Meckel’s cave is also termed as Meckel cavity, trigeminal cave, and trigeminal cavity. In the brain’s mid cranial fossa, a natural mouth aperture filled with cerebrospinal fluid is located and connected to the posterior cranial fossa. If we discuss pathology associated with this area, many Meckel cave tumors are divided according to expanding cancer. The intrinsic tumors that expand to the Meckel cave include trigeminal schwannoma and meningioma of the Meckel cave.
Meckel’s cave cancer causes trigeminal neuralgia. When cancer extends and protrudes close by bones as it spreads towards the Meckel cave, they are considered extrinsic tumors. It includes bony metastasis, chordoma, and chondrosarcoma. The tumor can grow at any age; people above the age of 50 are more prone to it. The tumor of Meckel’s cave is usually associated with fifth nerve dysfunction.
What is Meckel’s cave tumor?
Meckel cave acts as a duct for the largest cranial nerve, the trigeminal nerve. The trigeminal nerve branches into the mandibular nerve, maxillary nerve, and ophthalmic nerve. A physical examination with the patient’s family history and neurological examination help in better understanding the disease. Diagnosis depends on the type of pain, location of pain that part of the face is suffering, and stimuli pain triggered. Neurosurgeons diagnose it by considering neurological examination in which the analysis helps in determining the problem.
Techniques like image studies of the brain support diagnosis and suggestion of effective treatment, including computed tomography (CT) or magnetic resonance imaging (MRI). A shallow mortality rate of approximately 2% was reported in the case of Meckel’s cave lesions. However, the patient might suffer depression in chronic cases.
Meckel’s cave tumor Symptoms
Meckel’s cave tumor shows a variety of signs and symptoms most associated with trigeminal neuralgia. The trigeminal nerve becomes dysfunctional and impairments of other cranial nerves in the patients with a small tumor or a large tumor. The patients with tumors in Meckel cave often complain about the mild tingling sensation in the face or jaw, initially. On progression, it feels the pain of being stabbed and having an electrical shock along with numbness on the face.
The episodes are small and sudden in which patients feel facial pain on just slight movement and touch around the mouth, jaw, and face. Everyday tasks include brushing the teeth, shaving, eating, applying make-up, talking, and chewing acts as a trigger of pain. With time, the pain in one small area spread over a large area of the face. The episodes may last from a few seconds to several minutes up to weeks and months with an increase in intensity. Rarely do symptoms occur on both sides of the face. Mostly happen on one side of the face only.
Patients experience remission without symptoms and pain-free intervals, with or without treatment. But it re-occurs with more severe and more frequent symptoms than before. Some atypical symptoms have also been seen in some patients that are more constant pain without being triggered by any movement and touch.
Meckel’s cave tumor Causes
The primary cause of Meckel’s cave tumor is trigeminal neuralgia. It is caused due to aging or due to abnormal blood flow in the brain that leads to malfunction or due to diseases like multiple sclerosis, or other disorders produce hyperactive transmission of signal due to breakage of the outer covering myelin sheath of the trigeminal sensory nerve. Sometimes, people have cystic brain lesions, strokes, facial trauma, and surgical injuries that cause Meckel’s cave tumors. Rarely, no reason was found behind the pain.
Meckel’s cave tumor Treatment
Treatment of Meckel’s cave tumor consists of medications administered initially to relieve pain with the anticonvulsant drugs, and antispasmodic drugs as the first treatment of choice. Radiation therapy to microsurgery decompression helps control the tumor if medications are unable to produce the desired effect or side effects of medications becomes unmanageable.
But before surgery, tumor size and its extent to other areas are examined as in other malignancies. After surgery, complete resection was achieved in most patients, and they asked for follow- up for up to 4 to 5 years to observe the long-term outcomes. But rarely patients may experience postoperative complications because of the severity of the surgery, such as leakage of cerebrospinal fluid, cranial nerve deficits, and hydrocephalus.
Other procedures may include opening the sphenoid sinus called sphenoidectomy, balloon compression, and tumor removal, depending on the tumor’s condition. In the case of Meckel’s cave cystic lesion, the endonasal endoscopy gives safe and effective results. Tiny pieces of evidence show that the patient found improvement with acupuncture and vitamin or nutritional therapy.