like symptoms is a benign tumor called an acoustic neuroma. The reported clinical symptoms of the acoustic neuroma are hearing deficits (60 to 97%), tinnitus (50 to 66%), vestibular disturbances (46 to 59%), numbness or tingling in the face (33%), headache (19 to 29%), dizziness (23%), facial paresis (17%), and trigeminal nerve disturbances (hypesthesia, paresthesia, and neuralgia) (12 to 45%). magnetic resonance imaging with gadolinium enhancement or computed tomography with contrast media are each reported to have excellent abilities to detect intracranial tumors (92 to 93%). This article then reports a rare case of a young female patient who was mistakenly diagnosed and treated for a temporomandibular disorder but was subsequently found to have an acoustic neuroma located in the CPA.- - - - - - - - - - ranking = 6keywords = neuralgia (Clic here for more details about this article) |
4/15. Tic convulsif caused by cerebellopontine angle schwannoma.A case is presented of painful tic convulsif caused by schwannoma in the cerebellopontine angle (CPA), with right trigeminal neuralgia and ipsilateral hemifacial spasm. Magnetic resonance images showed a 4 cm round mass displacing the 4th ventricle and distorting the brain stem in the right CPA. The schwannoma, which compressed the fifth and seventh cranial nerves directly, was subtotally removed by a suboccipital craniectomy. Postoperatively, the patient had a complete relief from the hemifacial spasm and marked improvement from trigeminal neuralgia. The painful tic convulsif in this case was probably produced by the tumor compressing and displacing the anterior cerebellar artery directly.- - - - - - - - - - ranking = 2keywords = neuralgia (Clic here for more details about this article) |
5/15. cerebellopontine angle epidermoid tumor presenting with 'tic convulsif' and tinnitus--case report.A 22-year-old female presented with a cerebellopontine angle epidermoid tumor manifesting as a rare combination of hemifacial spasm, trigeminal neuralgia, and tinnitus. magnetic resonance imaging demonstrated the tumor distorting the brainstem and the fourth ventricle. The tumor was almost completely resected and the seventh-eighth cranial nerve complex was decompressed by mobilizing the anterior inferior cerebellar artery loop. No arterial loop was related to the trigeminal nerve. The patient was completely relieved of the "tic convulsif" and tinnitus after the surgery. The inflammatory nature of epidermoid tumor may be involved in the etiology of the syndrome. Microvascular decompression may be needed in addition to tumor removal in such cases.- - - - - - - - - - ranking = 1keywords = neuralgia (Clic here for more details about this article) |
6/15. Malignant squamous degeneration of a cerebellopontine angle epidermoid tumor. Case report.The authors present the case of a woman with a cerebellopontine angle (CPA) epidermoid cyst that degenerated into a squamous cell carcinoma. Malignant degeneration of an epidermoid cyst is an extremely rare occurrence. Malignant transformation must be considered in the differential diagnosis when new contrast enhancement on imaging studies and progressive neurological deficit are seen in a patient harboring an epidermoid cyst. The patient initially presented with a 10-year history of left trigeminal neuralgia, subacute left-sided hearing loss, and with facial weakness of 3 weeks' duration. Initial magnetic resonance (MR) imaging revealed a left CPA mass, consistent with an epidermoid. There was faint contrast enhancement where the tumor was in contact with the lateral brainstem. A subtotal resection was performed. Histopathological findings were consistent with an epidermoid tumor. One year after initial presentation, the patient's neurological deficit had increased, and follow-up MR imaging demonstrated a large contrast-enhancing tumor filling the left CPA and compressing the brainstem. At repeated surgery a squamous cell carcinoma arising from the previous epidermoid was found. The patient was subsequently treated with external-beam radiotherapy and stereotactic radiosurgery. Her tumor stabilized. Three years and 8 months after the patient's initial presentation, a new area of tumor developed at the torcular Herophili. The patient died shortly thereafter. Malignant squamous degeneration is a rare cause of enhancement on MR images, as is progressive neurological deficit in a patient with an epidermoid. The combination of subtotal resection, external-beam radiotherapy, and stereotactic radiosurgery may be useful for local tumor control but the long-term prognosis is guarded.- - - - - - - - - - ranking = 1keywords = neuralgia (Clic here for more details about this article) |
7/15. Pain relief by stellate ganglion block in a case with trigeminal neuralgia caused by a cerebellopontine angle tumor.A 29-year-old woman with symptoms suggestive of trigeminal neuralgia is presented. Because of her age, an intracranial tumor was suspected, but images of a brain computerized tomography scan revealed nothing in particular. A magnetic resonance imaging was scheduled 2 weeks later. However, as the pain increased and occurred more frequently, the patient returned to the hospital 2 days later. After a stellate ganglion block with transient nausea and dizziness, the pain was noticeably relieved. Using magnetic resonance scanning, a tumor in the cerebellopontine angle was discovered, and at surgical resection was diagnosed as an epidermoid tumor. stellate ganglion block may provide pain relief to some patients who are suspected to have symptomatic trigeminal neuralgia.- - - - - - - - - - ranking = 6keywords = neuralgia (Clic here for more details about this article) |
8/15. Preoperative evaluation of trigeminal neuralgia due to epidermoid tumor using a three dimensional fast advanced spin echo--case report.We report preoperative virtual images reconstructed from three-dimensional fast advanced spin echo (3D-FASE)and evaluate the cause of a trigeminal neuralgia due to an epidermoid tumor. A 60-year-old man had a 3-year-history of atypical trigeminal neuralgia in the left V2 region accompanied by a hypesthesia in the cheek. neuroimaging demonstrated an epidermoid tumor in the left cerebello-pontine cistern. As the preoperative virtual images reconstructed from 3D-FASE images indicated that the superior cerebellar artery compressed the trigeminal nerve at the root entry zone, we carried out total removal of the tumor and microvascular decompression of the trigeminal nerve. It was possible to visualize the fine structures around the trigeminal nerve, because an epidermoid tumor shows a high intensity mass on 3D-FASE images. The simulated 3D images were useful in deciding upon the additional microvascular decompression surgery for trigeminal neuralgia after total removal of the epidermoid tumor.- - - - - - - - - - ranking = 7keywords = neuralgia (Clic here for more details about this article) |
9/15. trigeminal neuralgia secondary to tumor with normal exam, responsive to carbamazepine.trigeminal neuralgia is most commonly idiopathic, although it can be associated with multiple sclerosis. Tumors are rare causes of trigeminal neuralgia. A case is presented of trigeminal neuralgia with normal neurological examination and responsive to carbamazepine, secondary to a cerebellopontine angle meningioma. literature relative to neoplastic etiologies of trigeminal neuralgia is reviewed. The role of electrodiagnostic testing in the evaluation of trigeminal neuralgia is considered. A normal neurological examination and responsiveness to carbamazepine do not exclude tumor as an etiology of trigeminal neuralgia.- - - - - - - - - - ranking = 10keywords = neuralgia (Clic here for more details about this article) |
10/15. Cerebello-pontine angle (CPA) tumor causing contralateral trigeminal neuralgia--a case report.A rare case of CPA tumor causing contralateral trigeminal neuralgia was encountered in our hospital. The radiological findings showed a right CPA tumor with compression and distortion of the brain stem and obliteration of the left CP angle. This was considered the cause of the left trigeminal neuralgia. In this case report, clinical management is discussed and the literature is reviewed.- - - - - - - - - - ranking = 6keywords = neuralgia (Clic here for more details about this article) |
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