Trigeminal Neuralgia Caused by Cerebellopontine Angle Tumors: Surgical Series

Abstract

Introduction Cerebellopontine angle (CPA) tumors represent an important cause of persistent and refractory trigeminal neuralgia (TN). It is believed that ∼ between 1 and 9.9% of the cases of patients presenting with TN painful manifestation are caused by space-occupying lesions.

Objective The objective of the present study is to describe the clinical and surgical experience of the operative management of patients presenting with secondary type TN associated with CPA tumors.

Method An observational investigation was conducted with data collection from patients with secondary type TN associated with CPA tumors who were treated with surgical resection of the space-occupying lesion and decompression of the trigeminal nerve from January 2013 to November 2016 in 2 different centers in the western region of the state of São Paulo, Brazil.

Results We operated on 11 consecutive cases in which TN was associated with CPA during the period of analysis. Seven (63.6%) patients were female, and 4 (36.4%) were male. Seven (63.6%) patients presented with right-side symptoms, and 4 (36.4%) presented with left-side symptoms. After 2 years of follow-up, we observed that 8 (72.7%) patients showed a complete improvement of the symptoms, with an excellent outcome, and that 3 (27.3%) patients showed an incomplete improvement, with a good outcome. No patient reported partial improvement or poor outcome after the follow-up. There was no operative mortality.

Conclusion Cerebellopontine angle tumors represent an important cause of TN and must be included in the differential diagnosis of patients presenting with refractory and persistent symptoms. Surgical treatment with total resection of the expansive lesion and effective decompression of the trigeminal nerve are essential steps to control the symptoms.

Resumo

Introdução Os tumores de ângulo pontocerebelar (APC) representam uma importante causa de neuralgia do nervo trigêmeo (NT) persistente e refratária. Cerca de 1 a 9,9% dos casos de pacientes com manifestação dolorosa do trigêmeo são causados por lesões expansivas.

Objetivo O objetivo do presente estudo é descrever a experiência clínica e cirúrgica do tratamento de pacientes que apresentam tipo secundário de NT associada a tumores de APC.

Método Foi realizada uma investigação observacional com coleta de dados de pacientes com NT secundária associada a tumor de APC tratados com ressecção cirúrgica de lesão expansiva e descompressão do nervo trigêmeo entre janeiro de 2013 e novembro de 2016, em 2 diferentes centros da região oeste do estado de São Paulo, Brasil.

Resultados Foram abordados 11 casos consecutivos nos quais NT foi associada a tumores de APC durante o período de análise. Sete (63,6%) pacientes eram do sexo feminino, e 4 (36,4%) do sexo masculino. Sete (63,6%) pacientes apresentaram sintomas no lado direito, e 4 (36,4%) apresentaram sintomas no lado esquerdo. Após 2 anos de seguimento, 8 (72,7%) pacientes apresentaram melhora completa dos sintomas com excelente resultado, e 3 (27,3%) pacientes apresentaram melhora incompleta com boa evolução. Não houve mortalidade operatória.

Conclusão Os tumores de APC representam uma importante causa de NT e devem ser incluídos no diagnóstico diferencial de pacientes com sintomas refratários e persistentes. O tratamento cirúrgico com ressecção total da lesão expansiva e descompressão efetiva do nervo trigêmeo são etapas essenciais para o controle dos sintomas.

Keywords

trigeminal neuralgia - cerebellopontine angle tumors

Palavras-chave

neuralgia trigeminal - tumor do ângulo pontocerebelar

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