Kamer Aaron P, Bonnin Jose M, Spinner Robert J, Cohen-Gadol Aaron A
Departments of1Radiology and Imaging Sciences, and.
2Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
J Neurosurg. 2019 Feb 8;132(3):700-704. doi: 10.3171/2018.10.JNS182665. Print 2020 Mar 1.
Intracranial extension of temporomandibular joint (TMJ) ganglion cysts is very rare. Two previously reported cases presented clinically due to effects on cranial nerves and had obvious association with the TMJ on imaging. To the authors' knowledge, intracranial extension of a TMJ ganglion cyst presenting with seizures and mimicking a primary brain tumor has not been previously reported. The patient underwent resection of a presumptive primary cystic temporal lobe tumor, but the lesion had histopathological features of a nonneoplastic cyst with a myxoid content. He was followed with serial imaging for 5 years before regrowth of the lesion caused new episodes of seizures requiring a repeat operation, during which the transdural defect was repaired after the adjacent segment of the TMJ was curetted. A thorough review of all imaging studies and the histopathological findings from the repeat operation led to the correct diagnosis of a TMJ ganglion cyst. This case highlights an unusual presentation of this rare lesion, as well as its potential for recurrence. TMJ ganglion cysts should be included in the differential diagnosis of cystic tumors involving the anterior temporal lobe, presenting with or without seizures. Focused imaging evaluation of the TMJ can be helpful to rule out the possible role of associated TMJ lesions.
颞下颌关节（TMJ）神经节囊肿的颅内扩展非常罕见。先前报道的两例病例临床上是由于对颅神经的影响而出现，并且在影像学上与颞下颌关节有明显关联。据作者所知，以癫痫发作表现且酷似原发性脑肿瘤的颞下颌关节神经节囊肿的颅内扩展此前尚未见报道。该患者接受了疑似原发性囊性颞叶肿瘤的切除，但病变具有含黏液样成分的非肿瘤性囊肿的组织病理学特征。在病变复发导致新的癫痫发作需要再次手术之前，对其进行了连续5年的影像学随访，再次手术期间，在刮除颞下颌关节相邻节段后修复了硬脑膜缺损。对所有影像学研究以及再次手术的组织病理学结果进行全面回顾后，得出了颞下颌关节神经节囊肿的正确诊断。该病例突出了这种罕见病变的不寻常表现及其复发的可能性。颞下颌关节神经节囊肿应纳入涉及颞叶前部的囊性肿瘤的鉴别诊断中，无论有无癫痫发作。对颞下颌关节进行针对性的影像学评估有助于排除相关颞下颌关节病变的可能作用。
