title: Cavernous Malformation in the Trigeminal Distribution: A Case Report of Aggressive Presentation and Management.
abstract: BACKGROUND
  Cavernous malformation (CM) is a vascular malformation found in the encephalic parenchyma, spinal cord, nerve roots, and extraneural tissue. CM in the trigeminal distribution is exquisitely uncommon and its biological behavior not completely understood. The clinical picture might be diverse, depending on the affected sector of the trigeminal architecture, and literature debating its pathobiology is scarce.
  
  
  METHODS
  We describe a case of 56-year-old woman who presented with left trigeminal neuralgia and a rapidly growing cavernous malformation of the entire distribution of the fifth nerve. The clinical picture evolved to a progressive gait ataxia and follow-up neuroimaging showed a large intracranial mass leading to a brainstem compression. After microsurgical resection, the mass proved to be a typical CM of the trigeminal root.
  
  
  CONCLUSIONS
  We present an uncommonly aggressive progression of a CM of the trigeminal root, Gasserian ganglion, and cavernous sinus evolving to severe brainstem compression. The documentation of this unique case as well as its management is presented is discussed.
authors.affiliation: Service of Neurosurgery and Post Graduation Program of Surgical Sciences, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: João Thiago
authors.initials: JT
authors.lastname: Frossard
authors.affiliation: Service of Neurosurgery and Post Graduation Program of Surgical Sciences, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Flavio
authors.initials: F
authors.lastname: Domingues
authors.affiliation: Department of Neuroradiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Pedro
authors.initials: P
authors.lastname: Neves
authors.affiliation: Department of Pathology and Post-Graduation Program of Pathology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Canhedo
authors.affiliation: Service of Neurosurgery and Post Graduation Program of Surgical Sciences, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address: jormarcondes@gmail.com.
authors.forename: Jorge Marcondes
authors.initials: JM
authors.lastname: de Souza
mesh_terms: D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D014277:Trigeminal Neuralgia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
keywords: Cavernous angioma of the cavernous sinus; Cavernous malformation; Trigeminal nerve; Trigeminal neuralgia