Abou-Al-Shaar Hussam, Gozal Yair M, Hunt Jason P, Couldwell William T
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.
Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah.
Oper Neurosurg. 2019 Nov 1;17(5):E205. doi: 10.1093/ons/opz014.
Malignant peripheral nerve sheath tumors (MPNSTs) of the trigeminal nerve are uncommon lesions that pose a surgical challenge to neurosurgeons. The case described in this video involved a 67-yr-old man who presented with a 2-yr history of left-sided facial numbness spreading from his chin along the left mandible to the preauricular area. He also reported left-sided tongue numbness and decreased taste on the left side of the tongue. On examination, he had left-sided facial numbness along the V3 distribution to pinprick and light touch. Magnetic resonance imaging (MRI) revealed an enhancing left V3 lesion extending from Meckel's cave to the angle of the mandible. The patient underwent a left temporal craniotomy for biopsy of the lesion, formalizing the diagnosis of a MPNST of the left trigeminal nerve. A multidisciplinary resection of his lesion was performed. Left infratemporal fossa approach with neck dissection, mandibulectomy, and frontotemporal craniotomy were performed. Additionally, a frontal external ventricular drain was placed for 3 d to aid in CSF diversion to avoid CSF leak, and free-flap reconstruction was undertaken. The patient tolerated the procedure well. Postoperatively, he retained his facial numbness, dysphagia, and dysarthria. The patient was discharged to inpatient rehabilitation on postoperative day 12. Postoperative computed tomography and MRI depicted complete resection of the left trigeminal nerve MPNST. At his last follow-up appointment, 3 mo after surgery, the patient reported significant improvement in his symptoms. Neuroimaging demonstrated no residual tumor and adjuvant radiotherapy was recommended. The patient provided consent for publication.
三叉神经恶性外周神经鞘瘤（MPNSTs）是一种罕见的病变，给神经外科医生带来了手术挑战。本视频中描述的病例是一名67岁男性，有2年左侧面部麻木病史，麻木从下巴沿左侧下颌骨蔓延至耳前区域。他还报告左侧舌部麻木和左侧味觉减退。检查时，他在V3分布区域存在左侧面部针刺觉和轻触觉麻木。磁共振成像（MRI）显示左侧V3区有一强化病变，从 Meckel腔延伸至下颌角。患者接受了左侧颞部开颅手术以对病变进行活检，确诊为左侧三叉神经MPNST。对其病变进行了多学科切除。采用了左侧颞下窝入路并进行颈部清扫、下颌骨切除术和额颞部开颅手术。此外，放置了额部外置脑室引流管3天，以帮助脑脊液引流，避免脑脊液漏，并进行了游离皮瓣重建。患者对手术耐受良好。术后，他仍存在面部麻木、吞咽困难和构音障碍。患者于术后第12天出院接受住院康复治疗。术后计算机断层扫描和MRI显示左侧三叉神经MPNST已完全切除。在术后3个月的最后一次随访中，患者报告症状有明显改善。神经影像学检查未发现残留肿瘤，建议进行辅助放疗。患者同意发表此病例。
