Perineural tumor spread from the ophthlamic branch of the trigeminal nerve: a case report.

Perineural tumor spread of head and neck malignancies
is a well known form of metastatic disease in
which a lesion can migrate away from the primary site
along the cranial nerves.
Nerve function can be preserved even in advanced stages
of the disease, making neuroradiological assessment of perineural
tumor location and extension of utmost importance,
as radiological or pathological examination may reveal
normal or nonspecific nerve function.
Computed Tomography is useful in detecting foraminal enlargement
or more destructive bone patterns. Magnetic
Resonance imaging is the modality of choice because it can
provide direct (nerve enlargement and enhancement) and
indirect evidence of the disease (neuropathic muscular atrophy,
obliteration of fat planes) owing to its superior softtissue
contrast resolution, its multiplanar imaging and the
decreased amount artifacts from dental hardware. Fat suppression
images after contrast injection are mandatory to
better detect nerve enhancement.
We report the case of a female patient with perineural diffusion
along the ophthalmic branch. This clinical picture is
very rare, compared to those involving the mandibular and
maxillary branches of the fifth cranial nerve.