Outcomes of surgical resection of cerebellopontine angle tumors causing trigeminal neuralgia

Introduction: Tumors may be responsible for up to 10% of trigeminal neuralgia (TN) cases. Surgical resection is often recommended to treat tumor-induced TN. Predictors of long-term pain relief after surgical resection of various cerebellopontine angle (CPA) tumor types are not well understood. Previous studies have suggested that size and extent of resection are associated with long-term pain status. Studies have also noted that meningiomas may be more likely to have concurrent neurovascular compression (NVC) of the trigeminal nerve. The purpose of this study was to evaluate outcomes and characteristics of patients with CPA tumor-induced TN that underwent surgical resection.

Methods: In a prospective cohort study, we evaluated clinical outcomes and complications after surgical resection of non-acoustic CPA tumors causing trigeminal neuralgia. The primary outcome was pain-freedom. We performed logistic regression analyses to examine the relationship between pain-freedom at last follow-up and age, side of symptoms, pre-operative symptom duration, tumor diameter, tumor type, and concurrent NVC. Chi-square analysis was used to evaluate if there was a difference in the presence of NVC of the trigeminal nerve between meningiomas and epidermoid cysts.

Results: Of 17 patients with a non-acoustic CPA tumor causing trigeminal neuralgia treated with surgical resection, 82.4% were pain-free at last follow-up (mean 34.1 months). Age (p=0.11), side (p=0.24), pre-operative symptom duration (p=0.92), tumor diameter (p=0.29), type of tumor (p=0.39), and presence of NVC (p=0.15) were not associated with post-operative pain freedom at long term follow-up. Chi-square analysis showed no significant difference between presence of NVC of the trigeminal nerve in meningiomas and epidermoid cysts (p=0.71).

Conclusion : This study provides additional evidence that patients with meningiomas, epidermoid cysts, and lipomas causing trigeminal neuralgia may undergo surgical resection with equal likelihood of achieving pain-freedom. These results also dispute previously reported data that meningiomas are more likely to have concurrent NVC of the trigeminal nerve.