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Case Reports
. 2015 Jul;76(1):e18-22.
doi: 10.1055/s-0034-1390020. Epub 2015 Jan 16.

Aneurysmal Bone Cyst of the Temporal Bone Presenting with Headache and Partial Facial Palsy

Stephanie N Kletke  1 , Snezana Popovic  2 , Almunder Algird  3 , Abdullah Alobaid  3 , Kesava K V Reddy  3
Affiliations
Case Reports

Aneurysmal Bone Cyst of the Temporal Bone Presenting with Headache and Partial Facial Palsy

Stephanie N Kletke et al. J Neurol Surg Rep. 2015 Jul.

Abstract

Background Aneurysmal bone cysts (ABCs) are benign bony lesions that rarely affect the skull base. Very few cases of temporal bone ABCs have been reported. We describe the first case of a temporal bone ABC that was thought to be consistent with a meningioma based on preoperative magnetic resonance imaging (MRI) findings. Clinical Presentation An otherwise healthy 23-year-old woman presented with a pulsatile noise in her left ear and a 4-week history of throbbing headache with nausea. There was no associated emesis, visual or auditory changes, or other neurologic features. Neurologic examination revealed a left lower motor neuron facial paresis. Computed tomography and MRI studies demonstrated a large lesion in the left middle cranial fossa skull base with erosion of the petrous temporal bone. Based on the presence of a "dural tail" on preoperative contrast-enhanced T1-weighted imaging, the lesion was interpreted to likely be consistent with a meningioma. An orbitozygomatic approach was utilized for surgical excision. Histopathologic evaluation was consistent with an ABC. Conclusion Postoperatively the patient had improvement in the lower motor neuron facial paresis. It is important to consider ABC in the differential diagnosis of intracranial lesions accompanied by the dural tail sign on MRI.

Keywords: aneurysmal bone cyst; dural tail sign; skull base; temporal bone.

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Figures

Fig. 1
Fig. 1
Preoperative magnetic resonance imaging. (A) Axial T1-weighted noncontrast. (B) Axial T1-weighted noncontrast. (C) Axial fluid-attenuated inversion recovery (FLAIR) noncontrast.
Fig. 2
Fig. 2
Preoperative magnetic resonance imaging. (A) Axial T1-weighted with contrast. (B) Coronal T1-weighted with contrast. (C) Coronal magnetization-prepared rapid acquired gradient echo (MP-RAGE).
Fig. 3
Fig. 3
Computed tomography images. (A) Preoperative axial. (B) Preoperative coronal. (C) Postoperative axial. (D) Postoperative coronal.
Fig. 4
Fig. 4
Microscopic sections (hematoxylin and eosin stain) demonstrate features of aneurysmal bone cyst. (A) Blood-filled cystic cavity. (B) Fibrous tissue septa surrounding cavity with osteoid formation. (C) Presence of giant cells.
See this image and copyright information in PMC

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