Primary melanoma of Meckel's cave: case report

Abstract

-We present a case of trigeminal neuralgia with cranial normal magnetic resonance image (MRI) and computed tomography.The pain was not relieved by carbamazepine and microvascular decompression surgery was done.After two months the pain was similar to the condition before surgery. At this time, MRI showed an expansive lesion in Meckel's cave that was treated with radical resection by extra-dural approach. The pathologic examination revealed a primary melanoma. The follow-up after six months did not show abnormalities.KEY WORDS: primary melanoma, central nervous system, Meckel's cave, carbamazepine.Melanoma primário do cavo de Meckel: relato de caso RESUMO -Apresentamos um caso de neuralgia do trigêmeo com investigação radiológica de ressonância magnética (RM) e tomografia computadorizada apresentando resultado normal.A dor não apresentou alívio com carbamazepina, sendo indicado descompressão microvascular do trigêmio. Passados dois meses, o paciente queixava-se de dor com intensidade similar à do pré-operatório. Nova RM mostrou lesão expansiva no cavo de Meckel, a qual foi tratada cirurgicamente por abordagem extra-dural. O exame anatomopatológico foi compatível com melanoma primário. O seguimento radiológico, após seis meses da cirurgia, não apresentou anormalidades.PALAVRAS-CHAVE: melanoma primário, sistema nervoso central, cavo de Meckel, carbamazepina.The central nervous system (CNS) is host to a wide variety of melanocytic neoplasms including the common metastatic malignant melanoma and the relatively benign, as well as overtly malignant, primary neoplasms of leptomeningeal melanocyte 1 . Metastases of malignant melanomas in the CNS are fairly common; their incidence is approximately 5-10% of all tumors metastatizing to the CNS. In contrast, primary melanomas of the CNS are a rare occurrence 2,3 .Trigeminal neuralgia is often the first complaint for a tumor of the Gasserian ganglion. Tumors of the fifth nerve in general are extremely rare and comprise 0.2 % of all primary and secondary intracranial neoplasms 4 . Melanomas of the fifth nerve are even rarer 5,6 . We report a case of trigeminal neuralgia that was not relieved by carbamazepine and microvascular decompression. The expansive lesion was detected in Meckel´s cave only after a second magnetic resonance image (MRI) and the histopathological examination showed a primary melanoma. CASEA 55-year old man, smoker, complains of right trigeminal neuralgia that began 4 months ago. The neurological examination was normal and treatment was instituted with carbamazepine 600mg a day.The neurological investigation was performed by cranial MRI and computed tomography (CT).After 30 days the patient returned without relief of the facial pain and with a normal neuroradiological examination (Fig. 1A). Microvascular decompression was indicated with displacement of the vessel impinging on nerve. The pain relief was temporary. After 60 days the pain was similar to the conditions before surgery and carbamazepine dose was increased to 1000 mg a day CT showed only t...

Primary Circumscribed Meningeal Melanoma Involving the Meckel’s Cave: A Report of a Rare Case and Review of Literature

“…Bhandari et al attributed the first case of primary solitary intracranial melanoma to Oogle in 1899 [ 7 ]. Melanomas of Meckel’s cave are even rarer [ 2 ].…”

“…Primary intracranial meningeal melanomas are rare entities, compromising 1% of all melanoma cases and a mere 0.07% of all brain tumors [ 1 ]. Primary malignant meningeal melanoma of the Meckel’s cave is even rarer [ 2 ]. The prognosis of primary malignant meningeal melanoma can be much better if complete resection is achieved as compared to the patients with CNS metastases from melanomas of other sites [ 3 ].…”

Primary CNS Melanoma of Meckel's Cave: A Rare Case with Literature Review

“…3,4 Leptomeningeal melanosis is a normal variant found in 85% of the population, but heterotrophic melanin in the dura is rare. 5 As a result, dural melanomas are rare, and melanomas of the fifth nerve are even rarer. Only two cases of primary malignant melanoma in the Meckel's cave have been reported in the literature so far.…”

“…Only two cases of primary malignant melanoma in the Meckel's cave have been reported in the literature so far. 5,6 Falavigna et al reported the case of a 55-year-old male who presented with worsening right-sided facial pain. The melanoma was radically excised and there was no recurrence at 9-month follow-up.…”

Access to Meckel’s cave for biopsies of indeterminate lesions: a systematic review

“…Neuroendocrine carcinoma [63] Adenoid cystic carcinoma [5] Malignant melanotic schwannoma [23,61,101] Squamous cell carcinoma [63] Adenocarcinoma [63] Inflammatory Sarcoidosis [19,69] Amyloidoma [22,24,28] IgG4 disease [63] Necrotizing granulomatous inflammation [63] Inflammatory pseudotumor [63] Hematologic malignancies Primary malignant lymphoma [26] Multiple myeloma [32] NK/T lymphoma [63] Diffuse B-cell lymphoma* Plasmacytoma [63] Marginal zone lymphoma [63] Chronic eosinophilic leukemia [63] Lymphoplasmocytic lymphoma [63] Non-Hodgkin lymphoma [63] Cystic Arachnoid cyst [5,21,34,61,64] Epidermoid cyst [17,29] Meningoceles [102] *Illustrative case report presented in this article should, however, be seen as complementary and not competitive [73], since each one of them carries its own risks and advantages. Even though newly described endoscopic approaches appear promising, clinical experiences remain to be reported and an advanced anatomical knowledge of the neurovascular array within and surrounding the skull base is of utmost priority to assure safety during and after procedures.…”