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Cavernous hemangioma of the third cranial nerve: case report
Eyal Itshayek1, Xicotencatl Perez-Sanchez, Jose E Cohen
1Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. eyalit@md.huji.ac.il
Objective:
The authors report a rare case of a cavernous hemangioma (CH) involving the third cranial nerve.
Clinical Presentation:
A 25-year-old Caucasian woman presented with neuralgic facial pain that responded to pharmacological management. She had no neurological deficit. Magnetic resonance imaging scans revealed a space-occupying lesion in the interpeduncular cistern with no evidence of hemorrhagic event. Preoperative cerebrospinal fluid and blood samples were negative for cytology and tumor markers.
Intervention:
The patient underwent craniotomy and exploration of the interpeduncular cistern. A lesion with the raspberry-like appearance characteristic of a CH was found emerging from between the fibers and completely encircling Cranial Nerve III. The surgeon decided to leave the lesion in place to avoid creation of a new neurological deficit in the young patient. The patient is asymptomatic with a stable radiological picture 18 months after surgery.
Conclusion:
CH should be considered as a possible differential diagnosis of extra-axial space-occupying lesions along the course of the cranial nerves. Resection with resulting deficit may not be indicated in patients presenting with normal neurological function. Further research and longer follow-up periods are required to better understand the natural history of CH involving the cranial nerves.
