Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota.
Oper Neurosurg (Hagerstown). 2021 Apr 15;20(5):E353. doi: 10.1093/ons/opaa418.
Trigeminal nerve schwannomas (TNSs) are rare lesions that typically present with symptoms of trigeminal neuropathy or other cranial nerve palsies. These lesions classically have a dumbbell shape, with an anterior component within Meckel's cave and posterior component extending into the posterior fossa through the porus trigeminus. Surgical resection of TNSs can often be achieved via an extradural subtemporal approach to Meckel's cave without an anterior petrousectomy, even for tumors with a significant posterior fossa component, as the tumor often erodes a portion of the petrous apex.1 We present the case of a 53-yr-old female presenting to our institution with complete trigeminal neuropathy secondary to a right-sided, previously resected and radiated TNS. Serial imaging demonstrated an interval growth of significant residual tumor despite multiple adjuvant therapies, and, thus, the patient was recommended to undergo additional surgical resection. The lesion was approached through a right-sided subtemporal approach to Meckel's cave,2 with a plan to utilize an anterior petrousectomy only if difficulty resecting the posterior fossa component of the tumor was encountered. Intraoperatively, the posterior fossa component was found to be densely adherent to the adjacent brainstem, likely secondary to prior surgery and radiation therapy, and, thus, an anterior petrousectomy was performed. Postoperatively, the patient had stable trigeminal neuropathy without any new neurological deficits and a magnetic resonance imaging (MRI) confirmed a gross total resection. In the accompanying video, we hope to demonstrate the steps and nuances of both the subtemporal approach to accessing Meckel's cave and anterior petrousectomy when employed for the resection of TNSs. The patient in question provided formal consent for the making of this video.
三叉神经鞘瘤（TNS）是一种罕见的病变，通常表现为三叉神经病变或其他颅神经麻痹的症状。这些病变通常呈哑铃状，前部位于 Meckel 腔，后部通过三叉神经孔延伸至颅后窝。TNS 的手术切除通常可以通过经颞下入路到达 Meckel 腔，而无需进行前岩骨切除术，即使对于具有明显颅后窝成分的肿瘤也是如此，因为肿瘤通常会侵蚀一部分岩骨尖。我们报告了一例 53 岁女性患者，因右侧先前切除和放疗的 TNS 而出现完全性三叉神经神经病。连续影像学检查显示尽管进行了多次辅助治疗，但仍有明显的残留肿瘤间隔生长，因此建议患者进行额外的手术切除。该病变通过右侧经颞下入路到达 Meckel 腔，2 计划仅在遇到肿瘤颅后窝成分切除困难时使用前岩骨切除术。术中发现颅后窝成分与相邻脑干紧密粘连，可能是由于先前的手术和放射治疗所致，因此进行了前岩骨切除术。术后，患者的三叉神经神经病稳定，无新的神经功能缺损，磁共振成像（MRI）证实大体全切除。在随附的视频中，我们希望展示经颞下入路到达 Meckel 腔和前岩骨切除术的步骤和细微差别，这些方法用于切除 TNS。所讨论的患者已正式同意制作此视频。
