Trigeminal neuralgia caused by cavernoma: A case report with literature review

Abstract

Cavernoma is the second most common cerebrovascular lesion. Cavernoma involving the cranial nerves is very rare. Only 15 cases of cavernoma presenting with trigeminal neuralgia (TN) have been previously reported. Here, we report a rare case of cavernoma manifesting with TN. A young female patient with a 15-day history of right-sided lancinating pain in the face, difficulty in opening the mouth, and hearing dysesthesia. Magnetic resonance imaging (MRI) revealed a well-demarcated lesion in the cerebellopontine angle related closely to the root of the trigeminal nerve. The initial impression was that of a neurinoma. The lesion was surgically resected via the retrosigmoid approach, postoperative pathological analysis confirmed the diagnosis of cavernoma, and the patient's pain and difficulty in opening the mouth resolved completely. We presented the 16th documented case of cavernoma with TN. Although cavernoma involving the trigeminal nerve is extremely rare, this diagnosis should be taken into consideration when a lesion in the cerebellopontine angle is detected on MRI, and the clinical manifestation is consistent with that of secondary TN. Specialized MRI sequences, such as susceptibility weighted imaging (SWI), gradient echo T2, and constructive interference in steady-state (CISS)-weighted imaging, aid in establishing the diagnosis. Resection via craniotomy may be the primary management strategy for cavernoma causing TN. In addition, gamma knife radiosurgery (GKRS) and percutaneous balloon compression (PBC) may ameliorate the pain to some extent.

Case Report: Recurrent pediatric cavernous malformation of the trigeminal nerve

“…Samadian et al, in a case of CM associated with the trochlear nerve recommended sectioning and reanastomosis of the nerve to achieve resection ( 8 , 22 ). Liu et al in their case report described a CM of the trigeminal nerve that was intimately related to the sensory root which was sacrificed while preserving the motor root ( 11 ). Mascarenhas et al, described resection of a CM adherent to the second and third division of the trigeminal nerve that required taking some of the rootlets of the nerve ( 12 ).…”

“…Trigeminal CM are extremely rare with only 17 cases reported in literature (2,4,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Majority of these cases presented with trigeminal neuralgia and were treated with surgical resection.…”