title: Cavernous malformations isolated from cranial nerves: Unexpected diagnosis?
abstract: OBJECTIVE
  Cranial nerves (CN) cavernous malformations (CMs) are lesions that are isolated from the CNs. The authors present three cases of CN CMs, for which MR was demonstrated to be critical for management, and surgical resection produced good outcomes for the patients. Surgical removal is the recommended course of action to restore or preserve neurological function and to eliminate the risk of future haemorrhage. However, the anatomical location and the complexity of nearby neural structures can make these lesions difficult to access and remove. In this study, the authors review the literature of reported cases of CN CMs to analyse the clinical and radiographic presentations, surgical approaches and neurological outcomes.
  
  
  METHODS
  A MEDLINE/Pub Med search was performed and revealed 86 cases of CN CMs. The authors report three additional cases in this study for a total of 89 cases. CMs affecting the optic nerve (CN II), oculomotor nerve (CN III), facial/vestibule-cochlear nerves (CN VII, CN VIII) have been described. The records of three patients were reviewed with respect to the lesion locations, symptoms, surgical approaches and therapeutic considerations. Clinical and radiological follow-up results are reported. Three patients (2 females, 1 male; age range 21-37 year) presented with three CN lesions. One lesion involved CN III, one lesion involved CN VII-CN VIII, and one involved CN II. The patient with the CN III lesion had a one-month history of mild right ptosis and diplopia. The patient with the CN VII-CN VIII lesion exhibited acute hearing loss and on the left and left facial paresis. The patient with the opticchiasmatic lesion presented with acute visual deterioration on the right and a left temporal field deficit in the left eye. Pterional and orbitozygomatic craniotomies were performed for the CN III lesion and the CN II lesion, and retrosigmoid craniotomy was performed for the cerebello-pontine angle lesion.
  
  
  RESULTS
  All patients experienced symptom improvement after surgery. On MR follow-up, recurrence was excluded in all patients.
  
  
  CONCLUSIONS
  CN CMs present with specific symptoms and require complex surgical techniques for resection. These lesions are frequently symptomatic, because of the complexity of the origin tissue. Symptomatic CN CMs should be resected microsurgically and completely when possible to prevent further losses of nerve function, improve function, avoid recurrence, and to eliminate the risk of future haemorrhages. The authors discuss the therapeutic options and the radiological features of these infrequent localisation of CMs. Specifically, the authors focus on the role of magnetic resonance imaging in the identification of these rare lesions.
authors.affiliation: Department of Neuroscience, Second University of Naples, CTO Hospital Viale Colli Aminei 21, 80131 Naples, Italy. Electronic address: michele.rotondo@unina2.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Rotondo
authors.affiliation: Department of Neuroscience, Second University of Naples, CTO Hospital Viale Colli Aminei 21, 80131 Naples, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Natale
authors.affiliation: Department of Neuroscience, Second University of Naples, CTO Hospital Viale Colli Aminei 21, 80131 Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: D'Avanzo
authors.affiliation: Department of Neuroscience, Second University of Naples, CTO Hospital Viale Colli Aminei 21, 80131 Naples, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Pascale
authors.affiliation: Department of Neuroscience, Second University of Naples, CTO Hospital Viale Colli Aminei 21, 80131 Naples, Italy.
authors.forename: Assunta
authors.initials: A
authors.lastname: Scuotto
mesh_terms: D000328:Adult; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D003389:Cranial Nerve Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D055815:Young Adult
keywords: Cavernous malformations; Cranial nerves; Magnetic resonance; Surgical treatment