Atypical Spread of an Atypical Meningioma: The Trigeminal Pathway.

Perineural spread (PNS) of a meningioma is a rare but potentially devastating manifestation of disease progression that can affect prognosis, management, and monitoring. The trigeminal and facial nerves are most commonly involved. However, involvement of the hypoglossal and oculomotor nerves has also been described ]. Atypical and anaplastic meningiomas are most commonly implicated in PNS, demonstrating contiguous spread along the epineurium and perineurium . The clinical presentation is variable, but may include neuropathic pain, sensory loss, and weakness; our patient presented with headaches in the setting of a recurrent atypical meningioma that progressed to vision loss, facial deformity, and neuropathic pain in a V2 and V3 distribution. Early recognition and treatment of PNS, either through surgery or radiation therapy, is vital to prevent tumor progression and irreversible deficits.