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Case Report: Recurrent pediatric cavernous malformation of the trigeminal nerve
Mikhail Harty1, Muhammad Waqas Saeed Baqai1, Jahangir Sajjad1
1Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
Frontiers in Surgery
|January 8, 2024
Summary
Cavernous malformations (CM) rarely affect cranial nerves. This case shows CM recurrence after nerve-sparing surgery, necessitating complex skull base reoperation for optimal outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Skull Base Surgery
Background:
- Cavernous malformations (CM) typically affect brain parenchyma.
- Cranial nerve involvement by CM is rare.
- Recurrence of cranial nerve CM after resection is not previously documented.
Observation:
- An 11-year-old girl presented with otalgia and headache due to a trigeminal cavernous malformation.
- Initial nerve-sparing resection via retrosigmoid approach was performed.
- Recurrence along the trigeminal nerve occurred 18 months post-surgery, extending into Meckel's cave and middle cerebellar peduncle.
Findings:
- A second surgery using an extended middle fossa approach with anterior petrosectomy achieved complete resection.
- Postoperative complications included transient facial paresis and hemiparesis, which resolved.
- This case demonstrates the possibility of recurrence even after nerve-sparing resection.
Implications:
- Close postoperative surveillance is crucial for cranial nerve CM.
- Recurrent cranial nerve CM may require complex skull base approaches for complete resection.
- Management strategies need to consider the potential for recurrence and the complexity of reoperation.
