title: Synchronous ipsilateral cavernous malformations of the trochlear nerve.
abstract: BACKGROUND
  Cranial nerve cavernous malformations (CM) are rare benign congenital vascular anomalies, with approximately 44 preceding cases in the literature. We report the fifth case of trochlear CM, as well as the first instance of two discrete CM occurring simultaneously along the same cranial nerve.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A fifty-seven year-old man presented with several years of diplopia; physical examination identified a complete left trochlear nerve paralysis. MRI revealed a 1cm enhancing lesion within the left ambient cistern, and the patient underwent left pretemporal transcavernous resection. Intraoperatively, a second, discrete CM of the trochlear nerve was also discovered; wide excision of the intrinsic trochlear lesions was completed, allowing both tumors to be removed en bloc with negative margins. Pathologic analysis confirmed both to be CM of the trochlear nerve. The patient recovered with a persistent left trochlear paralysis only, and follow-up MRI was negative for residual or recurrent disease.
  
  
  CONCLUSIONS
  Cranial nerve CM are rare but potentially morbid mass lesions, with the capacity to precipitate significant neuropathies. Differential diagnosis includes schwannoma and hemangioblastoma. Definitive diagnosis may not be possible preoperatively; however, resection is recommended in symptomatic patients, potentially accompanied by nerve repair.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Graffeo
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: William R
authors.initials: WR
authors.lastname: Copeland
authors.affiliation: Department of Pathology, Arkansas Neuroscience Institute, St Vincent Infirmary, Little Rock, AR, United States.
authors.forename: Perkins
authors.initials: P
authors.lastname: Mukunyadzi
authors.affiliation: Department of Neurosurgery, Arkansas Neuroscience Institute, St Vincent Infirmary, Little Rock, AR, United States.
authors.forename: Ali F
authors.initials: AF
authors.lastname: Krisht
mesh_terms: D003390:Cranial Nerve Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D018325:Hemangioblastoma / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000000981:diagnostic imaging* / Q000473:pathology; D014321:Trochlear Nerve / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000473:pathology; D020432:Trochlear Nerve Diseases / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: Cavernous malformation; Transcavernous approach; Trochlear nerve; Trochlear palsy