Vestibular and trigeminal schwannoma
Secondary hemifacial spasm due to vestibular schwannoma is very rare. A study by S Peker et al..[1] was the first reported case of hemifacial spasm that responded to gamma knife radiosurgery in a patient with intracanalicular vestibular schwannoma. Both resolution of the spasm and control of tumor growth were achieved with a single session of gamma knife radiosurgery. Control of tumor growth was achieved and there were no changes in tumor volume at the last follow-up at 22 months. The hemifacial spasm resolved completely after one year. Surgical removal of the presumably causative mass lesion has been reported to be the only treatment in secondary hemifacial spasm.
Figura 1: Escwanoma del trigémino y maloclusión dental por Brandon Emilio Bertot et al..[2]The criticism that can be made of this statement is that in our case it is the masseter muscle that is involved, but this criticism is answered: if there is a hemifacial spasm due to vestibular scwannoma, then could a masticatory spasm due to trigeminal scwannoma occur? From a study by Ajay Agarwa [3] It seems that intracranial trigeminal schwannomas are rare tumors. Patients often present with symptoms of trigeminal nerve dysfunction, with facial pain being the most common symptom. MRI is the imaging modality of choice and is usually diagnostic in the appropriate clinical setting. Axial 3D CISS T2-weighted sequences are important for a correct evaluation of the cisternal segment of the nerve. They are usually hypointense on T1, hyperintense on T2 with accretion after gadolinium. But it cannot surprise us that cases like the one described by Brandon Emilio Bertot et al..[2]in which a clinical case of a 16-year-old boy with atypical presentation of a large trigeminal schwannoma, dental malocclusion, painless and unilateral masticatory weakness is reported. The authors confirm that this case is the first documented case in which a trigeminal schwannoma has resulted in malocclusion; This is the 19th documented case of unilateral trigeminal motor neuropathy of any etiology.
- ↑ Peker S, Ozduman K, Kiliç T, Pamir MN, «Relief of hemifacial spasm after radiosurgery for intracanalicular vestibular schwannoma», in Minim Invasive Neurosurg, Georg Thieme Verlag, 2004, Stuttgart · New York».
DOI:10.1055/s-2004-818485 - ↑ 2.0 2.1 Brandon Emilio Bertot, Melissa Lo Presti, Katie Stormes, Jeffrey S Raskin, Andrew Jea, Daniel Chelius, Sandi Lam. Trigeminal schwannoma presenting with malocclusion: A case report and review of the literature.Surg Neurol Int. 2020 Aug 8;11:230. doi: 10.25259/SNI_482_2019.eCollection 2020.
- ↑ Ajay Agarwal. Intracranial trigeminal schwannoma Ajay Agarwal. Neuroradiol J.2015 Feb;28(1):36-41. doi: 10.15274/NRJ-2014-10117.