ACOUSTIC NEUROMA PRESENTING AS REFRACTORY TRIGEMINAL NEURALGIA

A 56-year old female presented to our pain clinic with history of shooting pain on face & neck for last 4-5 months and was on medical treatment without much relief. For diagnostic & therapeutic reasons we gave mandibular, maxillary & glossopharyngeal nerve block to which she responded partially. This made us to investigate the patient for other possibilities. Plain X-ray Skull AP view with mouth open showed bilateral elongated styloid process especially on rt. side. In order to look for vascular compression CT was done which showed Acoustic neuromas. MRI done showed right sided CP angle mass (extracannalicular schwannoma) pressing on rt. trigeminal nerve. She was referred for gamma knife surgery by the neurosurgeon. Repeat MRI done after two months showed intracannalicular extension of acoustic neuroma.