Department of Dermatology, The University of Texas Medical Branch, Galveston, Texas, USA.
Dermatol Online J. 2023 Dec 15;29(6). doi: 10.5070/D329663002.
A 74-year-old woman who presented initially with trigeminal neuralgia of the left forehead and scalp was later found to have a poorly differentiated squamous cell carcinoma (SCC) with large-nerve perineural and intraneural invasion of the left supraorbital nerve. Negative histopathologic margins were achieved in three stages of permanent fixed tissue en face processing and the final defect was repaired with a large rotation flap. Approximately one month after repair, the patient presented with new-onset diplopia and was found to have a complete left cranial nerve VI palsy suspicious for continued disease spread. MRI confirmed perineural spread along the ophthalmic branch of the trigeminal nerve through the superior orbital fissure into the cavernous sinus. She was subsequently treated with radiation therapy (66Gy in 33 fractions). The involvement of two distinct cranial nerves by perineural invasion is uncommon and has mostly been described involving branches of the trigeminal and facial nerves. This case highlights the rare presentation of perineural invasion involving both the trigeminal nerve and the abducens nerve. Anatomically, this clinical presentation can be explained by the retrograde perineural spread along the ophthalmic branch of the trigeminal nerve through the supraorbital fossa into the cavernous sinus where these two nerves are in close proximity.
一位 74 岁女性最初表现为左额和头皮三叉神经痛，后来发现患有分化不良的鳞状细胞癌（SCC），左眶上神经有大神经周围和神经内侵袭。在永久性固定组织正面处理的三个阶段中实现了阴性组织学边缘，最后用大旋转皮瓣修复了最终缺陷。修复后大约一个月，患者出现新发性复视，并发现左侧第六颅神经完全麻痹，怀疑疾病继续扩散。MRI 证实神经周围通过眶上裂沿三叉神经眼支扩散至海绵窦。随后，她接受了放射治疗（66Gy 分 33 次）。神经周围侵犯累及两个不同的颅神经并不常见，主要涉及三叉神经和面神经的分支。本例突出了神经周围侵犯累及三叉神经和外展神经的罕见表现。从解剖学上讲，这种临床表现可以通过三叉神经眼支逆行神经周围扩散通过眶上裂进入海绵窦来解释，这两条神经在那里非常接近。
