A cavernous malformation of the trigeminal nerve: A case report and pathology highlight

Abstract

Background

Cavernous malformations of the cranial nerves are rare, especially of the trigeminal nerve. The following case report highlights the course and treatment of this patient, particularly focusing on the imaging and pathology highlights of the case.

Case Description

A 70-year-old male who presented with one year history of decreased sensation on the right side of the face prior to admission, progressed to complete ipsilateral facial numbness, as well as severe ataxia, vertigo, and nausea. Physical exam demonstrated lack of sensation in the V1-3 distribution on the right side, as well as nystagmus and hearing loss on the right side. CTA displayed a cryptic vascular malformation, and MRI demonstrated a lesion with surrounding contrast enhancement. The patient underwent a procedure for microsurgical resection of the hemorrhagic lesion.

Discussion

Frozen intraoperative pathology suggested a hyalinized vascular lesion, which was later confirmed to be a cavernous malformation. The patient experienced significant improvement in ataxia and balance following resection but had persistent right sided facial numbness with only mild improvement in sensation. Cavernous malformations of the trigeminal nerve can present with focal neurologic deficits and in some cases, trigeminal neuralgia. This patient uniquely presented with facial numbness and not trigeminal neuralgia, as seen in previous reports.

Conclusion

Early removal of cavernous malformations, ideally prior to hemorrhage, can result in improved patient outcomes and improvement of neurologic symptoms.

1 Background.