Cavernous hemangioma of the third cranial nerve: Case report

OBJECTIVE: The authors report a rare case of a cavernous hemangioma (CH) involving the third cranial nerve. CLINICAL PRESENTATION: A 25-year-old Caucasian woman presented with neuralgic facial pain that responded to pharmacological management. She had no neurological deficit. Magnetic resonance imaging scans revealed a space-occupying lesion in the interpeduncular cistern with no evidence of hemorrhagic event. Preoperative cerebrospinal fluid and blood samples were negative for cytology and tumor markers. INTERVENTION: The patient underwent craniotomy and exploration of the interpeduncular cistern. A lesion with the raspberry-like appearance characteristic of a CH was found emerging from between the fibers and completely encircling Cranial Nerve III. The surgeon decided to leave the lesion in place to avoid creation of a new neurological deficit in the young patient. The patient is asymptomatic with a stable radiological picture 18 months after surgery. CONCLUSION: CH should be considered as a possible differential diagnosis of extra-axial space-occupying lesions along the course of the cranial nerves. Resection with resulting deficit may not be indicated in patients presenting with normal neurological function. Further research and longer follow-up periods are required to better understand the natural history of CH involving the cranial nerves.