“Apoplectic” Recurrence of Massive Trigeminal Neurinomas: Report of 7 Cases

The pattern of recurrence of large trigeminal neurinomas is analyzed on the basis of experience with 7 cases. This is a report of 7 cases of large trigeminal neurinomas that were operated on an average of 11 years earlier. After being relatively asymptomatic over the years, these patients worsened relatively suddenly in their neurologic symptoms and were reoperated. Imaging showed massive recurrence with tumor having cystic and solid components with sizes ranging from 4.5–11 cm. In 4 cases, the cysts at the time of initial presentation and at the time of recurrence showed a well-defined fluid level within the fluid content of the cyst. During operation it was seen that the tumor contained “hemorrhagic” fluid that was under significant pressure. The solid component in the circumferential periphery of the cyst fluid was soft, necrotic, and vascular. The entire recurrence in the middle and posterior cranial fossa and in the extracranial compartment was “interdural” or within the dural confines. Radical tumor resection within the dural confines by deploying relatively small surgical exposure resulted in “unusually” rapid recovery in the symptoms. Histological examination of the tumor did not reveal any malignant transformation. The cases add further insight to the growth pattern and characteristics of large trigeminal neurinomas.