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[Extracranial trigeminal schwannomas with middle temporal fossa development]
P Paquis1, L Castillo, M Lonjon
1Service de Neurochirurgie, Hôpital Pasteur, CHU, Nice.
Neuro-Chirurgie
|October 3, 1998
Summary
Rare trigeminal nerve schwannomas, primarily extra-cranial with intracranial extension, present with facial pain or diplopia. Surgical removal is feasible, offering a good prognosis for these unusual tumors.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Schwannomas of the trigeminal nerve are rare, constituting a small fraction of intracranial tumors.
- Jefferson's type D tumors are predominantly extra-cranial with potential intracranial involvement.
Observation:
- Three cases (two male, one female; ages 36-63) of predominantly extra-cranial trigeminal nerve schwannomas with intracranial extension were analyzed.
- Presenting symptoms included facial pain, hypoesthesia, and diplopia.
- CT and MRI revealed large, hypodense tumors in the infratemporal fossa with intracranial extension, displacing adjacent structures.
Findings:
- Tumors showed hypointensity on T1-weighted MRI with significant post-gadolinium enhancement.
- One cystic tumor exhibited hyperintensity on T2-weighted imaging.
- Surgical approaches included combined subtemporal-transmaxillary and transmaxillary-only methods.
- No surgical mortality occurred; one patient experienced residual painful anesthesia.
Implications:
- Extra-cranial schwannomas with intracranial extension are rare but diagnostically identifiable via neuroradiology (CT/MRI).
- Early symptoms like facial neuralgia or diplopia warrant investigation.
- Surgical intervention, guided by imaging, can achieve total tumor removal in most cases.