Casabella Amanda M, Kiyofuji Satoshi, Perry Avital, Graffeo Christopher S, Eschbacher Kathryn L, Link Michael J
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, University of Tokyo, Tokyo, Japan.
World Neurosurg. 2019 Jun;126:30-36. doi: 10.1016/j.wneu.2019.02.118. Epub 2019 Mar 5.
Renal cell carcinoma (RCC) accounts for ∼8% of all brain metastatic disease; however, spread to the cranial nerves and their ganglia is uncommon. To the best of our knowledge, we report the first case of RCC metastatic to Meckel's cave, which was diagnosed secondary to new trigeminal sensory loss.
A 45-year-old man had presented with acute-onset right V3 numbness. Magnetic resonance imaging demonstrated contrast enhancement of the ipsilateral V3, extending from its root at the Gasserian ganglion to the foramen ovale.
He elected for observation, and his symptoms resolved over several weeks. At the scheduled, routine 3-month follow-up examination, he reported symptomatic relapse with new concomitant hyperesthetic/neuropathic pain. Magnetic resonance imaging demonstrated interval enlargement of the enhancing lesion in an atypical pattern, potentially consistent with trigeminal schwannoma versus meningioma, and operative resection was recommended.
We have reported a case of RCC presenting with numbness via metastatic spread to Meckel's cave. Although uncommon, metastasis is an important diagnostic consideration for enhancing cranial nerve lesions. Our case has demonstrated that, although a history of malignancy, multiple lesions, or systemic/constitutional symptoms are typical, rare cases can demonstrate isolated central nervous system findings. Thus, short-term radiographic surveillance is indicated if the diagnosis of an intracranial or cranial nerve mass lesion is equivocal.
肾细胞癌（RCC）占所有脑转移疾病的约8%；然而，扩散至颅神经及其神经节并不常见。据我们所知，我们报告了首例转移至梅克尔腔的肾细胞癌病例，该病例因新出现的三叉神经感觉丧失而被诊断。
一名45岁男性出现急性起病的右侧V3麻木。磁共振成像显示同侧V3有对比增强，从其在半月神经节的根部延伸至卵圆孔。
他选择观察，其症状在数周内缓解。在预定的3个月常规随访检查时，他报告症状复发，并伴有新出现的感觉过敏/神经性疼痛。磁共振成像显示强化病变呈非典型模式进行性增大，可能与三叉神经鞘瘤或脑膜瘤相符，建议手术切除。
我们报告了一例通过转移至梅克尔腔而出现麻木症状的肾细胞癌病例。尽管不常见，但转移是强化性颅神经病变的重要诊断考虑因素。我们的病例表明，尽管恶性肿瘤病史、多发病变或全身/全身症状是典型表现，但罕见病例可能仅表现为孤立的中枢神经系统症状。因此，如果颅内或颅神经肿块病变的诊断不明确，则需进行短期影像学监测。
