Trigeminal Neuralgia Due to a Small Meckel's Cave Epidermoid Tumor: Surgery Using an Extradural Corridor

Abstract

Tumors at the petrous apex are associated with a variety of symptoms, which most often involve the trigeminal nerve. The authors present a rare case of a small epidermoid tumor in Meckel's cave that caused medically refractory trigeminal neuralgia. The surgical challenge associated with approaches to such lesions is discussed. The skull base tumor was excised completely through a small temporal craniotomy. The practicality of neuronavigation in reaching the petrous apex using a small extradural window is presented.

Keywords: Epidermoid tumor; Meckel's cave; petrous apex; trigeminal nerve; trigeminal neuralgia.

Figures

Figure 1

(A) Axial T1-weighted image (WI) showing as isointense to hyperintense in left Meckel's cave (white arrowhead). (B) Coronal T2-WI showing a hyperintense lesion. Curved arrow shows the extradural corridor to the lesion.

Figure 2

The lesion (white arrowhead) is hyperintense on (A) axial fluid attenuated inversion recovery (FLAIR) sequence and (B) diffusion-weighted image.

Figure 3

Operative photograph showing epidermoid tumor (A) engulfing the V3 division (B); the margins of incised dura (C) are seen in the periphery.

Figure 4

Axial T2-weighted image shows (A) tumor before surgery and (B) postoperatively the same area after complete tumor excision. White arrowhead points to the site of tumor.