J Neurol Surg B Skull Base 2016; 77(01): 047-053
DOI: 10.1055/s-0035-1558834
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Management of Recurrent Trigeminal Neuralgia Associated with Petroclival Meningioma

Shyamal C. Bir
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
,
Tanmoy Kumar Maiti
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
,
Papireddy Bollam
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
,
Anil Nanda
1   Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, United States
› Author Affiliations
Further Information

Publication History

02 February 2015

11 June 2015

Publication Date:
03 August 2015 (online)

Abstract

Objective Petroclival meningioma (PM) presents with trigeminal neuralgia (TN) in < 5% of cases. Neurosurgeons often face the dilemma of formulating a treatment protocol when TN recurs. In this study, we sought to set up a protocol in patients with PM who had a recurrent TN.

Materials and Methods We performed a retrospective review of 57 patients with PM. Of the 57 patients, only 7 patients presented with TN, and six patients experienced recurrent TN. The study population was evaluated clinically and radiographically after treatment.

Results Overall improvement of pain control after various treatments was 67%, and tumor control was 100%. The pain-free period was 2 years for the Gamma Knife radiosurgery (GKRS) group and 4 years for the resection group when treated as a primary treatment (p = 0.034). Of the six patients, four patients had Barrow Neurosurgical Institute (BNI) score I (no TN, no medication), and two patients had BNI score III (some pain controlled with medication). The Karnofsky performance scale score was significantly improved after treatment compared with the pretreated status (78 versus 88; p = 0.044).

Conclusion Microsurgical resection is superior to GKRS in achieving and maintaining pain-free status in patients with recurrent trigeminal pain associated with PM.