Breast Cancer Metastasis Involving Pterygopalatine Fossa: A Cause of Trigeminal Neuralgia

We present a case of metastatic breast cancer to pterygopalatine fossa (PPF) with a severe trigeminal neuralgia located in the V2 division of the trigeminal nerve area, which was diagnosed by computed tomography (CT) and magnetic resonance imaging (MRI). In 2002, a 62-year-old woman had a 6-month history of lancinating pain and hyphestesia on the right side of the face. The type of pain of this patient is a severe characteristic trigeminal neuralgia that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the V2 branch of the trigeminal nerve is distributed. Carbamazepine and other medications did not provide pain relief. Therefore, she has undergone maxillary nerve blocks whenever the pain worsened. She was operated for breast cancer on the right side in 2000. There were no findings of recurrence at the original site during her followup period. One year after the operation, CT examination of the lungs revealed a mass on the upper lobe of the right lung. She had undergone surgery for this mass and pathology revealed breast cancer metastasis. Neurological examination disclosed hypesthesia on the V2 branch of the right trigeminal nerve without other neurological deficits. There were no other cranial nerve abnormalities. Neurological examination was otherwise normal. CT examination revealed bony lyses of posterior wall of the right maxillary sinus (Figure 1A). MRI showed an enhancing soft tissue mass within the right pterygopalatine fossa and posterior portion of the maxillary sinus. Preand postcontrast T1-weighted images showed a right-sided soft tissue mass obliterating the fatty tissue of PPF (Figure 1B). Tumoral involvement was not detected in