Abstract
A patient with trigeminal neuralgia secondary to a vestibular schwannoma underwent fractionated radiotherapy without relief of her pain. She was then effectively treated with microsurgical resection of her tumor. Early identification of the lower cranial nerves and the origin of the facial and vestibulocochlear nerves is key to determining the operative corridors for vestibular schwannoma resection. To effectively treat trigeminal neuralgia, the trigeminal nerve root entry zone and motor branch are clearly identified and decompressed. Fractioned radiotherapy does not effectively treat trigeminal neuralgia secondary to vestibular schwannoma compression.The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21112
Highlights
A patient with trigeminal neuralgia secondary to a vestibular schwannoma underwent fractionated radiotherapy without relief of her pain
We describe the resection of a right-sided medium vestibular schwannoma with trigeminal neuralgia status post-fractionated radiotherapy
The patient had recently been treated with fractioned radiotherapy, her trigeminal pain had persisted and worsened over several months
Summary
A patient with trigeminal neuralgia secondary to a vestibular schwannoma underwent fractionated radiotherapy without relief of her pain. Axial FIESTA imaging demonstrates that the tumor is compressing the trigeminal nerve root entry zone and distorting the pons.[2] Arachnoid dissection around the lower cranial nerves is done and the accessory nerve is identified early on.
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