Yin Yu-Ting, Gui Chao
Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Medicine (Baltimore). 2025 Jan 17;104(3):e41295. doi: 10.1097/MD.0000000000041295.
Cerebellar pontine angle lipomas with trigeminal neuralgia are rare. The treatment choice is influenced by whether the pain is caused by the lipoma or the compression of blood vessels. Herein, we aimed to report a case of the disease and provide a reference for its treatment.
The patient was a 54-year-old female who presented with a 20-year history of left-sided facial pain. Her pain had gradually worsened over time and oral medications became progressively less effective.
Brain magnetic resonance imaging detected a left cerebellar horn lesion, which was deemed a lipoma. Three-dimensional time-of-flight magnetic resonance angiography revealed a superior cerebellar artery adjacent to the trigeminal nerve root. Trigeminal nerve roots may have been compressed by lipomas and blood vessels.
The patient underwent a microvascular decompression of the trigeminal nerve. Part of the lipoma was removed, and the trigeminal nerve was isolated from the blood vessels and tumor.
Postoperative pathology confirmed a lipoma. Neuralgia was completely relieved postoperatively, and no new neurological disorder was detected during the 6-month follow-up.
Surgery is recommended for patients with cerebellar pontine angle lipomas combined with trigeminal neuralgia when conservative treatment fails. Detailed preoperative imaging is crucial to identify lipomas and trigeminal root compression by the responsible artery. Complete decompression of the trigeminal nerve root is necessary for complete pain relief.
伴有三叉神经痛的桥小脑角脂肪瘤较为罕见。治疗方案的选择取决于疼痛是由脂肪瘤引起还是血管压迫所致。在此，我们旨在报告一例该疾病病例，并为其治疗提供参考。
患者为一名54岁女性，有20年左侧面部疼痛病史。随着时间推移，她的疼痛逐渐加重，口服药物的效果也越来越差。
脑部磁共振成像检测到左侧小脑角有一个病变，诊断为脂肪瘤。三维时间飞跃磁共振血管造影显示一条小脑上动脉毗邻三叉神经根。三叉神经根可能受到脂肪瘤和血管的压迫。
患者接受了三叉神经微血管减压术。切除了部分脂肪瘤，并将三叉神经与血管和肿瘤分离。
术后病理证实为脂肪瘤。术后神经痛完全缓解，在6个月的随访期间未发现新的神经功能障碍。
对于保守治疗无效的桥小脑角脂肪瘤合并三叉神经痛患者，建议进行手术治疗。详细的术前影像学检查对于识别脂肪瘤和责任动脉对三叉神经根的压迫至关重要。为了完全缓解疼痛，有必要对三叉神经根进行彻底减压。
