Neurological Surgery No Shinkei Geka Volume 42, Issue 12 (December 2014)

Trigeminal Neuralgia Caused by Cerebellopontine Angle Lipoma:A Case Report and Review of the Literature Chika YOSHIMURA 1 , Asami KIKUCHI 1 , Yuichi TAKAHASHI 1 , Suguru YOKOSAKO 1 , Naoyuki ARAI 1 , Yasuhiro KUROI 1 , Yoshikazu KOSEKI 1 , Hidenori OHBUCHI 1 , Kengo HIROTA 1 , Shinji HAGIWARA 1 , Shigeru TANI 1 , Atsushi SASAHARA 1 , Mariko FUJIBAYASHI 2 , Hidetoshi KASUYA 1 1Department of Neurosurgery, Tokyo Women's Medical University Medical Center East 2Department of Surgical Pathology, Tokyo Women's Medical University Medical Center East Keyword: cerebellopontine angle , complication , lipoma , trigeminal neuralgia pp.1131-1136
Published Date 2014/12/10
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 A 59-year-old man presented with right trigeminal neuralgia of the second branch, which had been treated with carbamazepine. The pain could not be controlled adequately because of side effects. CT and MRI revealed a 2-cm lesion in the right cerebellopontine angle. Retrosigmoid lateral suboccipital craniectomy was performed, and a soft yellowish mass was found to be associated with the 5th, 7th, and 8th cranial nerves, anterior inferior cerebellar artery, and small vessels. The lipoma was partially resected from around the root entry zone(REZ)of the 5th nerve and small vessels were coagulated around the REZ. After surgery, there was no trigeminal neuralgia, but facial numbness and cerebellar signs were noted. Postoperative MRI showed decompression of the trigeminal nerve and venous infarction in the middle cerebellar peduncle. Reviewing similar cases, we found 19 lipoma patients presenting with trigeminal neuralgia. Symptoms of involvement of other cranial nerves were also present in 11 patients, and 14 were younger than 30 years old. Of 17 surgical cases, total resection was not attempted apart from one case. Although pain relief was achieved in all surgical cases, complications developed in 11. Surgery should be performed only in patients with disabling and uncontrolled symptoms.

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Neurological Surgery 脳神経外科
42巻12号 (2014年12月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院