Shibao Shunsuke, Akiyama Takenori, Tomita Hideyuki, Kuramae Takumi, Mochizuki Youichi, Yoshida Kazunari
Department of Neurosurgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga-City, Tochigi, Japan.
Neurosurg Rev. 2016 Jan;39(1):169-74; discussion 174. doi: 10.1007/s10143-015-0670-y. Epub 2015 Oct 6.
In cavernous sinus (CS) surgery, venous complication may occur in some types of venous drainage. The sphenobasal vein (SBV) drains from the superficial middle cerebral vein (SMCV) to the pterygoid venous plexus at the temporal skull base. A frontotemporal epi- and interdural approach (Dolenc approach), which is one of the CS approaches, may damage the SBV's route. We report a case of intracavernous trigeminal schwannoma that contained the SBV and discuss our modified surgical procedure that combined epi- and subdural approaches to preserve the SBV. A 64-year-old man complained of right progressive oculomotor palsy and was referred to our hospital for surgery. MR images revealed a hemorrhagic tumor in the right CS. Three-dimensional venography revealed that the SMCV drained into the pterygoid venous plexus via the SBV. After identifying the first branch of the trigeminal nerve epidurally, we incised the dura linearly along the sylvian fissure and entered the subdural space to visualize the SBV. The incision was continued to the meningeal dura of the lateral wall of the CS along the superior margin of the first branch of the trigeminal nerve, and the Parkinson's triangle was opened from the subdural side. The tumor was grossly totally removed, and the SBV was preserved. In conclusion, a frontotemporal epi- and subdural approach to the intracavernous trigeminal schwannoma can effectively preserve the SBV.
在海绵窦（CS）手术中，某些类型的静脉引流可能会发生静脉并发症。蝶基底静脉（SBV）从大脑中浅静脉（SMCV）引流至颞骨颅底的翼静脉丛。额颞硬膜外和硬膜间入路（多伦克入路）是CS入路之一，可能会损伤SBV的走行。我们报告一例海绵窦内三叉神经鞘瘤病例，该肿瘤包绕SBV，并讨论我们采用硬膜外和硬膜下联合入路以保留SBV的改良手术方法。一名64岁男性因右侧动眼神经进行性麻痹前来就诊，并被转诊至我院接受手术。磁共振成像（MR）显示右侧CS有一个出血性肿瘤。三维静脉造影显示SMCV经SBV引流至翼静脉丛。在硬膜外识别三叉神经第一分支后，我们沿外侧裂线性切开硬脑膜，进入硬膜下间隙以显露SBV。切口沿三叉神经第一分支上缘继续延伸至CS外侧壁的脑膜硬脑膜，从硬膜下侧打开帕金森三角。肿瘤被大体完全切除，SBV得以保留。总之，额颞硬膜外和硬膜下联合入路处理海绵窦内三叉神经鞘瘤可有效保留SBV。
