A Case of Meckel's Cave Epidermoid Cyst With Unilateral Abducens Nerve Paresis As the Sole Presentation Publisher



Sharifi G¹ ; Mohammadi E² ; Jafari A¹ ; Jamali E³ ; Sabouri S⁴ ; Akbari N⁵
Source: Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Published:2022

Abstract

Background: Meckel's cave is a space lateral to cavernous sinus that hosts trigeminal nerve. Cranial nerves (CN) pass from its adjacency through cavernous sinus. There has been no report of Meckel's cave tumor with CN VI involvement while other nerves, especially trigeminal nerve, remaining preserved. Clinical presentation: A 32-year-old otherwise healthy man complained of double vision. Signs and symptoms were inconclusive other than left-sided strabismus and abduction paresis. MRI revealed a cystic, well-defined, popcorn textured, 3-cm space occupying lesion in Meckel's cave with a high-signal appearance on both T1 and T2 sequences, as well as hyperintense patchy signals in periphery when contrast was added. Tumor had an outgrowing appendage that extended posteriorly. During six months of follow up tumor showed a growing pattern and indicated surgery. Left subtemporal approach was chosen to reach the foramen ovale. Tumor was completely removed without complication. The tumor tail was indirectly compressing the CN VI outside Meckel's cavity. Neurologic deficit gradually improved. Conclusion: Tumors of the Meckel's cave can present with odd symptoms of neurovascular involvement. Trigeminal nerve as is the predominant nerve to be affected, but there is a chance that other nerves can be compressed without compromising trigeminal nerve. © 2022 The Author(s)