Invisible compression, anterior fossa tumor causing trigeminal neuralgia

Area of Science:

• Neurosurgery
• Neurology
• Skull Base Tumors

Background:

• Trigeminal neuralgia (TN) is typically associated with tumors in the posterior and middle cranial fossae.
• Anterior fossa neoplasms have not been previously linked to secondary trigeminal neuralgia.

Observation:

• A 75-year-old female presented with right hemifacial pain, diagnosed with an anterior clinoid meningioma.
• Initial neuroimaging showed no apparent compression, but MRI revealed V3 hyperintensity.

Findings:

• Surgical resection of the anterior clinoid meningioma completely resolved the patient's hemifacial pain.
• The V3 hyperintensity observed on MRI also disappeared post-surgery and did not recur.

Implications:

• This case suggests anterior skull base lesions, like meningiomas, can cause TN even without direct compression.
• Microvascular or pressure gradient changes may underlie TN in such cases.
• Surgical intervention for anterior clinoid meningiomas can be a definitive treatment for associated trigeminal neuralgia.