Clinic of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia.
Clinic of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia.
World Neurosurg. 2022 Dec;168:206. doi: 10.1016/j.wneu.2022.10.005. Epub 2022 Oct 11.
Video 1 demonstrates the microsurgical resection of petrous apex meningioma. Even small lesions by general rules are regarded as large due to the delicate nature of anatomic localization. The intricate relationship between the tumor and vascular supply of the brainstem and interposition of cranial nerves makes them challenging lesions to resect. A 67-year-old female patient presented with a 6-month history of trigeminal neuralgia in the V2 and V3 branches. She underwent gross total resection of an extraaxial homogenously enhancing dural-based tumor in the right petroclival region, consistent with a large (3-4.5 cm) petrous apex meningioma, the least frequently reported subtype of petroclival meningiomas. Skull base approaches for surgical resection of these tumors include high-speed drilling of petrous bone to create a corridor that facilitates access to the lesion. Preserved hearing with suprameatal extension of the infratentorial component and absence of a tumor laterally and inferiorly to the internal auditory canal provided the rationale for selecting a subtemporal approach combined with anterior petrosectomy. Identification of anatomic landmarks of the Kawase triangle is the key first step for determining the bony removal corridor, outlined by the greater superficial petrosal nerve, the arcuate eminence, and the petrous ridge. An important step in surgical removal is the devascularization of feeding arteries arising from the meningohypophyseal trunk. Subsequent piecemeal removal and circumferential detachment while making sure to preserve major vascular and nerve elements is crucial for successful removal. The patient consented to the procedure. The postoperative course was uneventful. The patient's trigeminal neuralgia completely regressed with no new neurologic deficit.
视频 1 演示了岩尖脑膜瘤的显微切除术。即使是一般规则下的小病变，由于解剖定位的精细性质，也被视为大病变。肿瘤与脑干血管供应之间的复杂关系以及颅神经的介入，使得这些病变难以切除。一位 67 岁的女性患者，出现三叉神经痛 6 个月，V2 和 V3 分支。她接受了右侧岩斜区的一个硬膜外均匀增强的肿瘤的大体全切除，符合大（3-4.5 厘米）岩尖脑膜瘤，是岩斜脑膜瘤中报道最少的亚型。这些肿瘤的颅底手术切除方法包括对岩骨进行高速钻孔，以创建一个便于接近病变的通道。由于肿瘤位于颅神经内听道的外侧和下方没有累及，因此选择了经颞下入路联合前岩骨切除术，保留了听力，并扩大了小脑幕下部分。识别 Kawase 三角的解剖标志是确定骨切除通道的关键第一步，该通道由岩浅大神经、弓状隆起和岩嵴勾勒而成。手术切除的一个重要步骤是对来自脑膜垂体干的供血动脉进行血管化。随后的分片切除和环周分离，同时确保主要血管和神经元素的保留，对成功切除至关重要。患者同意了该手术。术后过程顺利。患者的三叉神经痛完全消退，无新的神经功能缺损。
