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Cranial nerve cavernous malformations causing trigeminal neuralgia and chiasmal apoplexy: Report of 2 cases and review of the literature.

Pereira de Morais NM, Mascarenhas AL, Soares-Fernandes JP, Moreira da Costa JA - Surg Neurol Int (2012)

Bottom Line: Cavernous malformations (CMs) confined to the cranial nerves (CN) are extremely rare lesions.The authors report 2 cases of CMs, one involving the trigeminal nerve presenting with a 3 years history of a refractory right trigeminal neuralgia that was microsurgically resected by a retromastoid approach with resolution of the neuralgia; and another CM involving the chiasma with an abrupt onset of vision loss with acute intralesional bleeding that was removed through a right pterional approach with vision improvement.Surgical resection is recommended in the context of progressive significant neurological deficit, emergency decompression as a result of recent hemorrhage for symptomatic relief or increase in size on serial magnetic resonance imaging (MRI).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Hospital de Braga, Sete Fontes, São Victor, 4710-243 Braga, Portugal.

ABSTRACT

Background: Cavernous malformations (CMs) confined to the cranial nerves (CN) are extremely rare lesions.

Case description: The authors report 2 cases of CMs, one involving the trigeminal nerve presenting with a 3 years history of a refractory right trigeminal neuralgia that was microsurgically resected by a retromastoid approach with resolution of the neuralgia; and another CM involving the chiasma with an abrupt onset of vision loss with acute intralesional bleeding that was removed through a right pterional approach with vision improvement.

Conclusion: Surgical resection is recommended in the context of progressive significant neurological deficit, emergency decompression as a result of recent hemorrhage for symptomatic relief or increase in size on serial magnetic resonance imaging (MRI).

No MeSH data available.


Related in: MedlinePlus

Cerebral MRI. Left image: Preoperative axial gradient echo scan. Right image: Postoperative axial gradient echo scan
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Figure 1: Cerebral MRI. Left image: Preoperative axial gradient echo scan. Right image: Postoperative axial gradient echo scan

Mentions: A 49-year-old female patient presented to our hospital with a 3 years history of right trigeminal neuralgia in the territory of the first division of the trigeminal nerve refractory to the best medical therapy. Neurological examination was normal. Magnetic resonance imaging (MRI) showed multiple CMs, one of which located on the cisternal segment of the right trigeminal nerve [Figure 1]. We performed a right retrosigmoid craniotomy and total removal of the CM. Histopathological study was compatible with a CM. On the follow-up 28 months later the patient is pain and medication free.


Cranial nerve cavernous malformations causing trigeminal neuralgia and chiasmal apoplexy: Report of 2 cases and review of the literature.

Pereira de Morais NM, Mascarenhas AL, Soares-Fernandes JP, Moreira da Costa JA - Surg Neurol Int (2012)

Cerebral MRI. Left image: Preoperative axial gradient echo scan. Right image: Postoperative axial gradient echo scan
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475881&req=5

Figure 1: Cerebral MRI. Left image: Preoperative axial gradient echo scan. Right image: Postoperative axial gradient echo scan
Mentions: A 49-year-old female patient presented to our hospital with a 3 years history of right trigeminal neuralgia in the territory of the first division of the trigeminal nerve refractory to the best medical therapy. Neurological examination was normal. Magnetic resonance imaging (MRI) showed multiple CMs, one of which located on the cisternal segment of the right trigeminal nerve [Figure 1]. We performed a right retrosigmoid craniotomy and total removal of the CM. Histopathological study was compatible with a CM. On the follow-up 28 months later the patient is pain and medication free.

Bottom Line: Cavernous malformations (CMs) confined to the cranial nerves (CN) are extremely rare lesions.The authors report 2 cases of CMs, one involving the trigeminal nerve presenting with a 3 years history of a refractory right trigeminal neuralgia that was microsurgically resected by a retromastoid approach with resolution of the neuralgia; and another CM involving the chiasma with an abrupt onset of vision loss with acute intralesional bleeding that was removed through a right pterional approach with vision improvement.Surgical resection is recommended in the context of progressive significant neurological deficit, emergency decompression as a result of recent hemorrhage for symptomatic relief or increase in size on serial magnetic resonance imaging (MRI).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Hospital de Braga, Sete Fontes, São Victor, 4710-243 Braga, Portugal.

ABSTRACT

Background: Cavernous malformations (CMs) confined to the cranial nerves (CN) are extremely rare lesions.

Case description: The authors report 2 cases of CMs, one involving the trigeminal nerve presenting with a 3 years history of a refractory right trigeminal neuralgia that was microsurgically resected by a retromastoid approach with resolution of the neuralgia; and another CM involving the chiasma with an abrupt onset of vision loss with acute intralesional bleeding that was removed through a right pterional approach with vision improvement.

Conclusion: Surgical resection is recommended in the context of progressive significant neurological deficit, emergency decompression as a result of recent hemorrhage for symptomatic relief or increase in size on serial magnetic resonance imaging (MRI).

No MeSH data available.


Related in: MedlinePlus