• World Neurosurg · Mar 2019

    The tethered effect of vestibular schwannoma tumor shrinkage following stereotactic radiosurgery in secondary trigeminal neuralgia.

    • Masaki Izumi, Yoshinori Higuchi, Maidinamu Yakufujiang, Takayuki Motoshima, Kentaro Horiguchi, Kyoko Aoyagi, Osamu Nagano, Toru Serizawa, Yasuo Iwadate, and Iwao Yamakami.
    • Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
    • World Neurosurg. 2019 Mar 1; 123: 136-141.

    BackgroundCompression of the trigeminal nerve by vessels and tumors causes trigeminal neuralgia. However, a tethering effect, provoking an abnormal root-stretching force, has been previously reported to play a role in trigeminal nerve hyperexcitability. We report 2 patients with vestibular schwannomas treated by stereotactic radiosurgery (SRS) who presented with typical manifestations of trigeminal neuralgia after tumor shrinkage. Furthermore, we discuss the mechanisms of trigeminal neuralgia.Case DescriptionTwo patients without a history of trigeminal dysfunction, including trigeminal neuralgia, underwent SRS for vestibular schwannomas. Both patients demonstrated tumor shrinkage after transient tumor expansion following SRS. Neither patient presented with facial pain or dysesthesia at the time of peak tumor volume. However, trigeminal neuralgia occurred after tumor shrinkage. One patient underwent surgery, as the neuralgia was refractory to medical treatment; although the trigeminal nerve was adhered and tethered to the tumor, no neurovascular conflict was identified between the tumor and the nerve. We removed the tumor partially, dissecting between the nerve and the tumor, and relieved the tethered effect. Trigeminal neuralgia was relieved without medication after surgery.ConclusionsThe present cases demonstrate a tethered effect of tumor shrinkage after SRS, which was considered to play a role in trigeminal neuralgia. Surgical dissection surrounding the nerve root is effective for medically resistant neuralgia, even if the tumor shrinks. Partial tumor removal is adequate in such cases, as the tumor has been controlled by radiosurgery.Copyright © 2018 Elsevier Inc. All rights reserved.

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