Recurrent arachnoid cyst of Meckel's cave mimicking a brain stem ischaemia. Report of a rare case.
A 44-years old man developed TIA-like symptoms with dysaesthesia around the mouth, vertigo and diplopia. MRI revealed a cystic space-occupying lesion on the right Meckel's cave, which spread out into cerebellopontine angle in a further examination. Therefore surgical exploration was performed using a suboccipital approach. An arachnoidal cyst was found and removed including its wall. About three months later the patient suffered again from dysaesthesias of the right side of the face and a new MRI revealed a recurrence of the lesion, with extension into the cerebellopontine angle, too. Surgical revision was done using the same approach and the recurrent cyst was removed. Postoperatively, there were a transient hypaesthesia in the distribution area of the right trigeminal nerve and a light pulmonary embolism occurred as a complication. No symptoms have returned during an observation period of 15 months.


CONCLUSIONS
An arachnoidal cyst must be considered as a rare cause, when a lesion is found at the Meckel's cave with intermittent clinical symptoms of a trigeminal nerve affection. As surgical treatment we favour fenestration and cyst wall resection.
Wörner
B A
BA
Department of Neurosurgery, Klinikum Villingen-Schwenningen, Germany.
Noll
M
M
Rahim
T
T
Fink
U
U
Oeckler
R
R
D000328:Adult; D016080:Arachnoid Cysts / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D002545:Brain Ischemia / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D001933:Brain Stem / Q000098:blood supply* / Q000503:physiopathology; D002530:Cerebellopontine Angle / Q000098:blood supply / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000473:pathology; D009412:Nerve Fibers / Q000502:physiology; D019635:Neurosurgical Procedures; D010292:Paresthesia / Q000209:etiology; D011183:Postoperative Complications / Q000503:physiopathology / Q000523:psychology; D012008:Recurrence; D020433:Trigeminal Nerve Diseases / Q000175:diagnosis / Q000209:etiology / Q000473:pathology