Prugue Cesar, Abood Delaney C, LaPenna Paul
Edward Via College of Osteopathic Medicine, Spartanburg, SC, USA.
Case Rep Neurol. 2025 Jun 25;17(1):102-106. doi: 10.1159/000546760. eCollection 2025 Jan-Dec.
Meckel's cave cephalocele, also known as petrous apex cephalocele (PAC), is a rare cystic lesion caused by herniation of the cerebrospinal fluid into the Meckel's cave. Bilateral PACs are exceptionally rare, with only 21 reported cases. PACs may present with headache, diplopia, tinnitus, or cranial nerve palsy.
A 74-year-old male presented with acute onset headache, vision changes, and gait instability. His medical history included hypertension and melanoma. Examination revealed a left cranial nerve VI palsy. Initial imaging with head CT and CTA showed no acute intracranial abnormalities but revealed moderate chronic sinusitis. Magnetic resonance imaging demonstrated large bilateral Meckel's cave cephaloceles, more prominent on the left, with mass effect on the inferior margins of the cavernous sinus. Steroid treatment was initiated for suspected influenza-associated cranial neuropathy. Follow-up did not reveal an immediate improvement. However, after several weeks of steroid treatment, his symptoms improved significantly. The patient deferred surgical intervention.
This case highlights a rare presentation of bilateral PACs with cranial nerve VI palsy. Although surgical intervention may be definitive, conservative treatment can provide relief of symptoms in select cases. More research is needed to guide optimal management strategies.
梅克尔腔脑膨出，也称为岩尖脑膨出（PAC），是一种罕见的囊性病变，由脑脊液疝入梅克尔腔引起。双侧PAC极为罕见，仅有21例报告病例。PAC可能表现为头痛、复视、耳鸣或颅神经麻痹。
一名74岁男性，出现急性头痛、视力改变和步态不稳。他的病史包括高血压和黑色素瘤。检查发现左侧颅神经VI麻痹。最初的头部CT和CTA成像未显示急性颅内异常，但显示中度慢性鼻窦炎。磁共振成像显示双侧巨大梅克尔腔脑膨出，左侧更明显，对海绵窦下缘有占位效应。因怀疑流感相关性颅神经病变开始使用类固醇治疗。随访未显示立即改善。然而，经过数周的类固醇治疗后，他的症状明显改善。患者推迟了手术干预。
本病例突出了双侧PAC伴颅神经VI麻痹的罕见表现。虽然手术干预可能是决定性的，但在某些情况下保守治疗可以缓解症状。需要更多研究来指导最佳管理策略。
