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KMID : 0614520040140010113
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Journal of the Korean Pain Research Society
2004 Volume.14 No. 1 p.113 ~ p.118
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Sustained Trigeminal Tumor Causing Facial Pain after Radiosurgery -Case Report-
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Han Song-Yup
Kang Seung-Hee
Kim Se-Hyuk
Ahn Young-Hwan
Cho Kyung-Gi
Cho Ki-Hong
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Abstract
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Facial pain is commonly caused by vascular compression and also developed by the tumor arising around the trigeminal nerve root entry zone. The trigeminal schwannoma, regardless of its size (i.e., even a small tumor), can cause facial pain. To treat secondary facial pain caused by tumor, control of both tumor growth and pain are essential. We experienced two geriatric patients of trigeminal schwannoma who suffered facial pain. Both patients were treated with LINAC based stereotactic radiosurgery (12∼13 Gy of marginal dose at 50% isodose line, BrainScan, BrainLab). Patient 1 was a 69-year-old female who presented with a several-month history of atypical facial pain. After SRS, facial pain was immediately improved, but it recurred and became even worse 3 months later. The pain responded to Carbamazepine and became sufficiently tolerable that no further therapy was needed for the next 5 years. In the second patient (86-year-old female, seven year history of trigeminal neuralgia), even though facial pain was controlled immediately after radiosurgery, it recurred suddenly 7 days after radiosurgery. Additional treatments including medication and trigeminal rhizotomy using radiofrequency were needed to control the pain. In the first patient, continuous Carbamazepine medication was also required after then. In both patients, the size of tumor on follow-up MRI scan was not changed for 5 years after radiosurgery. However, facial pain was not controlled so effectively with radiosurgery alone, so that additional treatment modalities were needed. We report two cases of trigeminal tumor treated with radiosurgery, suggest a possible cause of failure of pain control and provide a review of the literature.
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KEYWORD
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Trigeminal neuralgia, Trigeminal schwannoma, Radiosurgery, Facial pain
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