Muhsen Baha'eddin A, Najera Edinson, Borghei-Razavi Hamid, Adada Badih
Department of Neurosurgery, Braathen Center, Cleveland Clinic Florida, Weston, Florida, United States.
J Neurol Surg B Skull Base. 2021 Jun 22;83(Suppl 3):e615. doi: 10.1055/s-0041-1727108. eCollection 2022 Aug.
Trigeminal schwannomas are rare benign tumors, it is second most common intracranial schwannomas after vestibular schwannomas. The management includes not limited to observation, stereotactic radiosurgery/radiotherapy, and/or surgical resection. Tumor size and patient clinical status are the most important factors in management. In this video, we describe the technical nuances of an extended middle fossa approach for large trigeminal schwannoma with cavernous sinus extension resection. A 44-year-old right-handed female with several months' history of progressive right facial paresthesia and pain in the distribution of V3 mainly. On physical examination, she had decreased sensation to light touch over the right V1 to V3 distribution with loss of cornel reflex. The brain MRI showed 3.5 cm bilobed mass extends from the pontine root entry zone to the cavernous sinus. Craniotomy was performed and followed by middle fossa dural peeling, peeling of temporal lobe dura away from the wall of the cavernous sinus, extradurally anterior clinoidectomy, drilling of the petrous apex, coagulation of superior petrosal sinus followed incision of the tentorium up to the tentorial notch with preservation the fourth cranial nerve, and tumor dissected away from V1 and then gradually removed from the superior wall of the cavernous sinus. The technique presented here allows for complete tumor resection, safe navigation through the relative cavernous sinus compartments, and minimizes the possibility of inadvertent injury to the cranial nerves. The postoperative course was uneventful except for right eye incomplete ptosis from the swelling. Her facial pain subsided after the surgery without any extra ocular movement impairment. The link to the video can be found at: https://youtu.be/zxi2XK2R9QU .
三叉神经鞘瘤是一种罕见的良性肿瘤，是继前庭神经鞘瘤之后第二常见的颅内神经鞘瘤。其治疗方法包括但不限于观察、立体定向放射外科手术/放射治疗和/或手术切除。肿瘤大小和患者临床状况是治疗中最重要的因素。在本视频中，我们描述了一种扩大中颅窝入路切除侵犯海绵窦的大型三叉神经鞘瘤的技术细节。一名44岁右利手女性，有几个月渐进性右侧面部感觉异常病史，主要为V3分布区疼痛。体格检查发现，她右侧V1至V3分布区轻触觉减退，角膜反射消失。脑部MRI显示一个3.5厘米的双叶肿块，从脑桥神经根进入区延伸至海绵窦。行开颅手术，随后进行中颅窝硬脑膜剥离，将颞叶硬脑膜从海绵窦壁上剥离，硬膜外切除前床突，磨除岩尖，凝固岩上窦，然后切开小脑幕直至小脑幕切迹，保留第四脑神经，将肿瘤从V1分离，然后逐渐从海绵窦上壁切除。此处介绍的技术可实现肿瘤的完全切除，安全通过海绵窦相关腔隙，并将无意中损伤脑神经的可能性降至最低。术后过程顺利，只是右眼因肿胀出现不完全上睑下垂。术后她的面部疼痛缓解，无任何眼球运动障碍。视频链接可在：https://youtu.be/zxi2XK2R9QU 找到。
