Surgical resolution of trigeminal neuralgia due to intra-axial compression by pontine cavernous angioma.

BACKGROUND

Trigeminal neuralgia is usually caused by microvascular conflict with the fifth cranial nerve in the pontocerebellar angle. Rarely is it secondary to other extra-axial or intra-axial lesions. Few cases of trigeminal neuralgia due to cavernous angiomas have been reported in the literature. This is the first report of surgical decompression of the intra-axial trigeminal nerve tract from a deep pontine cavernous angioma.

METHODS

A 45-year-old man came to our attention for frequent and intense left facial pain episodes compatible with trigeminal neuralgia in the V1 and V2 branches, poorly responsive to carbamazepine treatment. Magnetic resonance imaging revealed a left posterolateral pontine cavernous angioma. No neurovascular conflict was found.

RESULTS

The cavernous angioma was surgically excised. No new neurological deficit arose and the pain episodes completely disappeared.

CONCLUSIONS

Trigeminal neuralgia can occur occasionally secondary to the compressive effect of a pontine cavernous angioma. In this patient surgical removal of the cavernous angioma can be considered a successful and relatively safe treatment.