title: Recurrent paraganglioma of Meckel's cave: Case report and a review of anatomic origin of paragangliomas.
abstract: BACKGROUND
  Paragangliomas are rare, usually benign tumors of neural crest origin. They account for only 0.6% of all head and neck tumors. In the craniocervical area, they are more common in the carotid body and tympanico-jugular regions. To the authors' knowledge, a case of paraganglioma in Meckel's cave has not yet been reported in the medical literature. The pathogenesis and natural history of paragangliomas are still not well understood. We present a case of recurrent paraganglioma in Meckel's cave.
  
  
  METHODS
  A 53-year-old woman was diagnosed with trigeminal neuralgia, dysesthesia and hypoesthesia on the left side of the face, hearing disturbance and a history of chronic, persistent temporal headaches. Magnetic resonance imaging (MRI) showed a lesion located in Meckel's cave on the left side, extending to the posterior cranial fossa and compressing the left cerebral peduncle. The lesion was first thought to be a recurrence of an atypical meningioma, as the pathologist described it in the tissue specimen resected 3 years earlier, and a decision for re-operation was made. A lateral suboccipital approach to the lesion was used under neuronavigational guidance. The tumor was removed, and histological examination proved the lesion to be a paraganglioma. Five months later, the follow-up MRI showed local regrowth, which required subsequent surgical intervention.
  
  
  CONCLUSIONS
  A paraganglioma in Meckel's cave is an uncommon tumor in this location. Although ectopic paragangliomas have been described in the literature, a paraganglioma atypically located in Meckel's cave makes a topographic correlation difficult, mainly because paraganglionic cells are usually not found in Meckel's cave. Another peculiarity of the case is the local recurrence of the tumor in a relatively short time despite an attempted, almost gross total resection.
authors.affiliation: Department of Neurosurgery, Klinikum Kassel, Kassel, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Prajsnar
authors.forename: Naci
authors.initials: N
authors.lastname: Balak
authors.forename: Gerhard F
authors.initials: GF
authors.lastname: Walter
authors.forename: Alexandru C
authors.initials: AC
authors.lastname: Stan
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Deinsberger
authors.forename: Leyla
authors.initials: L
authors.lastname: Tapul
authors.forename: Cicek
authors.initials: C
authors.lastname: Bayindir