Total resection of a recurrent trigeminal cavernous malformation

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.