Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.
Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2019 Jul;127:e534-e541. doi: 10.1016/j.wneu.2019.03.194. Epub 2019 Mar 28.
The objectives of this study were to report 4 cases diagnosed with trigeminal schwannomas (TS), among whom tumor in epidural space of middle fossa broke through dura mater into subdural space, and to analyze the potential reason for recurrence of TS in middle fossa after surgical removal by endoscopic endonasal approach (EEA) or interdural approach.
The information of 4 patients diagnosed with TS who were surgically treated was retrospectively analyzed and the selection of approaches, surgical strategies, and potential reason for recurrence after middle fossa TS removal by EEA and interdural approach were discussed.
During last 10 years, 43 patients with TS received surgical treatment at Xuan Wu Hospital of Capital Medical University, among whom 1 patient with TS extending from middle fossa to infratemporal fossa was first treated by EEA, then the tumor recurred and the patient underwent a second operation via a frontotemporal subdural approach. During the second operation, we found part of tumor had broken through the dura mater into subdural space. Moreover, this phenomenon was detected in another 3 patients with middle-posterior fossa TS.
TS in middle fossa has been widely believed to be totally located at epidural space, whereas we found that it could occasionally breach into subdural space and accept blood supply from the pial artery. We believe this could be the potential reason for recurrence after tumor resection by EEA and interdural approach.
本研究旨在报告 4 例诊断为三叉神经鞘瘤（TS）的病例，其中肿瘤突破中颅窝硬脑膜进入硬脑膜下腔，并分析内镜经鼻入路（EEA）或硬脑膜间入路切除中颅窝 TS 后复发的潜在原因。
回顾性分析 4 例经手术治疗的 TS 患者的资料，讨论了 EEA 和硬脑膜间入路治疗中颅窝 TS 切除的入路选择、手术策略及潜在复发原因。
在过去的 10 年中，首都医科大学宣武医院共收治 43 例 TS 患者，其中 1 例从中颅窝延伸至颞下窝的 TS 患者首先接受 EEA 治疗，然后肿瘤复发，患者接受了经额颞部硬脑膜下入路的第二次手术。第二次手术时，我们发现部分肿瘤已突破硬脑膜进入硬脑膜下腔。此外，在另外 3 例中后颅窝 TS 患者中也发现了这种现象。
人们普遍认为中颅窝 TS 完全位于硬膜外，但我们发现它偶尔会突破硬脑膜进入硬脑膜下腔，并接受脑膜动脉的血液供应。我们认为这可能是 EEA 和硬脑膜间入路切除肿瘤后复发的潜在原因。
