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Trigeminal neuropathy secondary to perineural invasion of head and neck carcinomas

From the Departments of Neurology (Drs. Boerman and Maassen), Radiology (Dr. Joosten), Radiotherapy (Dr. Kaanders), Otolaryngology (Dr. Marres), Neurosurgery (Dr. van Overbeeke), and Pathology (Dr. Wilde), University Hospital Nijmegen; and the Department of Neurology (Dr. Boerman), Rijnstate Hospital Arnhem, The Netherlands.

Address correspondence and reprint requests to Dr. R.H. Boerman, Dept. of Neurology, University Hospital Nijmegen St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.

Perineural spread of head and neck cancer is an uncommon cause of cranial neuropathy. We studied five patients with cranial neuropathy resulting from perineural spread of head and neck carcinomas. Trigeminal neuropathy with facial pain or paresthesias was the most common clinical manifestation. MRI in the coronal plane under gadolinium enhancement established the diagnosis by visualization of the lower divisions of the trigeminal nerve. Perineural tumor spread can cause headaches in patients with head and neck cancer.