Total resection of a recurrent trigeminal cavernous malformation

Abstract

Background: Cerebral cavernous malformations (CMs) are benign lesions of thin, hyalinized blood vessels without brain parenchyma. These lesions can result in various neurologic symptoms resulting from mass effect or focal neuropathies. A rare proportion of CMs have grown along the trigeminal nerve, causing trigeminal neuralgia as the principal presenting symptoms. Observations: We report a recurrent case of a 63 year old female with a CM growing near the Obersteiner-Redlich zone of her right trigeminal nerve resulting in symptoms consistent with trigeminal neuralgia. This lesion was initially thought to be a neoplasm and was incompletely resected during the initial surgery with a plan to follow on final pathology. Interval growth of the lesion was appreciated over a period of 3 months, resulting in recurrence of her symptoms, making this case the first publication of recurrent trigeminal neuralgia secondary to cavernous malformation. A right retrosigmoid craniotomy was successfully performed for gross total resection of the lesion. Lessons: This case highlights the importance of including CMs on the differential for trigeminal Obersteiner-Redlich zone lesions and emphasizes the necessity of gross total resection to prevent recurrence. It is the first published case report to include intraoperative video of the resection.

Keywords

• Trigeminal
• Cavernous malformation
• Total resection