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Malignant lymphomatous invasion of Meckel’s cave: pathoanatomical considerations of the petrous apex
  1. Dario Alfredo Marotta1,2,
  2. Matthew Mason1,
  3. Aaron Cohen-Gadol3,4 and
  4. Hassan Kesserwani5
  1. 1Department of Research, Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
  2. 2Department of Neurology, Division of Neuropsychology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
  4. 4The Neurosurgical Atlas, Indianapolis, Indiana, USA
  5. 5Dothan Neurology, Dothan, Alabama, USA
  1. Correspondence to Dario Alfredo Marotta; marottad{at}


Secondary central nervous system lymphoma is rare, occurring in up to 10% of non-Hodgkin's lymphoma patients and in 5% of diffuse large B-cell lymphoma patients. The prognosis is poor, even rarer is metastasis of large B-cell lymphomas into Meckel’s cave and the trigeminal nerve roots. We describe a relapsing case of a large B-cell lymphoma that migrated into Meckel’s cave, the mandibular branch of the trigeminal nerve and the adjacent cavernous sinus. We review petrous apex anatomy, review the literature of metastatic spread into Meckel’s cave and analyse existing pathoanatomical studies that explain the conduits and barriers of tumour spread. Understanding this pathoanatomical relationship is critical for neurologists and neurosurgeons alike to effectively correlate patient signs and symptoms to intracranial pathology and identify origins and sites of metastatic dispersion in similar rare clinical scenarios.

  • malignant and benign haematology
  • neuroimaging

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  • Contributors DAM and MM are responsible for drafting and revising the manuscript critically. AC-G is responsible for revising the manuscript critically and approving the final version. HK is responsible for identification of the case, drafting the manuscript, revising the manuscript critically and approving the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.