Cystic Progression of a Cavernous Malformation at the Level of the Trigeminal Root Entry Zone Presenting With Sudden Onset of Trigeminal Neuralgia

Scavo, Carlo Giacobbo; Roperto, Raffaelino; Cacciotti, Guglielmo; Mastronardi, Luciano

doi:10.1097/scs.0000000000004501

Cited by 7 publications

(5 citation statements)

References 11 publications

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“…Majority of these cases presented with trigeminal neuralgia and were treated with surgical resection. Only 2 were treated with stereotactic radiosurgery and one with percutaneous balloon compression ( 10 , 13 , 19 ). Adachi et al classified these lesions into 4 types according to the origin of the CM: within the Gasserian ganglion, within the cisternal segment, within the intra-axial trigeminal nerve root in the pons, and within the spinal tract of the trigeminal nerve.…”

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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“…Cyst formation in CCMs occurs due to recurrent episodes of hemorrhage from vascular sinusoids or the neocapillaries of the cyst wall, which causes changes in osmotic pressure across the membrane of the CCM (which is histologically similar to the outer membrane of a chronic subdural hematoma), which in turn leads to gradual fluid accumulation, cystic change, and subsequent growth. 4 5 6 10 11 12 14 30 40 41 Other mechanisms include ectasia of vascular channels, capillary budding, repeated hemorrhages causing obliteration of septae between adjacent sinusoids leading to their incorporation, and organization and encapsulation of a perilesional hemorrhage. 6 10 11 29 Another hypothesis states that they can show significant growth even in the absence of a prior hemorrhagic event (which may be due to an inherent proliferative mechanism in the lesion itself), which makes them mimic other neoplasms, and adds to diagnostic challenges.…”

Section: Discussionmentioning

confidence: 99%

“…Keywords used for the search were “cystic cavernomas,” “cystic cavernous malformations,” and “cystic cavernous angiomas.” All articles in English literature where the emphasis was placed on the reporting of intracranial cCCMs (the imaging appearance showed a significant cystic component to the lesion) and their typical features were selected for analysis; and a total of 42 publications reporting 52 cases of cCCMs were identified and analyzed ( Table 1 ). 2 3 4 5 6 7 8 9 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 Epidemiological data, namely age, sex, and family history; clinical symptoms at presentation; imaging features; extent of surgical resection; and outcome were analyzed descriptively. Radiation-induced cCCMs were excluded.…”

Section: Methodsmentioning

confidence: 99%

Cystic Cerebral Cavernous Malformations: Report of Five Cases and a Review of Literature

et al. 2023

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Introduction Cerebral cavernous malformations (CCMs) account for about 5 to 13% of intracranial vascular malformations. Cystic cerebral cavernous malformations (cCCMs) are a rare morphological variant and can cause diagnostic and therapeutic dilemmas. We describe our five such cases and review the existing literature on this entity. Methods A search of the PubMed database for cCCMs was done, and all articles in English emphasizing the reporting of cCCMs were selected. A total of 42 publications describing 52 cases of cCCMs were selected for analysis. Epidemiological data, clinical presentation, imaging features, the extent of resection, and outcome were analyzed. Radiation-induced cCCMs were excluded. We have also described five of our cases of cCCMs and reported our experience. Results The median age at presentation was 29.5 years. Twenty-nine patients had supratentorial lesions, 21 had infratentorial lesions, and 2 had lesions in both compartments. Among our four patients, three had infratentorial lesions, whereas one had a supratentorial lesion. Multiple lesions were seen in four patients. A majority (39) had symptoms of mass effect (75%), and 34 (65.38%) had raised intracranial pressure (ICP), whereas only 11 (21.15%) had seizures. Among our four operated patients, all of them had symptoms of mass effect, and two of them also had features of raised ICP. The extent of resection was gross total in 36 (69.23%), subtotal in 2 (3.85%), and not reported in 14 (26.93%). All four of our operated patients underwent gross total resection, but two of them underwent a second surgery. Of the 48 patients in whom the surgical outcome was reported, 38 improved (73.08%). One showed a transient worsening followed by improvement, one developed a worsening of the pre-existing focal neurological deficit (FND), two developed a new FND, and 5 had no improvement in their FNDs. Death occurred in one patient. All four of our operated patients improved after surgery, although three of them showed a transient worsening of FNDs. One patient is under observation. Conclusion cCCMs are rare morphological variants and can cause considerable diagnostic and therapeutic dilemmas. They should be considered in the differential diagnosis of any atypical cystic intracranial mass lesion. Complete excision is curative, and the outcome is generally favorable; although transient deficits may be seen.

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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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Cystic Progression of a Cavernous Malformation at the Level of the Trigeminal Root Entry Zone Presenting With Sudden Onset of Trigeminal Neuralgia

Cited by 7 publications

References 11 publications

Case Report: Recurrent pediatric cavernous malformation of the trigeminal nerve

Case Report: Recurrent pediatric cavernous malformation of the trigeminal nerve

Cystic Cerebral Cavernous Malformations: Report of Five Cases and a Review of Literature

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

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