Gasserian ganglion neurosarcoidosis mimicking trigeminal schwannoma

Neurosarcoidose do gânglio de gasser simulando um schwannoma trigeminal

A MRI of a 59-year-old male with right hemifacial hypoesthesia showed a low signal T2-weighted expansive mass in the right Meckel's cave. After failure of initial conservative treatment (Figure 1), surgery was done with partial lesion resection (Figure 2). The pathology and chest CT were consistent with granulomatous disease: neurosarcoidosis. On follow-up the lesion increased in size but after corticosteroids it reversed (Figure 3). The involvement of the trigeminal nerve is very rare with only few cases described in literature. Although rare, sarcoid infiltration of the Gasserian ganglion must be considered in the differential diagnosis of an isolated mass at Meckel’s cave, especially if it has T2 hypointensity signal.

Figure 1
Initial pre-operative images and follow up one month later.

Figure 2
Early post-operative evaluation.

Figure 3
Follow up after surgery with steroid therapy.

References

• ¹
  Shah R, Roberson GH, Curé JK. Correlation of MR imaging findings and clinical manifestations in neurosarcoidosis. Am J Neuroradiol. 2009;30(5):953-61. http://dx.doi.org/10.3174/ajnr.A1470
  » https://doi.org/10.3174/ajnr.A1470
• ²
  Quinones-Hinojosa A, Chang EF, Khan SA, McDermott MW. Isolated trigeminal nerve sarcoid granuloma mimicking trigeminal schwannoma: case report. Neurosurgery. 2003;52(3):700-5.
• ³
  Amin A, Balderacchi JL. Trigeminal neurosarcoidosis: case report and literature review. Ear Nose Throat J. 2010;89(7):320-2.
• ⁴
  Arias M, Iglesias A, Vila O, Brasa J, Conde C. MR imaging findings of neurosarcoidosis of the gasserian ganglion: an unusual presentation. Eur Radiol. 2002;12(11):2723-5. http://dx.doi.org/10.1007/s00330-001-1287-9
  » https://doi.org/10.1007/s00330-001-1287-9
• ⁵
  Ahn JY, Kwon So, Shin MS, Joo JY, Kim TS. Chronic granulomatous neuritis in idiopathic trigeminal sensory neuropathy: report of two cases. J Neurosurg. 2002;96(3):585-8.

Publication Dates

• Publication in this collection
  Feb 2015

History

• Received
  19 Sept 2014
• Reviewed
  02 Oct 2014
• Accepted
  22 Oct 2014