What Makes a Neurosurgeon an Expert?
Jeffrey A. Brown, MD, FACS, FAANS First, some basic requirements: there are a lot, but that is the point, too. Doctors educated in the United States are granted their MD […]
Only about 1% of people with trigeminal neuralgia have their symptoms caused by a brain tumor. Pain caused by a vascular loop, or even pain caused by MS is much more common. Nevertheless, the possibility of a brain tumor is the most important reason that any person presenting with facial pain symptoms should undergo an MRI as part of the routine workup.
In the rare instance where a brain tumor is the cause, there are three types of brain tumors that may be: the first two are the two most common types of benign brain tumor: meningioma and schwannoma. Vestibular schwannomas (also known as acoustic neuromas) can cause facial numbness or pain only if they grow large enough to affect the trigeminal nerve. The third is a rare type of benign brain cyst tumor know as an epidermoid. It would be extremely rare for other types of brain tumors, including metastatic tumors and malignant brain tumors to cause trigeminal neuropathic pain. Tumors of the face involving the trigeminal nerve may also cause pain, but it would be unusual for pain caused by these tumors to be typical of neuralgia.
Undergoing an MRI during diagnostic testing should show the existence of a tumor and would provide you and your doctor information about how to proceed with treatment. Neurologists and neurosurgeons understand when and how to image the trigeminal nerve whenever the diagnosis of trigeminal neuralgia is considered.
In a series of 1,185 patients who underwent surgery for TN over a period of two decades by Dr. Peter Jannetta, less than 1%, or eight patients, had an associated acoustic neuroma (AN) tumor. In a series of 2,000 patients over one decade operated on by Dr. John Tew, only four patients had an associated AN. The patients in Dr. Tew’s series had numbness in their faces caused by the tumor, and one had burning pain, not the typical stabbing pain associated with TN. These observations may indicate what treatment is likely to be more effective.
Upon review of his treatment of his eight patients with AN, Dr. Jannetta concluded that the cause of their stabbing pain was the presence of an artery that had been pushed towards the trigeminal nerve by the expanding AN. It was not the tumor causing the neuropathic facial pain; rather, it was the compression of the nerve by the force of arterial pulsations. To cause TN, an AN has to grow large enough to come into contact with the trigeminal nerve.
If a tumor is compressing your trigeminal nerve, the goal of the surgery is to move that rtery off the nerve and maintain that separation with a small cushion- the same goal as an MVD surgery. The goal of radiation is to prevent tumor growth, not to make the tumor shrink or disappear; therefore, TN caused by a tumor will likely not be relieved. If the target is the trigeminal nerve, radiation may be an option.
There are neurosurgeons experienced treating tumors and trigeminal neuropathic pain who can discuss with you the options for treatment and help you to decide what the best one is for you.
Excerpts from Marc S. Schwartz, MD Facial Pain: A 21st Century Guide and Brown, Jeffrey. “Acoustic Neuroma and Trigeminal Neuralgia- Is There a Causative Relationship?” ANA Notes, no. 142, 10 June 2017, pp. 4–7.
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