2026 Poster Presentations
P090: TRIGEMINAL NEURALGIA SECONDARY TO SKULL BASE TUMORS: A COMPARATIVE ANALYSIS
Mauro A Segura-Lozano, MD, PhD; Angel G Parra-Galván, MD; Mario A Del Real-Gallegos, MD; Pedro Mendoza-Lemus, MD; Alejandro González-Silva, MD; Aarón G Munguía-Rodríguez, PhD; Neurología Segura
Background: Trigeminal neuralgia (TN) secondary to intracranial tumors is an uncommon but challenging entity in skull base surgery. Tumor-related TN often presents with atypical features, delayed diagnosis, and requires specific management strategies. Understanding the epidemiological distribution and clinical differences among tumor subtypes may guide diagnostic and therapeutic approaches.
Methods: We retrospectively analyzed a cohort of patients with TN secondary to intracranial tumors treated at our center between 2015 and 2024. Clinical variables included age at symptom onset, symptom duration, sex, affected side, and tumor volume (calculated by the ellipsoid formula from MRI dimensions). Tumor frequencies were described, and the three most prevalent entities (epidermoid cysts, meningiomas, and vestibular schwannomas) were compared using non-parametric and chi-square tests.
Results: Among 3,242 patients presenting with TN symptoms, 164 (5.1%) had a tumor-related etiology. The most frequent tumors were epidermoid cysts (n = 52, 31.7%), meningiomas (n = 51, 31.1%), and vestibular schwannomas (n = 30, 18.3%), followed by pituitary adenomas (n = 14, 8.5%), thalamic gliomas (n = 6, 3.7%), osteomas (n = 3, 1.8%), hemangioblastomas (n = 3, 1.8%), chordomas (n = 2, 1.2%), metastatic tumors (n = 2, 1.2%), and a mandibular sarcoma (n = 1, 0.6%).
In the comparative analysis of the three most common tumors, age of symptom onset differed significantly (p < 0.001): epidermoid cysts presented earlier (x¯ = 36.7 years) compared with meningiomas (x¯ = 51.8 years) and schwannomas (x¯ = 55.3 years). Symptom duration before diagnosis did not differ (p = 0.22), with medians of 6.3, 6.2, and 4.7 years, respectively.
Regarding tumor volume, the medians were meningiomas 15,367.7 mm³, schwannomas 7,997.4 mm³, and epidermoid cysts 10,494.1 mm³, with no statistically significant differences between groups (p = 0.65).
Sex distribution revealed a predominance of female patients with meningiomas (86%), whereas schwannomas and epidermoid cysts had more balanced ratios; this difference was statistically significant (p = 0.029). Side distribution (right, left, bilateral) did not differ among groups (p = 0.64).
Conclusions: In this large single-center cohort, epidermoid cysts, meningiomas, and vestibular schwannomas accounted for more than 80% of cases of tumor-related trigeminal neuralgia. The main distinguishing factor was the significantly earlier onset of symptoms in epidermoid cysts and the strong female predominance in meningiomas. Symptom duration, laterality, and tumor volume did not differ significantly across tumor types. These findings highlight the importance of considering patient age and sex patterns in the differential diagnosis of tumor-related TN and underscore the heterogeneity of its clinical presentation.
Keywords: trigeminal neuralgia, skull base tumors, epidermoid cyst, meningioma, vestibular schwannoma, tumor volume, clinical comparison.
Figure 1. Representative MRI findings of tumors associated with trigeminal neuralgia.
(A) Epidermoid cyst, (B) petroclival meningioma, (C) vestibular schwannoma, (D) pituitary adenoma, (E) temporal bone osteoma, and (F) thalamic glioma. The red arrow indicates the tumor location, while the white arrow highlights the trigeminal nerve.