Presentation
Right sided short lived maxillary facial pain 6 times a day. Trigeminal neuralgia?
Patient Data
2.9 cm mildly hyperdense lesion with partial thin curvilinear calcification at the right cerebello-pontine angle associated with expansion of the corresponding internal auditory meatus.
No intra-axial abnormality.
No midline shift or hydrocephalus.
3cm avidly enhancing right CPA mass extending into and expanding the right internal auditory meatus. The mass extends 1.4cm into the intracanilicular segment of the internal auditory canal. The mass has a dural tail, but no internal cystic change.
The mass compresses and displaces the pre-ganglionic segment of the right trigeminal nerve at its origin fro the pons and is effacing and mildly displacing the pons.
Left IAM is normal.
Anatomy of the trigeminal nerve and its pre-ganglionic segment illustrated.
Case Discussion
Large cerebellopontine angle mass compressing the root entry zone of the trigeminal nerve giving rising to classical symptoms of trigeminal neuralgia.
A vestibular schwannoma and meningioma are the chief differentials. The dural tail and calcification on CT would point to meningioma being the most likely despite the extensive intra-canilicular extension of the mass.
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