Trigeminal complications arising after surgery of

Authors: Ulf Westerlund Bengt Linderoth Tiit Mathiesen

Publish Date: 2011/10/18

Volume: 35, Issue: 2, Pages: 203-210

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Abstract

Chronic severe facial pain is a feared sequel of cranial base surgery This study explores the symptomatology incidence and impact on the individual of postoperative de novo trigeminal nerve affection as well as the recovery potential Out of 231 patients operated for cranial base meningiomas at the Karolinska University Hospital during 7 years 25 complained of de novo trigeminal symptoms at clinical followup 3 months after surgery Six were later lost to followup leaving 19 participants in the study which was conducted using a questionnaire and a structured telephone interview All patients complained of facial numbness affecting the V1 branch in 10/19 patients 53 the V2 branch in 18/19 95 and the V3 branch in 9/19 47 Surprisingly only three 16 suffered from trigeminal pain which could be adequately managed by pharmacotherapy However five patients 26 demonstrated ocular dysaesthetic problems Twelve 63 described their handicap to be mild while seven 37 had daily or severe symptoms Five patients 26 reported no improvement over time while nine 47 showed improvement and four 21 stated good recovery Only one patient 5 claimed complete symptom remission In the present study 11 of the patients presented with a de novo postoperative affection of the trigeminal nerve after removal of a cranial base meningioma 37 of these reported daily/severe symptoms Only 26 showed good recovery observed in patients without tumour infiltration of the nerve or intraoperative nerve damage In spite of frequent complaints of numbness pain was uncommon 16 and often manageable by pharmacotherapy while ocular symptoms turned out to be more frequent and more disabling than expectedIn my opinion this work covers a defective point in the literature where complications related to the ocular motor nerves facial nerve or lower cranial nerves palsies following skull base surgery are much more evident than complications related to trigeminal or olfactory nerve injuryIn this series the authors present their experience with postoperative trigeminal neuropathy in a series of 231 patients treated for skull base meningioma The study is based on subjective data given by patients with different tumour sites from different age groups and with different pain thresholds I personally think they could have used a standardized questionnaire SF36 for instance for better assessment They can still cover this point in a future studyCalculating the incidence of trigeminal complications among all patients operated for skull base meningioma is very deceiving as many of these tumours are not related to the trigeminal nerve This is the case in most tuberculum sellae meningiomas and foramen magnum meningioma as an example The study would have been more informative if the authors were more selective and chose meningiomas intimately related to the course of the trigeminal nerve as those involving the cavernous sinus and the petroclival regionIt is also important to outline the impact of surgical approach on such complications Diminished lacrimation does not necessarily mean V1 injury it could be the result of greater superficial petrosal nerve injury during drilling of the petrous apex It is not clear in this paper if some of the sensory complications mentioned are related to the approach rather than the original pathology as in supraorbital nerve injury for instanceHowever this work presents the experience of the authors with postoperative trigeminal neuropathy in a clear and descriptive way It sends an important message that some of the operative complications seen as “minor” by treating physicians could affect the patients’ quality of life significantly

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