Trigeminal neuralgia and vascular compression in patients with trigeminal schwannomas

OBJECTIVE: Trigeminal neuralgia (TN) is often associated with neurovascular compression. However, intracranial tumors are occasionally observed, particularly when symptoms are atypical. We describe three patients with Type-1 TN and trigeminal schwannoma diagnosed by magnetic resonance imaging, with concomitant arterial compression of the trigeminal nerve. CLINICAL PRESENTATION: All three patients had Type-1 TN with spontaneous onset, paroxysm-triggered pain, and response to antiepileptic medication. Contrast-enhanced T1-weighted magnetic resonance imaging scans demonstrated an ipsilateral enhancing perineural mass consistent with a schwannoma. Two of the three patients had previously undergone gamma knife radiosurgery without improvement. Subsequent high-resolution magnetic resonance imaging in all three patients revealed obvious compression of the trigeminal nerve by an arterial structure. INTERVENTION: Two patients underwent retrosigmoid craniectomy followed by microvascular decompression and remain pain-free. One patient elected not to pursue surgical intervention. CONCLUSION: Although intracranial tumors are occasionally observed in patients with TN, neurovascular compression must still be considered as an etiology, especially if typical TN symptoms are reported.