Cavum trigeminale cephalocele associated with intracranial hypertension in an 18-month-old child: illustrative case.
CSF = cerebrospinal fluid
CT = computed tomography
CTC = cavum trigeminale cephalocele
ICP = intracranial pressure
MRI = magnetic resonance imaging
VPS = ventriculoperitoneal shunt
cranial nerves
middle fossa cephalocele
pseudotumor cerebri
ventriculoperitoneal shunt
Journal
Journal of neurosurgery. Case lessons
ISSN: 2694-1902
Titre abrégé: J Neurosurg Case Lessons
Pays: United States
ID NLM: 9918227275606676
Informations de publication
Date de publication:
31 May 2021
31 May 2021
Historique:
received:
02
03
2021
accepted:
18
03
2021
entrez:
20
7
2022
pubmed:
31
5
2021
medline:
31
5
2021
Statut:
epublish
Résumé
Cavum trigeminale cephaloceles (CTCs) are characterized by a cystic appearance and extension of the posterolateral aspect of Meckel's cave into the superomedial portion of the petrous apex. A possible mechanism is a transient or sustained increase of intracranial pressure transmitted to Meckel's cave, leading to its secondary herniation, in the presence of predisposing local factors. The majority of CTCs are incidental findings. Among symptomatic cases, headache, trigeminal neuralgia, cerebrospinal fluid leak, vertigo, ataxia, facial numbness, hearing loss, diplopia, and other visual disturbances have been described. The authors describe a case of an 18-month-old male patient referred to their hospital with drowsiness, vomiting, left cranial nerve VI palsy, and papilledema. Neuroradiological investigation revealed the presence of a CTC with a swollen aspect of the left pontine hemisection and indirect signs of intracranial hypertension. The patient was managed with implantation of a ventriculoperitoneal shunt. CTCs are rare lesions that are difficult to recognize on neuroimaging, in which they can be mistaken for tumoral or inflammatory lesions. The most frequent asymptomatic forms should be considered as "leave-me-alone" lesions. In cases of intracranial hypertension, according to a supposed theory on the origin of CTCs, the authors recommend treating only the intracranial hypertension instead of performing more invasive surgical procedures, especially in pediatric patients.
Sections du résumé
BACKGROUND
BACKGROUND
Cavum trigeminale cephaloceles (CTCs) are characterized by a cystic appearance and extension of the posterolateral aspect of Meckel's cave into the superomedial portion of the petrous apex. A possible mechanism is a transient or sustained increase of intracranial pressure transmitted to Meckel's cave, leading to its secondary herniation, in the presence of predisposing local factors. The majority of CTCs are incidental findings. Among symptomatic cases, headache, trigeminal neuralgia, cerebrospinal fluid leak, vertigo, ataxia, facial numbness, hearing loss, diplopia, and other visual disturbances have been described.
OBSERVATIONS
METHODS
The authors describe a case of an 18-month-old male patient referred to their hospital with drowsiness, vomiting, left cranial nerve VI palsy, and papilledema. Neuroradiological investigation revealed the presence of a CTC with a swollen aspect of the left pontine hemisection and indirect signs of intracranial hypertension. The patient was managed with implantation of a ventriculoperitoneal shunt.
LESSONS
CONCLUSIONS
CTCs are rare lesions that are difficult to recognize on neuroimaging, in which they can be mistaken for tumoral or inflammatory lesions. The most frequent asymptomatic forms should be considered as "leave-me-alone" lesions. In cases of intracranial hypertension, according to a supposed theory on the origin of CTCs, the authors recommend treating only the intracranial hypertension instead of performing more invasive surgical procedures, especially in pediatric patients.
Identifiants
pubmed: 35855463
doi: 10.3171/CASE21136
pii: CASE21136
pmc: PMC9245737
doi:
Types de publication
Case Reports
Langues
eng
Pagination
CASE21136Informations de copyright
© 2021 The authors.
Déclaration de conflit d'intérêts
Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Références
Pediatr Radiol. 2014 Mar;44(3):325-39; quiz 323-4
pubmed: 24584333
J Clin Neurosci. 2016 Mar;25:155-7
pubmed: 26549681
Otol Neurotol. 2006 Dec;27(8):1131-41
pubmed: 17068409
J Child Neurol. 2005 Feb;20(2):168-70
pubmed: 15794191
Diagn Interv Radiol. 2010 Mar;16(1):7-9
pubmed: 20108203
Surg Radiol Anat. 2015 Dec;37(10):1179-82
pubmed: 25963119
J Neuroradiol. 2015 Jun;42(3):156-61
pubmed: 25857688
Int J Surg Case Rep. 2020;72:373-376
pubmed: 32563824
AJNR Am J Neuroradiol. 2009 Feb;30(2):434-6
pubmed: 18945801
Otolaryngol Head Neck Surg. 2003 Jan;128(1):32-8
pubmed: 12574756
AJNR Am J Neuroradiol. 2001 Nov-Dec;22(10):1867-71
pubmed: 11733318
AJR Am J Roentgenol. 2011 Mar;196(3 Suppl):WS26-37 Quiz S40-3
pubmed: 21343538
Otolaryngol Clin North Am. 2007 Jun;40(3):479-519, viii
pubmed: 17544693
Eur J Radiol. 2007 Jun;62(3):378-84
pubmed: 17306489