Giant cavernous sinus teratoma: A clinical example of a rare entity: Case report

OBJECTIVE AND IMPORTANCE: Teratomas represent 0.5% of all intracranial tumo rs. These benign tumors have tissue representative of the three germinal la yers: ectoderm, mesoderm, and endoderm. Most teratomas are midline tumors l ocated predominantly in the sellar and pineal regions. Cavernous sinus loca tion is very rare; only two purely intracavernous teratomas have been repor ted. CLINICAL PRESENTATION: A 14-year-old boy presented with a history of progre ssive right eye proptosis and visual acuity impairment, headaches, and a ne uralgia-like facial pain in the right Va distribution. A head computed tomo graphic scan and magnetic resonance imaging disclosed a large tumor filling the right cavernous sinus and extending into the ipsilateral middle fossa. These scans also demonstrated mixed signals derived from different tissues conforming to the tumor (fat, cartilage, muscle strands, bone, and a primo rdial tooth). Heterogeneous enhancement was seen after infusion of contrast medium. Significant bone erosion and remodeling was evident in the middle fossa floor and right orbit, with secondary proptosis, A presumptive diagno sis of mature teratoma was made. INTERVENTION: With the use of a right frontotemporal interfascial approach, a combined extra- and intradural dissection of the tumor was performed. Th e lesion entirely occupied the cavernous sinus, laterally displacing the Ga sserian ganglion and trigeminal branches (predominantly V1 and V2). The int ernal carotid artery and Cranial Nerve VI were medially displaced by the tu mor mass. The lesion was composed of different tissues, including hair, fat , cartilage, muscle, nerve-like tissue, bone, and a primordial tooth. The t umor was removed completely, and the pathological report confirmed the diag nosis of a mature teratoma. There was no evidence of recurrence at the 8-mo nth follow-up examination. CONCLUSION: Because of the lesion's location in the lateral wall of the cav ernous sinus, a total removal was achieved with the use of standard microsu rgical techniques. Knowledge of the microanatomy is essential in treating i ntracavernous pathology. We present the third reported case of a giant matu re teratoma of the cavernous sinus.