Iwasaki Kazuhiko, Watanabe Satoshi, Ikku Yusuke, Yano Seiji
Department of Internal Medicine, Anamizu General Hospital, Ta-8, Anamizu-chou, Ho-su gun, Kawashima, Ishikawa 927-0027 Japan.
Department of Respiratory Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa Japan.
Int Cancer Conf J. 2024 Nov 8;14(1):56-59. doi: 10.1007/s13691-024-00736-9. eCollection 2025 Jan.
Osimertinib has emerged as the standard first-line treatment for advanced non-small cell lung cancer (NSCLC) with EGFR mutations, offering improved tolerability and demonstrating superior efficacy against brain metastases in comparison with other tyrosine kinase inhibitors. The Meckel's cave is a dural recess in the posteromedial part of the middle cranial fossa that acts as a conduit for the trigeminal nerve between the anterior pontine cisterna and the cavernous sinus, and houses the Gasserian ganglion and proximal radicle of the trigeminal nerve. Trigeminal neuropathy, characterized by numbness and dysesthesia of the skin and mucous membranes of the face, poses diagnostic challenges and often requires differentiation from conditions, such as compression neuropathy, inflammation, and drug-induced reactions. Here, we report the case of Meckel's cave metastasis. She presented headache, anorexia, left facial numbness, and pain indicative of trigeminal neuropathy. Imaging revealed metastasis to Meckel's cave, consistent with her clinical symptoms. EGFR L858R mutation was detected by primary lesion of the lung DNA analysis. Treatment with osimertinib led to regression of the primary tumor and improvement of the trigeminal neuropathy within 3 months. Importantly, our review of the relevant literature identified only two similar cases with metastasis of lung adenocarcinoma to Meckel's cave. Ours was the only case in which symptom resolution was achieved. We underscore the utility of MRI and PET/CT studies in evaluating trigeminal-related symptoms and discuss imaging characteristics that may aid in their differentiation.
奥希替尼已成为晚期表皮生长因子受体（EGFR）突变型非小细胞肺癌（NSCLC）的标准一线治疗药物，与其他酪氨酸激酶抑制剂相比，其耐受性更好，对脑转移瘤的疗效更优。梅克尔腔是中颅窝后内侧的硬脑膜隐窝，是三叉神经在前脑桥池和海绵窦之间的通道，容纳三叉神经节和三叉神经近端神经根。三叉神经病变以面部皮肤和黏膜麻木及感觉异常为特征，给诊断带来挑战，常需与压迫性神经病变、炎症及药物不良反应等疾病相鉴别。在此，我们报告一例梅克尔腔转移瘤病例。患者出现头痛、厌食、左侧面部麻木及疼痛，提示三叉神经病变。影像学检查显示梅克尔腔转移，与临床症状相符。通过对肺部原发灶DNA分析检测到EGFR L858R突变。使用奥希替尼治疗3个月内，原发肿瘤缩小，三叉神经病变改善。重要的是，我们查阅相关文献仅发现两例肺腺癌转移至梅克尔腔的类似病例。我们的病例是唯一症状得到缓解的。我们强调磁共振成像（MRI）和正电子发射断层显像/计算机断层扫描（PET/CT）检查在评估三叉神经相关症状中的作用，并讨论有助于鉴别诊断的影像学特征。
