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Case Reports
. 2023 Dec 22:10:1278177.
doi: 10.3389/fsurg.2023.1278177. eCollection 2023.

Case Report: Recurrent pediatric cavernous malformation of the trigeminal nerve

Mikhail Harty  1 , Muhammad Waqas Saeed Baqai  1 , Jahangir Sajjad  1 , Greg Fellows  2 , Philip J Clamp  2 , Kumar Abhinav  1
Affiliations
Case Reports

Case Report: Recurrent pediatric cavernous malformation of the trigeminal nerve

Mikhail Harty et al. Front Surg. .

Abstract

Background: Most cavernous malformations (CM) usually involve the parenchyma and rarely occur in cranial nerves. Recurrence of CM associated with cranial nerves after surgical resection has not been previously reported.

Case description: This paper describes the case of an 11-year-old girl who presented with left otalgia and headache because of a left trigeminal cavernous malformation. She underwent radical resection via a left retrosigmoid approach while sparing the trigeminal nerve. Surveillance imaging at 18 months demonstrated recurrence along the length of the trigeminal nerve into Meckel's cave with significant extension into the middle cerebellar peduncle. Subsequent re-operation via an extended middle fossa approach with anterior petrosectomy enabled complete resection with division of the trigeminal nerve. Postoperatively, she had a transient left facial paresis, and right hemiparesis that resolved within 48 h.

Conclusion: This case highlights the importance of close postoperative surveillance in CM associated with cranial nerves as recurrence after nerve-sparing resection is possible. Surgical treatment due to the morphology of significant recurrence required the use of a complex skull base approach through a new corridor to achieve optimal clinical outcome.

Keywords: cavernoma; cavernous malformation; cranial nerve cavernoma; pediatric; trigeminal nerve cavernous malformation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Schematic representation of the timeline from presentation and primary surgery through the recurrence of the lesion and the second operation.
Figure 2
Figure 2
(A) Axial contrast enhanced T1-weighted image showing a lesion in the left trigeminal nerve extending from pontine portion into Meckel's cave. (B) shows interval image at 1 year after presentation which showed involution of the lesion. (C, D), show new hemorrhage with cystic portion invaginating the brainstem which prompted surgical intervention. (E, F) show 6-month postoperative contrast enhanced T1-weighted axial and coronal images, respectively, after the first operation via retrosigmoid approach demonstrating gross total resection.
Figure 3
Figure 3
Shows images before and after the second operation via a subtemporal Kawase-Dolenc approach. (A) contrast enhanced T1-weighted imaging and (B) Susceptibility weighted image demonstrate the lesion filling Meckel's cave extending along the cisternal segment of the trigeminal nerve and invaginating the brain. (C) demonstrates the coronal FLAIR that shows the CM involving the brainstem and extending down to the internal acoustic meatus. (D,E) are contrast-enhanced T1, and T2-weighted images, respectively, and (F) is a coronal FLAIR that demonstrate complete resection of the recurrent lesion.
Figure 4
Figure 4
(A) axial and (B) coronal CT images demonstrating the extent of the anterior petrosectomy to give access to the lesion during the Kawase-Dolenc approach at the second operation.
See this image and copyright information in PMC

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