Cavernous Malformation in the Trigeminal Distribution: A Case Report of Aggressive Presentation and Management

Frossard, João Thiago; Domingues, Flavio S.; Neves, Pedro Pinheiro; Canhedo, Nathalie; Souza, Jorge Marcondes de

doi:10.1016/j.wneu.2015.10.086

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…Close clinical and radiological surveillance after surgical resection of trigeminal or a cranial nerve CM is needed because the clinical course is ill-defined in the pediatric population with a potentially higher risk of recurrence ( 9 , 21 ). This case additionally highlights the importance of the use of complex skull base approaches when required to achieve optimal clinical and surgical outcome in patients with surgically challenging recurrent CM particularly for those that directly or indirectly involve the brainstem.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Recurrent pediatric cavernous malformation of the trigeminal nerve

Harty,

Baqai,

Sajjad

et al. 2023

Front. Surg.

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BackgroundMost cavernous malformations (CM) usually involve the parenchyma and rarely occur in cranial nerves. Recurrence of CM associated with cranial nerves after surgical resection has not been previously reported.Case descriptionThis paper describes the case of an 11-year-old girl who presented with left otalgia and headache because of a left trigeminal cavernous malformation. She underwent radical resection via a left retrosigmoid approach while sparing the trigeminal nerve. Surveillance imaging at 18 months demonstrated recurrence along the length of the trigeminal nerve into Meckel's cave with significant extension into the middle cerebellar peduncle. Subsequent re-operation via an extended middle fossa approach with anterior petrosectomy enabled complete resection with division of the trigeminal nerve. Postoperatively, she had a transient left facial paresis, and right hemiparesis that resolved within 48 h.ConclusionThis case highlights the importance of close postoperative surveillance in CM associated with cranial nerves as recurrence after nerve-sparing resection is possible. Surgical treatment due to the morphology of significant recurrence required the use of a complex skull base approach through a new corridor to achieve optimal clinical outcome.

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Section: Discussionmentioning

confidence: 99%

“…Trigeminal CM are extremely rare with only 17 cases reported in literature (2,4,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Majority of these cases presented with trigeminal neuralgia and were treated with surgical resection.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Recurrent pediatric cavernous malformation of the trigeminal nerve

Harty,

Baqai,

Sajjad

et al. 2023

Front. Surg.

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“…[ 9 , 39 , 46 ] The CMs of the trigeminal nerve were also described in six cases, typically presenting with facial dysesthesia or hyperesthesia. [ 2 , 20 , 40 , 46 , 47 ] The trochlear nerve CMs have been only reported in five patients, with varying presentations. [ 27 , 46 , 55 ] Furthermore, only one case has been reported for the involvement of each hypoglossal, accessory, and abducens nerve.…”

Section: Discussionmentioning

confidence: 99%

An isolated cavernous malformation of the sixth cranial nerve: A case report and review of literature

Samadian

Maroufi

Bakhtevari

et al. 2021

Surgical Neurology International

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Background: Isolated cavernous malformation (CM) of the abducens nerve has not been reported in the literature. Herein, the authors address the clinical importance of these lesions and review the reported cases of CM from 2014 to 2020. Case Description: A 21-year-old man presented with binocular diplopia and headache from 2 months before his admission. The neurological examination revealed right-sided abducens nerve palsy. The brain MRI revealed an extra-axial pontomedullary lesion suggestive of a CM. The lesion was surgically removed. During the operation, the abducens nerve was resected considering the lesion could not be separated from the nerve and an anastomosis was performed using an interposition nerve graft and fibrin glue. Pathological examination of the resected lesion revealed that it was originated from within the nerve. The patient’s condition improved in postoperative follow-ups. Conclusion: Surgical resection of the cranial nerves CMs is appropriate when progressive neurological deficits are present. If the lesion is originated from within the nerve, we suggest resection of the involved nerve and performing anastomosis. Novel MRI sequences might help surgeons to be prepared for such cases and fibrin glue can serve as an appropriate tool to perform anastomosis when end-to-end sutures are impossible to perform.

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