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Vestibular schwannoma with contralateral facial pain - case report.

Eftekhar B, Gheini M, Ghodsi M, Ketabchi E - BMC Neurol (2003)

Bottom Line: Vestibular schwannoma (acoustic neuroma) most commonly presents with ipsilateral disturbances of acoustic, vestibular, trigeminal and facial nerves.Among 156 cases of operated vestibular schwannoma, we found one case with unusual presentation of contralateral hemifacial pain.It seems that displacement and distortion of the brainstem and compression of the contralateral trigeminal nerve in Meckel's cave by the large mass lesion may lead to this atypical presentation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery and Neurology, Sina Hospital, Tehran University, Iran. eftekhar@sina.tums.ac.ir

ABSTRACT

Background: Vestibular schwannoma (acoustic neuroma) most commonly presents with ipsilateral disturbances of acoustic, vestibular, trigeminal and facial nerves. Presentation of vestibular schwannoma with contralateral facial pain is quite uncommon.

Case presentation: Among 156 cases of operated vestibular schwannoma, we found one case with unusual presentation of contralateral hemifacial pain.

Conclusion: The presentation of contralateral facial pain in the vestibular schwannoma is rare. It seems that displacement and distortion of the brainstem and compression of the contralateral trigeminal nerve in Meckel's cave by the large mass lesion may lead to this atypical presentation. The best practice in these patients is removal of the tumour, although persistent contralateral pain after operation has been reported.

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Postoperatively, the tumour is totally removed and place of the craniectomy is seen. The brainstem seems to be returned to rather normal position.
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Figure 2: Postoperatively, the tumour is totally removed and place of the craniectomy is seen. The brainstem seems to be returned to rather normal position.

Mentions: A 44-year old woman presented with one month history of right hemifacial pain, ataxia, progressive vertigo and left sided hearing loss. She described the pain as burning and constant without any relation to a specific position or movement. The pain had started gradually, and had become increasingly annoying. The patient had saught medical consultation mainly for her facial pain. Physical examination revealed mild left facial paresis. The right of her face was dysesthetic in territories of all three subdivisions of trigeminal nerve. Her cerebellar tests were abnormal on the left side. She also had left sided hearing loss and hypoactive corneal reflexes on both sides . MRI studies with and without contrast showed a giant (45 × 44 × 42 mm) left cerebellopontine angle nonhomogenous mass compatible with a vestibular schwannoma (Fig. 1). The rostral and medial extension of the tumour and distortion of the brainstem was remarkable in this case. The patient was operated upon by retrosigmoid approach in sitting position. Pathologic examination of the tumour confirmed the preoperative diagnosis of vestibular schwannoma. Postoperatively (Fig. 2) her right hemifacial pain was relieved and her corneal reflexes returned to normal activity. The left facial nerve function could not be preserved.


Vestibular schwannoma with contralateral facial pain - case report.

Eftekhar B, Gheini M, Ghodsi M, Ketabchi E - BMC Neurol (2003)

Postoperatively, the tumour is totally removed and place of the craniectomy is seen. The brainstem seems to be returned to rather normal position.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC153508&req=5

Figure 2: Postoperatively, the tumour is totally removed and place of the craniectomy is seen. The brainstem seems to be returned to rather normal position.
Mentions: A 44-year old woman presented with one month history of right hemifacial pain, ataxia, progressive vertigo and left sided hearing loss. She described the pain as burning and constant without any relation to a specific position or movement. The pain had started gradually, and had become increasingly annoying. The patient had saught medical consultation mainly for her facial pain. Physical examination revealed mild left facial paresis. The right of her face was dysesthetic in territories of all three subdivisions of trigeminal nerve. Her cerebellar tests were abnormal on the left side. She also had left sided hearing loss and hypoactive corneal reflexes on both sides . MRI studies with and without contrast showed a giant (45 × 44 × 42 mm) left cerebellopontine angle nonhomogenous mass compatible with a vestibular schwannoma (Fig. 1). The rostral and medial extension of the tumour and distortion of the brainstem was remarkable in this case. The patient was operated upon by retrosigmoid approach in sitting position. Pathologic examination of the tumour confirmed the preoperative diagnosis of vestibular schwannoma. Postoperatively (Fig. 2) her right hemifacial pain was relieved and her corneal reflexes returned to normal activity. The left facial nerve function could not be preserved.

Bottom Line: Vestibular schwannoma (acoustic neuroma) most commonly presents with ipsilateral disturbances of acoustic, vestibular, trigeminal and facial nerves.Among 156 cases of operated vestibular schwannoma, we found one case with unusual presentation of contralateral hemifacial pain.It seems that displacement and distortion of the brainstem and compression of the contralateral trigeminal nerve in Meckel's cave by the large mass lesion may lead to this atypical presentation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery and Neurology, Sina Hospital, Tehran University, Iran. eftekhar@sina.tums.ac.ir

ABSTRACT

Background: Vestibular schwannoma (acoustic neuroma) most commonly presents with ipsilateral disturbances of acoustic, vestibular, trigeminal and facial nerves. Presentation of vestibular schwannoma with contralateral facial pain is quite uncommon.

Case presentation: Among 156 cases of operated vestibular schwannoma, we found one case with unusual presentation of contralateral hemifacial pain.

Conclusion: The presentation of contralateral facial pain in the vestibular schwannoma is rare. It seems that displacement and distortion of the brainstem and compression of the contralateral trigeminal nerve in Meckel's cave by the large mass lesion may lead to this atypical presentation. The best practice in these patients is removal of the tumour, although persistent contralateral pain after operation has been reported.

Show MeSH
Related in: MedlinePlus