title: Cavernous sinus tuberculoma mimicking a neoplasm: Case report, literature review, and diagnostic and treatment suggestions for tuberculomas in rare locations.
abstract: BACKGROUND
  Cavernous sinus tuberculomas are extremely rare, but the increasing incidence worldwide of central nervous system (CNS) tuberculosis, mostly due to human immunodeficiency virus and poor sanitary conditions, and the ability of tuberculomas to mimic a brain neoplasm makes cavernous sinus tuberculomas a suspicious pathologic finding in the differential diagnosis of a brain space-occupying lesion.
  
  
  METHODS
  We present an immunocompetent patient with no signs of systemic tuberculosis and an isolated right cavernous sinus space-occupying lesion. A skull base approach was performed and tumor resection achieved. The postoperative course was uneventful. Pathologic findings consisted of a tuberculoma and antituberculous treatment was immediately begun with total tumor regression after a 12-month regimen. After reviewing the literature, we propose suggestions to orient the diagnosis and a treatment algorithm for tuberculomas in rare locations.
  
  
  CONCLUSIONS
  Tuberculomas in rare locations, as the cavernous sinus, are a challenging pathology as they have the ability to mimic a brain neoplasm. Although first line treatment are antituberculous therapy (4 drugs for at least 12 months) and adjuvant steroids, in inconclusive cases, surgical biopsy or excision is recommended for histopathologic confirmation and to reduce the mass effect, always following with antituberculous therapy and adjuvant steroids.
authors.affiliation: Department of Neurosurgery, Juan A. Fernandez General Hospital, Buenos Aires City, Argentina.
authors.forename: Sebastián G
authors.initials: SG
authors.lastname: Jaimovich
authors.affiliation: Department of Neurosurgery, Juan A. Fernandez General Hospital, Buenos Aires City, Argentina.
authors.forename: Victor Castillo
authors.initials: VC
authors.lastname: Thea
authors.affiliation: Department of Neurosurgery, Juan A. Fernandez General Hospital, Buenos Aires City, Argentina.
authors.forename: Martin
authors.initials: M
authors.lastname: Guevara
authors.affiliation: Department of Neurosurgery, Juan A. Fernandez General Hospital, Buenos Aires City, Argentina.
authors.forename: Javier L
authors.initials: JL
authors.lastname: Gardella
keywords: Brain tumor; cavernous sinus; meningioma; skull base; tuberculoma; tuberculosis