International Journal of Research in Medical Sciences | May 2023 | Vol 11 | Issue 5 Page 1814 International Journal of Research in Medical Sciences Saxena A et al. Int J Res Med Sci. 2023 May;11(5):1814-1816 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 Case Report Gasserian ganglion metastases of oral squamous cell carcinoma in the absence of loco-regional metastases masquerading as trigeminal neuralgia Akriti Saxena 1 *, Niti Singhal 1 , Ashutosh Rath 2 , Vivekanand Singh 3 , Ravi Shankar 4 , Madhu Mati Goel 1 INTRODUCTION Review of the literature showed that brain metastases of oral squamous cell carcinoma in the absence of loco- regional spread are extremely rare accounting only for about 0.4% and 2-8% for those patients who already have distant spread to the lungs or other extracranial sites. The distant spread usually occurs late in the course of the disease and typically in the setting of advanced local- regional disease. 1-8 We presented an unusual case of a 43-year-old man presenting with symptoms of trigeminal neuralgia with a clinico-radiological diagnosis of maxillary nerve schwannoma. Surgical excision and histopathology revealed a diagnosis of metastases of squamous cell carcinoma to Gasserian ganglion. CASE REPORT A 43-year-old man presented to neurology out patient department (OPD) in March 2020 with complaints of headache in right temporal region, loss of sensation in right cheek, V1, V2 pain and hypoesthesia in right side of face with no motor weakness for 3 months. Magnetic resonance imaging (MRI) brain revealed enhancing mass lesion in the right middle cranial fossa or maxillary nerve schwannoma. After a written informed consent and pre- operative evaluation, the patient underwent right fronto- temporal craniotomy with sub temporal extradural approach for tumor excision and tumour specimen was submitted for histopathological examination. Intra- operatively tumor was firm, non suckable, mildly vascular and adherent to trigeminal nerve and right internal carotid artery. Post-operative period was uneventful. Post-operative CT-scan showed post- 1 Department of Pathology and Lab Medicine, 3 Department of Head and Neck Surgical Oncology, 4 Department of Neurosurgery, Medanta Hospital, Lucknow, Uttar Pradesh, India 2 AIIMS, Bibi Nagar, Telangana, India Received: 04 January 2023 Accepted: 31 March 2023 *Correspondence: Dr. Akriti Saxena, E-mail: akriti.hiht@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT We presented an unusual case of a 43-year-old man presenting with symptoms of trigeminal neuralgia with a clinico- radiological diagnosis of maxillary nerve schwannoma. Surgical excision and histopathology revealed a diagnosis of metastases of squamous cell carcinoma to Gasserian ganglion. On further investigation, the primary tumour was detected in the right alveolar region of mandible. Our purpose of presenting this case was to make the clinicians aware that all cases presenting with trigeminal neuralgia may not be benign and may be the sole presentation of brain metastases of oral cancer without the loco-regional spread. Keywords: Trigeminal neuralgia, Schwannoma, Squamous cell carcinoma metastasis, Gasserian ganglion DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20231362