Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
World Neurosurg. 2019 Jul;127:518-524. doi: 10.1016/j.wneu.2019.04.113. Epub 2019 Apr 19.
Trigeminal schwannomas are fifth cranial nerve tumors that originate from the nerve sheath. They rarely occur within the pediatric population and can cause dysfunction of the trigeminal nerve and surrounding structures. When patients become symptomatic, neurosurgeons should consider resection.
We report the case of a 14-year-old adolescent boy who presented with an isolated sixth nerve palsy manifested by diplopia. The patient was found to have a trigeminal schwannoma involving the ophthalmic and maxillary branches of the trigeminal nerve. A modified mini-pterional craniotomy was performed for an extended middle fossa approach with an anterior petrosectomy to gain access to the inferior aspect of the posterior fossa tumor component. Intraoperatively, the sixth nerve was compressed within Dorello's canal. Postoperatively, the patient's sixth nerve palsy resolved, and magnetic resonance imaging demonstrated near-total resection with residual enhancement along the superior orbital fissure near the oculomotor nerve entry zone and foramen rotundum.
We present a rare case of pediatric trigeminal schwannoma type Mp treated surgically with a near-total resection via a novel mini-pterional approach and use of cranial nerve diffusion tensor imaging.
三叉神经鞘瘤起源于神经鞘，是第五颅神经肿瘤。它们在儿科人群中很少见，但可导致三叉神经及其周围结构功能障碍。当患者出现症状时，神经外科医生应考虑进行切除。
我们报告了一例 14 岁青少年男性病例，表现为单纯性第六神经麻痹，表现为复视。患者被诊断为三叉神经鞘瘤，累及三叉神经的眼支和上颌支。采用改良的小翼点开颅术，通过前岩骨切除术进行扩大中颅窝入路，以到达后颅窝肿瘤下份。术中发现第六神经在 Dorello 管内受压。术后，患者的第六神经麻痹得到缓解，磁共振成像显示接近完全切除，残余强化位于动眼神经进入区和圆孔附近的眶上裂。
我们提出了一例罕见的儿童三叉神经鞘瘤 Mp 型病例，通过一种新颖的小翼点入路和颅神经弥散张量成像进行了接近完全切除的手术治疗。
