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. 2023 Aug 14;84(3):e80-e84.
doi: 10.1055/s-0043-1772157. eCollection 2023 Jul.

A Neuroenteric Cyst of the Cavernous Sinus: A Case Report

Walid Elshamy  1   2 , Burak Ozaydin  1 , Sima Sayyahmelli  1 , M Shahriar Salamat  1   3 , Mustafa K Baskaya  1
Affiliations

A Neuroenteric Cyst of the Cavernous Sinus: A Case Report

Walid Elshamy et al. J Neurol Surg Rep. .

Abstract

Background Neuroenteric cysts (NECs) are benign lesions mostly found as intradural extramedullary lesions in the cervicothoracic spinal cord. NECs in the cavernous sinus are very rare. To the best of our knowledge, this is only the second reported case and the first in an adult. Presentation We present a left cavernous sinus NEC in a 75-year-old female with gradually worsening headache and facial pain unresponsive to medical treatment. Imaging revealed a cystic mass lesion in the left cavernous sinus encasing the distal petrosal and cavernous segment of the internal carotid artery. Initial differential diagnoses included more common pathologies located near the cavernous sinus, including cystic schwannoma, craniopharyngioma, and dermoid and epidermoid tumors. The patient underwent a left pterional craniotomy with an extradural transcavernous approach for surgical exploration and possible resection of this mass lesion. Histopathology revealed an NEC lined with benign respiratory-type epithelium. Postoperative imaging revealed gross total tumor resection. The patient remained neurologically intact with complete resolution of facial pain. Conclusion We present a rare pathology that can easily be misinterpreted as other types of lesions. NECs should be kept in mind for differential diagnosis of cavernous sinus cystic lesions. The surgical aim should be maximal safe excision.

Keywords: Meckel's cave; cavernous sinus; neuroenteric cyst; trigeminal nerve.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Preoperative axial CT of the head in bone window ( A ) shows widening of the foramen ovale ( white arrow ), and brain window ( B ) shows an isodose mass lesion in the left cavernous sinus ( white arrow ).
Fig. 2
Fig. 2
Preoperative axial T1-weighted ( A ), T2-weighted ( B ), and T1-weighted with contrast enhancement ( C ) MRIs show a cystic mass lesion with septations in the left cavernous sinus. Note the contrast enhancement in the cyst wall and septations.
Fig. 3
Fig. 3
H&E stain reveals a complex cystic structure with a generous fibrotic wall (asterisks), original magnification 10X ( A ). H&E stained section of the cyst lining at original magnification of 40x reveals a pseudostratified columnar ciliated epithelium that several goblet cells ( arrows ), similar to the lining of the respiratory tract ( B ).
Fig. 4
Fig. 4
2nd day postoperative axial T1-weighted ( A ), T2-weighted ( B ), and T1-weighted with contrast enhancement ( C ) MRIs show gross total resection of the tumor. Note the T1 hyperintense and T2 hypointense signal ( arrows ) of the fat graft that was placed at the end of the resection.
Fig. 5
Fig. 5
Postoperative MRI brain after 15 months. Axial T1 weighted with contrast ( A ) and axial T2 weighted images ( B ) show no recurrence.
See this image and copyright information in PMC

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