Chung Jong Chul, Chung Seung Young, Kim Seong Min, Park Moon Sun
Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea.
J Korean Neurosurg Soc. 2010 Oct;48(4):383-7. doi: 10.3340/jkns.2010.48.4.383. Epub 2010 Oct 30.
Complete removal of three-compartment trigeminal schwannomas is a challenge to neurosurgeons. To expand exposure of each compartment, the combination and modification of skull base approaches are necessary. The 61-year-old woman was admitted with chronic headache. Preoperative magnetic resonance imaging showed 47×50×40 mm-sized tumor originating primarily in the middle cranial fossa extended to the posterior and the infratemporal fossa. We performed operation in five stage; 1. Zygomatic osteotomy, 2. Inferior temporal fossa plate removal and foramen ovale opening, 3. Cavernous sinus opening, 4. Tailored anterior petrosectomy, 5. Meckel's cave opening. Combination of skull base surgery should be concerned according to the patient. In this study, extradural basal extension with zygomatic osteotomy, interdural posterior extension with tailored anterior petrosectomy, and intracavernous exploration are reasonable options for remodeling three-compartment lesion into a single compartment. Tailoring of bone resection and exploring through natural pathway between meningeal layers accomplish single-stage operation for complete removal of tumors.
完整切除三室性三叉神经鞘瘤对神经外科医生来说是一项挑战。为了扩大每个腔室的暴露范围，颅底入路的联合与改良是必要的。一名61岁女性因慢性头痛入院。术前磁共振成像显示一个大小为47×50×40 mm的肿瘤，主要起源于中颅窝，延伸至后颅窝和颞下窝。我们分五个阶段进行手术：1. 颧骨截骨术；2. 颞下窝板切除及卵圆孔开放；3. 海绵窦开放；4. 定制前颞骨切除术；5. 梅克尔腔开放。应根据患者情况考虑联合颅底手术。在本研究中，采用颧骨截骨术进行硬膜外基底扩展、定制前颞骨切除术进行硬膜间后扩展以及海绵窦内探查是将三室性病变重塑为单室性病变的合理选择。通过骨切除的定制以及在脑膜层之间的自然路径进行探查可完成肿瘤完整切除的单阶段手术。
