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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 coronal T2-weighted scan. Right image: Postoperative coronal T2-weighted scan
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Figure 2: Cerebral MRI. Left image: Preoperative coronal T2-weighted scan. Right image: Postoperative coronal T2-weighted scan

Mentions: A 40-year-old female patient came to our attention with complains of sudden headache and vision loss. Examination revealed bitemporal hemianopia, diminished visual acuity in both eyes and nuchal rigidity. MRI showed multiple CMs, one of which localized in the optic chiasm, revealing recent bleeding [Figure 2]. The patient had undergone four previous craniotomies at another institution for removal of bleeding CMs in different locations without sequelae. The senior author (JAMC) decided to perform emergent surgical exploration through a right pterional craniotomy, removing the clot and the lesion. Histopathological examination was reported as a CM. On the follow-up, the vision improved and the patient is capable of reading and driving, but 11 years after the surgery a right homonymous hemianopsia persists.


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 coronal T2-weighted scan. Right image: Postoperative coronal T2-weighted scan
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Cerebral MRI. Left image: Preoperative coronal T2-weighted scan. Right image: Postoperative coronal T2-weighted scan
Mentions: A 40-year-old female patient came to our attention with complains of sudden headache and vision loss. Examination revealed bitemporal hemianopia, diminished visual acuity in both eyes and nuchal rigidity. MRI showed multiple CMs, one of which localized in the optic chiasm, revealing recent bleeding [Figure 2]. The patient had undergone four previous craniotomies at another institution for removal of bleeding CMs in different locations without sequelae. The senior author (JAMC) decided to perform emergent surgical exploration through a right pterional craniotomy, removing the clot and the lesion. Histopathological examination was reported as a CM. On the follow-up, the vision improved and the patient is capable of reading and driving, but 11 years after the surgery a right homonymous hemianopsia persists.

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