TREATMENT OF A RARE CASE OF GIANT VERTEBRAL EXTRACRANIAL ANEURYSM.

Extracranial vertebral artery (VA) aneurysms are extremely rare and are usually associated with trauma or dissection. Primary extracranial VA aneurysms are far less common. They may be of mycotic origin or associated with systemic diseases such as neurofibromatosis. The presentation and natural history remains idiopathic, and operative management can be often difficult. Angiography remains the gold standard in diagnosis and characterisation of these lesions. We hereby present a case of a primary aneurysm of the extracranial portion of the vertebral artery and its surgical management, which implied an initial endosvacular approach followed by a two-step surgery in order to resect the aneurysm and stabilise the spine.

Invisible compression, anterior fossa tumor causing trigeminal neuralgia.

BACKGROUND: Trigeminal neuralgia secondary to posterior and middle fossae tumors, whether ipsilateral or contralateral, has been well described. However, this disabling disease has never been reported in the context of anterior fossa neoplasms. CASE DESCRIPTION: A 75-year-old female with right hemifacial pain was diagnosed with an anterior clinoid meningioma. Despite neuroimaging did not show any apparent anatomical or neurovascular conflict, a detailed MRI analysis revealed a V3 hyperintensity. Not only symptoms completely resolved after surgical resection but also this radiological sign disappeared. Nowadays, the patient remains asymptomatic and V3 hyperintensity has not reappeared during her follow-up. CONCLUSION: A surgical definitive treatment can be offered to patients suffering from trigeminal neuralgia secondary to lesions adjacent to Gasserian ganglion or trigeminal branches. In this respect, posterior and middle fossae tumors are well-reported etiologies. Nevertheless, in the absence of evident compression, other neoplasms located in the vicinity of these critical structures and considered as radiological findings may be involved in trigeminal pain. Microvascular and pressure gradient changes could be an underlying cause of these symptoms in anterior skull base lesions. Here, we report the case of a patient with uncontrollable hemifacial pain resolved after anterior clinoid meningioma removal.