Trigeminal neuropathy associated with an enlarging arachnoid cyst in Meckel’s cave: case report, management strategy and review of the literature

Abstract

We describe a rare case and novel management strategy of painful trigeminal neuropathy caused by an arachnoid cyst confined to Meckel's cave. A 57-year-old female presented with several years of progressive trigeminal pain and signs of trigeminal deafferentation, including sensory loss, corneal anesthesia and mastication muscle atrophy. Medical treatment with carbamazepine provided partial and temporary pain control. Surgical treatment was eventually performed by aspiration of the arachnoid cyst through the foramen ovale using a percutaneous approach. The patient experienced relief of pain and improvement of numbness and muscle strength. To our knowledge, this is the first case description of a percutaneous drainage of a Meckel's cave arachnoid cyst.

Percutaneous Treatment of Meckel Cave Arachnoid Cyst: Case Report, Surgical Strategy and Literature Review

“…The secondary ones are less common and are associated with neoplasms, infections, bleeding, trauma or surgery. 2,3 Depending on their location and size, arachnoid cysts may become symptomatic.…”

“…In a literature review, we found only eight cases reported as MC arachnoid cyst (►Table 1). 2,[5][6][7][8][9][10][11] The average age of the patients was 41 years oldwith a range from 1 to 58 years oldand there was a female predominance (5 out of 8). The most affected side was the right side (five out of eight).…”

“…Arachnoid cysts are benign intracranial lesions that account for 1% of nontraumatic intracranial lesions. 1,2 They are usually located in the middle fossa, but can be found in other locationssuch as the suprasellar, the posterior fossa, the interhemispheric, the quadrigeminal cistern and the cerebral convexity. They are usually asymptomatic lesions, but may become symptomatic depending on location and size.…”

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

“…Messerer et al reported contamination of sample tissue with fat, CSF or blood, leading to diagnostic difficulties [83]. Drainage of arachnoid cysts, however, has been reported as feasible [21]. In the further course, an endoscopic transforamen ovale approach and observation of Meckel's cave were reported [48].…”

“…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.…”