Rationale: Cerebellar pontine angle lipomas with trigeminal neuralgia are rare. The treatment choice is influenced by whether the pain is caused by the lipoma or the compression of blood vessels. Herein, we aimed to report a case of the disease and provide a reference for its treatment.
Patient concerns: The patient was a 54-year-old female who presented with a 20-year history of left-sided facial pain. Her pain had gradually worsened over time and oral medications became progressively less effective.
Diagnoses: Brain magnetic resonance imaging detected a left cerebellar horn lesion, which was deemed a lipoma. Three-dimensional time-of-flight magnetic resonance angiography revealed a superior cerebellar artery adjacent to the trigeminal nerve root. Trigeminal nerve roots may have been compressed by lipomas and blood vessels.
Interventions: The patient underwent a microvascular decompression of the trigeminal nerve. Part of the lipoma was removed, and the trigeminal nerve was isolated from the blood vessels and tumor.
Outcomes: Postoperative pathology confirmed a lipoma. Neuralgia was completely relieved postoperatively, and no new neurological disorder was detected during the 6-month follow-up.
Lessons: Surgery is recommended for patients with cerebellar pontine angle lipomas combined with trigeminal neuralgia when conservative treatment fails. Detailed preoperative imaging is crucial to identify lipomas and trigeminal root compression by the responsible artery. Complete decompression of the trigeminal nerve root is necessary for complete pain relief.
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