Petroclivus meningioma causing trigeminal neuralgia
Presents with left facial pain over the last few months.
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Enhancing extra-axial mass at the junction of the clivus and petrous ridge distorting the left 5th nerve (and pons) as it exits Meckle's cave to enter the cistern (arrows)
Several theories exist to explain the possible causes of this trigeminal nerve pain (neuralgia). It is often idiopathic but can be associated with an arterial loop or an enlarged, aberrant or ectatic artery compressing the nerve near its connection with the pons (nerve root entry zone). Such compression can lead to neuralgic attacks at the slightest stimulation of any area served by the nerve as well as hinder the nerve's ability to shut off the pain signals after the stimulation ends.
Other rarer causes include aneurysm, AVM or arachnoid cysts. Tumors including schwannoma and meningioma as well as malignant lesions such as perineural metastasis from squameous cell carcinoma are encountered.